Can gaps between teeth be fixed at 39 years?

Question

Hi doctor,

I am a 39-year-old female, a non-smoker, with a history of chronic rhinitis and polyps. When I was 14, two of my lower second premolars were extracted due to crowding. The plan was to follow with braces. However, shortly after the braces were fitted, I found them very difficult to tolerate. My father removed it, which I agree is wrong. Unfortunately, the orthodontist refused to refit a new one.

As a result, I have had two gaps in my lower teeth for all these years. Now I have noticed the adjacent molar tooth is slanting down. It has taken me a long time to address this, but I am beginning to worry about any long-term consequences like gum disease. I would like it fixed and the molar tooth straightened, but is it possible after all these years? Please advise.

Thank you.

Answer 1

Hi,

Welcome to icliniq.com

I have reviewed your photos and the history (attachments removed to protect patient identity). It is unfortunate that you were unable to complete your orthodontic treatment earlier, but you can still get it done at 39 years of age.

Before starting the treatment, you will have to keep a few points in mind: Maintain good oral hygiene, with zero plaque deposits and cavities. If any cavities are present, they need to be restored before starting the treatment. Ensure no plaque deposits or cavities form during the treatment.

From the clinician's perspective, the treatment can be done if the following conditions are met:

Good oral hygiene.
Cavity-free mouth.
Good gum health with no active bleeding.
Adequate bone levels that can support the tooth during movements.

At this stage, you will have two primary options for orthodontic treatment:

Space closure: If your face profile allows the clinician to take the teeth back and close the spaces, the clinician will upright the molars, align all the teeth, and then close all the spaces. However, to obtain optimal overjet, the upper teeth also need to be aligned and maintain a harmonious relationship.
Space maintenance and placement of prosthetic teeth: In this option, the clinician uprights the molar and then places the prosthetic teeth to fill the space. However, the alignment and crowding of the front teeth will not be resolved.

So, once the initial requirements of oral health are met, you can discuss your expectations with the clinician and plan your treatment accordingly.

Please let me know if you require any clarification or have a follow-up question.

Thank you.

Answer 2

Hi,

Welcome back to icliniq.com

After reviewing the current stage images and focusing solely on the lower crowding without factoring in other variables that typically influence the decision for extractions, I would not have initially recommended any extractions as part of the initial treatment plan. As treatment progressed, I might have considered them depending on the results, but they would not have been part of the initial treatment plan.

As we age, teeth tend to drift forward. In your case, the molars may gradually shift and tilt, although the change may not be noticeable on a daily basis. Over time, however, you may observe a significant difference. This is also influenced by changes in the jawbone, particularly in areas where teeth are missing, as the bone tends to recede over time.

I would advise you to undergo some form of treatment, orthodontic, prosthetic, or a combination. It would help:

Preserve jawbone health.
Reduce the risk or severity of gum disease.
Improve your bite.
Enhance your smile.

Please feel free to reach out if you need further information or clarification.

I hope this answers your query.

Thank you.