Hello all,

A new patient brought her daughter to me last week. She is an attractive 21 year old who just finished her junior year of college and is getting ready to apply to PA school. She was a patient at a corporate office through her teenage years and was initially treated by an orthodontist there. She states she underwent a number of surgeries to expose an impacted canine, but they couldn't get the canine where it needed to be. She reports that after six years of ortho treatment, she felt her teeth were "even more messed up and I think he kind of gave up on me." She then saw my orthodontist who, she says, was able to get some movement of the canine after additional surgery, but only to where she is now. Her appliances were recently removed, but there was never really a plan for the canine. She and her mom gave up on the corporate office and my orthodontist referred her to me.

I have not yet had the chance to talk my orthodontist or the surgeon who last treated her for a full recap of the case. I haven't had her in for a full exam, but I took a few quick photos at the consult. This appears to be purely an "E" in EFSB. There did not appear to be any functional issues. She has virgin teeth all around. No structure or biology to worry about. She states she is more concerned about "filling the space" than she is about the obvious gingival margin issue that will result from restoring the tooth in this position. She is open to additional surgery if it would predictably help, but she is understandably hesitant about more surgery and feels like she "just wants to move on."

So...what would you all suggest here? With some movement reported, is this tooth really ankylosed? Are there additional surgical options here? Is a segmental osteotomy a viable option here? Remove it? If so, what about the obvious risks of hard and soft tissue defects? What about the cant? They did not say anything about it. I did notice when I met her, but I did not report any findings or treatment options to them. I simply wanted to find out where they were at.

Thank you in advance for your thoughts! This is one of the many reasons why I love the Spear community!

Mark

[image:011.jpg][image:013.jpg][image:015.jpg] [image:017.jpg][image:018.jpg]