question for orthos here

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#1 Post by **suetemi** » Mon Apr 28, 2008 6:23 pm

Hi, I hope it's OK to ask this. I have a problem understanding something and I'm really hoping that any of the orthodontists who might browse this forum might be willing to help me with my confusion:

Are mesially tipped molars impossible to move, and why? I had one of my lower 1st molars extracted years ago and the ones behind it (2nd and 3rd molars) have tipped mesially since then. I asked the ortho if he could close the extraction gap and he said it's not possible, and that my only option is to upright the molars and open the space for an implant. Is this true, that mesially tipped molars are impossible to move mesially/distally?
My dentist said that it's difficult but theoretically not impossible, which gave me some hope. I'm considering getting a second opinion about this. What exactly makes it "impossible"? Is there a high risk for root resorption in this case? Can't the molars first be uprighted so the roots are straight and then moved mesially?

Thanks for reading..I hope someone can help me understand.

#2 Post by **Luella** » Mon Apr 28, 2008 7:56 pm

From what I understand, it's not impossible. Take a look at my story, they're standing up my mesially tilted first and second molars so that I can have an implant to replace my congenitally missing #'s 20 & 29. The ortho I saw first suggested that I have those first and second molars moved mesially, and just forget the implant idea altogether but I didn't want to do that because then my upper second molars would be unopposed, and would super-erupt and I would lose them. Not cool! I'm 23, I want all the teeth I can get! So now, we're standing up my molars via mini implants! So, I would get a second opinion, or at the very least let the Dr know you've done research and that from what you understand, it is possible, and ask him for a more thorough explanation. If he cannot/ will not give that explanation to your satisfaction, then it's time for a new ortho consult!!!

#3 Post by **Clo** » Tue Apr 29, 2008 12:10 am

Just a professional patient speaking here. But I think your ortho was right. In the
sense of he not being able to do that. But I really believe it is perfectly possible.

#4 Post by **DrBill** » Wed Apr 30, 2008 8:26 am

There are few absolutes in health care, and in certain cases it may be possible, but the challenges are significant. One problem is anchorage; as the second and third molars are moved forward, the teeth used to move them move backward, throwing off the occlusion.

In todays orthodontic environment one would think an easy workaround would be temporary anchorage devices (TADS) - temporary screws that are placed to avoid taxing the teeth as anchorage. I've used TADS to intrude molars and retract teeth, so when I was interested in protracting a molar I started doing my homework. I couldn't find any case studies. I started asking some of the "big name" TAD speakers about the process and started communicating with a Harvard adjunct professor who had placed over 200 TADs. Even with a TAD, moving a molar is very slow and the space won't always predictably close. Why? Dense bone, a two rooted tooth, and a ridge that may have undergone some resorption. Perhaps someone will come along one day providing a predictable way to begin protracting molars, but I have yet to see it. And you're talking not one, but TWO molars (you still have your wisdom tooth.)

Of course there are many variables that can affect this - the length of time the first molar has been missing, whether the molars have drifted mesially on their own (and not just tipped), etc. But as a rule, simply saying "let's just move the molars mesially" is easier said then done.

#5 Post by **eggraid101** » Wed Apr 30, 2008 10:38 am

i agree; it isn't very easy, but it can be done. I would choose that route for myself, too, but you have to understand it will most likely lengthen your treatment time considerably!

#6 Post by **suetemi** » Thu May 01, 2008 9:41 am

DrBill wrote: Of course there are many variables that can affect this - the length of time the first molar has been missing, whether the molars have drifted mesially on their own (and not just tipped), etc.

The first molar was taken out about 8 years ago. I don't know if they're drifted mesially on their own -- but if so, it looks like just the crowns did and the roots stayed a little behind. On the x-rays the roots are pointed backward at around a 45 degree angle.

From the response by the orthos (thank you, by the way!), it sounds as if, even if it were possible to close the space, it would take a long time and the outcome would be unpredictable. I bet my ortho is wanting to err on the side of caution, or maybe he's trying to keep treatment within the original time frame and not delay my surgery.

*Sigh* All I want is for my 2nd and 3rd molars to become my 1st and 2nd molars. But, at this point, given that I'm months into treatment, the easiest thing to do is to get the awful implant (and yes I think they're awful!!)