Metal Mouth Message Board

I'm 6 months in and I now have a huge issue. The 1st left lower jaw premolar hasn't moved and I was told today that if it doesn't move at all in the next 2 months, it might be a case of tooth ankylosis, meaning that for whatever reason, the root has been fused with my jaw. I don't recall any trauma.
The original plan was no extractions and do IPR instead. Now the ortho is saying that if there is a fused tooth, they will extract it along with 3 more premolars. My teeth look straight and they aren't flaring much and I'm already happy the way the look now, so I'm very concerned that extractions will ruin my face.
Does anyone know what are my other options? I will decline the 4 extractions plan and he has to find another way to fix the issue. I don't mind having a misaligned premolar. Maybe the affected tooth can be extracted and replaced later on with an implant?

from all i read, i would never extract my 4 premolars..

how can your ortho be sure that it's fused to the jaw? is it something that can be diagnosed for sure? i would seek your dentist's opinion first to see if it's really fused. If it's not fused, just hard to move, then maybe do a round of propel?

A truly ankylosed tooth can be seen on an x-ray and also on clinical examination. If the tooth is indeed ankylosed, I don't think you can move it. I think what other options you have would depend on how bad your bite is. If it is not very bad, perhaps an option is to ask your ortho if he or she could probably work around it and move the other teeth around that tooth. Obviously, a misaligned premolar would affect your bite, so you may need to manage your expectations on that. Otherwise, your suggestion of just extracting that premolar and get an implant after treatment is complete sounds doable too. But I'm not an ortho, so these are just my uneducated guesses.

assertives wrote: ↑Wed Oct 17, 2018 12:27 am A truly ankylosed tooth can be seen on an x-ray and also on clinical examination. If the tooth is indeed ankylosed, I don't think you can move it. I think what other options you have would depend on how bad your bite is. If it is not very bad, perhaps an option is to ask your ortho if he or she could probably work around it and move the other teeth around that tooth. Obviously, a misaligned premolar would affect your bite, so you may need to manage your expectations on that. Otherwise, your suggestion of just extracting that premolar and get an implant after treatment is complete sounds doable too. But I'm not an ortho, so these are just my uneducated guesses.

Assertives makes some excellent points. Best of luck to you.

I'm definitely not going to proceed with 4 extractions no matter what, especially without evaluating any x-rays with my own eyes (I know how to read x-rays and I can definitely tell if it's ankylosed). I'd rather stop treatment now and leave my teeth in their current position, than lose 4 healthy teeth just for a premolar that might be ankylosed. When I started treatment, this premolar (1st on the lower left side), could not get connected to the archwire. After 2 months they managed to connect it. Everything went well. 2 months later they changed to a thicker rectangular archwire and they had issues connecting that bracket to the archwire. It took them quite a bit of time and they were pushing very hard to the point I was screaming in pain. They couldn't close the door too. Eventually they said the archwire got into place and door was closed. I was expecting to feel a lot of soreness and pressure on that tooth, but I didn't and tooth didn't move.

So, I was told the tooth didn't move and it might be ankylosed. They took photos and they put back the same archwire and replaced the upper archwire with new. When they placed back the old wire, it went in smoothly. No soreness, no issues closing the door. Today I started feeling soreness on that tooth and the 1mm gap between my lower central incisors closed completely this morning. I had this gap for about a month now. I feel that they messed up with the archwire and that bracket last time and this time it finally got connected properly and it's now working. The archwire definitely looks a lot less dented in that spot compared to what it was 2 months ago.

If, despite the soreness and pressure that I feel now, doesn't move, then I will ask him to work around that tooth. It's the 1st premolar and I highly doubt it will affect my bite much. If it was the 2nd premolar it would have been more problematic. I just hope that the pressure and soreness I feel on that tooth now, means that it's moving!

Update: It seems like my premolar isn't ankylosed after all. The archwire seems to have straighten since a couple of weeks ago and both sides are starting to look symmetrical now. It's not a pleasant experience being told that you might have a fused tooth and because of it you can end up with 4 extractions and change of treatment plan. I'm glad he gave my tooth time.
Assuming that it will get aligned with the rest of my teeth and that it's not ankylosed, what can I expect at my next visit? He said if it isn't ankylosed he will do IPR in front upper and lower front teeth. He said 0.2mm. I'm freaking out my teeth will look awful with these gaps. My lower teeth don't really show when I talk/smile, but my upper do and I'm freaking out. How fast do the gaps take to close?

What to expect depends on what your ortho is currently working on, where you are at in your treatment plan and how your teeth responds to the treatment I guess. As for how long the gaps will take to close, everyone responds differently, but the general rule of thumb I've read is that teeth move about 1 mm a month.

So, back from my ortho appointment and he isn't sure what is going on anymore
The premolar may and may not have moved. Neither me nor him are sure. I was definitely feeling clicking when he placed the wire last time. He said I might have one more ankylosed premolar on the other side. For that one I'm 100% sure it's not fused.
Anyway, he changed the wire to the thickest rectangular he had and within a few hours the pain in my lower premolars and front teeth made its appearance and made me so happy. So, now I'm 100% sure these 2 premolars are moving. The wire is a lot straighter than before. Unfortunately, I assume that these pesky teeth will delay my treatment I will see him again in early March and he will get X-rays and will reposition a couple of brackets. Fingers crossed I won't have any fused teeth!

Hi Little Tooth,
I know I've had issues with teeth tipping and not moving. After obtaining a couple of second opinions; one of them pointed out that I had a power chain on top and not on the bottom The consult suggested adding a power chain to the bottom. My ortho listened to the suggestion and instead decided to go with removing power chain and using a tie to the front four teeth only. I'm now in class 2 elastics and I think I'm having a little movement now. When I wore elastics before with the power chain in place; I would get popping in my jaw and lower jaw would tighten up requiring me to stretch it out routinely (of note; I had double jaw surgery with hardware placement too).

My point to my story is sometimes the ortho may need to tweak something that he may not be seeing. Sometimes getting an outside opinion and sharing it very nicely can restart an engine that has stalled or died.

Regarding the extraction and getting an implant idea...You might want to price that out before jumping on that band wagon. I believe that can run you upwards of 5K. I would respectfully suggest obtaining a 2nd opinion before you go all in and extract (4) teeth.
Karla

Thanks for the heads up!
The implant will cost me $4-5k, but this will be my last resort. It seems that the archwire has started to even out between the problematic premolar and the canine, so I'm quite optimistic now that the tooth isn't ankylosed. The little proxabrush slides a lot easier underneath that spot too, so it's definitely not in my imagination that the tooth is moving.
I've been through hell in the past 5yrs and recently my orthopaedic surgeon admitted that I was right to go against his suggestions, so I'm going to repeat the same with my orthodontist. I read a paper about a similar case and the ankylosed tooth was treated with surgery (non extraction). I will bring this up if he confirms my tooth is ankylosed. I don't believe in an ankylosed tooth, until I see an x-ray. I have an appointment with my dentist for cleaning on the 2nd, so I will ask them to give me a digital copy of my panoramic x-ray to check myself whether the root is ankylosed or not. I might show it to some MSK radiologists friends I have to get their opinion too.

I second the suggestion to get a second opinion too. Especially since you mentioned that your ortho isn't sure what is going on anymore. Would be good to get an objective 3rd party opinion on that matter which would help you make a better informed decision on moving ahead.

In my opinion, if your profile is nice, do not accept the extractions. Moreover the fused premolar will be so difficult to extract. And above all your profile will suffer a lot you do not have bimax protrusion.

Update: my premolar ended up being ankylosed and I opted for no extractions. My ortho wasn't sure he can make it work (he is a perfectionist too), but he did an amazing job and I'm very happy with it. The bite is perfect, except that single spot where the upper premolar doesn't meet the lower. I don't mind and it hasn't affected the alignment of the rest of the teeth. I was thinking that down the road it might be possible to just shave that tooth and put on a cerec crown to give that tooth a bit of height, but for now I don't want to touch it and destroy a perfectly fine tooth.

My braces are finally coming off in 2 months and I'm quite excited! Fingers crossed COVID-19 will not cause any further delays!