I am 19, female. How to fix the gap with an ankylosed tooth?

Question

Hi doctor,

I am a 19-year-old female; I have had braces for six years with no apparent date to get them off. My current orthodontist says I have a pretty rare case of ankylosis on my bottom jaw; when I was younger, I was told we had to wait till I was 16 to 17 because I would probably need jaw surgery. Now, they say I do not need the surgery they thought, or maybe even at all.

The interesting gap between my top and bottom teeth on my left side (which affects my facial appearance) is still not closing. Finally, I got tired of it, and at my last appointment, they changed the placement of the hooks and gave me a different way to wear the bands that bring my back teeth up, but nothing else. They cut the wire at my canine tooth because they thought if that was the only ankylosis, then the others would come up, and we would only have to deal with the one canine tooth.

But we have no way of telling if that is the only ankylosis or not. This sounds like another year of no progress, and I will go into college with braces. This has been the most frustrating journey, and it just does not seem normal to have braces this long. My teeth have become my biggest insecurity, and it seems like this should not be the only treatment for my problem.

I want to know if there are other faster treatments (surgery would not be off the table) for my specific case. I have pictures of my teeth and everything.

Please suggest.

Thank you.

Answer 1

Hi,

Welcome to icliniq.com.

I understand your concern.

A few possibilities come to mind from the history presented and the pictures attached (the attachments are removed to protect the patient's identity). The possibilities are ankylosis of teeth, condylar hypoplasia, condylar ankylosis, and primary failure of eruption. An infra occlusion of the left posterior segment results in a posterior open bite.

We must completely rule out ankylosis of teeth or condyle (temporomandibular joint, TMJ) to come to a solution. Treatment options can be provided to you based on the diagnosis and etiology. If it is ankylosis of teeth, you need to get either surgical luxation of teeth, re-implantation of teeth, or extraction of teeth, followed by prosthetics or osteogenic distraction.

For condylar hypoplasia, the osteogenic distraction would be an option. Similar remains for condylar ankylosis as well. If it is the primary failure of eruption, it is a genetic condition and is challenging to treat.

If ankylosis is ruled out, you have nonsurgical options to deal with the open bite with the help of mini implants (called TAD (temporary anchorage device). Please share your facial photo, a full smile, and a side profile photo with me to assist you further. Along with these, please share any X-rays done for you during your orthodontic treatment to let me evaluate any signs of ankylosis of teeth or jaws through the X-ray.

Do reach out for further queries or clarifications. Do rate the response and drop feedback to enable us to enhance the quality of answers.

I hope you find it helpful.

Kind regards.