ankylosed tooth nightmare...anyone have similiar experience?

[aj]

I would love to hear the experiences of anyone in braces with an ankylosed tooth. This is a tooth that refuses to move, because it is "stuck" in the bone. If the ankyosed tooth is in a wrong position, it will not move and can hold up the progress of all teeth around it.

If you have experience with an ankylosed tooth, did your orthodontists try to luxate it, pull it, hook it to power chains?

Just to put all my questions into perspective, I should give a short history of my experience with an ankylosed tooth. I am now 31 years old. I had braces put on five years ago, at age 26. Back then I had a big overbite, and a very narrow upper arch and very lower bottom arch. After three years in braces, my small town orthodontist guessed that one tooth wasn't moving on the bottom. It's the bottom cuspid. Because it didn't move, it held up the progress of all the other mildly crooked teeth on the bottom. While the braces on my top teeth "worked" and definitely widened my upper arch, the bottom braces caused no change, and the narrow bottom arch never widened.

So my orthodontist had no clue what an ankylosed tooth was. He didn't try 'power chains' and refused to pull it. After three years with him, he referred me to another orthodontist.

My second ortho also did not use power chains. He did a trick where he put a wire through all teeth except for the ankylosed tooth, and almost straightened the bottom teeth. But the ankylosed tooth was way out in front in an odd place, and my bottom arch never widened out like the top one did. He also refused to pull the ankylosed tooth. He performed a mini surgery to "luxate" the tooth. This is where he does all but extracts the tooth. He wiggles it and then immediately attatches it to a wire to move it.

Unfortunately the "luxating" didn't work. The ankylosed tooth refused to move. My ortho the, against my insistence, refused to pull it. Instead, he "reshaped" it and took the braces off. So at age 30, the braces were taken off. Teeth were perfect on top, ok I guess on bottom. But my bite didn't match... I also had problems with my jaws lining up... I had a broken jaw on one side, and problems with a condyle.. needed lower jaw surgery but didn't have surgery. Also needed my lower arch expanded, but to my knowledge, there is no surgery for widening a lower arch.

Which brings me to my point of contention with all orthodontists I meet and read about. This unspoken code: don't pull the ankylosed tooth. Let the patient suffer.

If either one of my orthodontist had pulled that ankylosed tooth, that could have allowed the rest of the teeth to move naturally and widen the bottom arch. Braces minus the ankylosed tooth could have made my bottom arch widen. Agghhhh, it's the only way, since no one knows of any surgery to other wise widen the bottom jaw. (If you know of any surgeries/methods, please let me know!!)

So now I am at the point where I've had a consult with an oral surgeon about moving forward my lower jaw (necessary since my jaw is so small, it causes sleep apnea... tongue blocks airway and i wake up gasping for breath at night... scary) So the lower jaw surgery is necessary, and of course braces have to be put back on.

BUt now my oral surgeon got scared by my complicated story, and even though my insurance specifically approves him, he won't go ahead with me due to the ankylosed tooth story. He was all systems go until I mentioned the ankylosed tooth, and then he unofficially referred me to another oral surgeon, which I later found out doesn't accept my insurance.

I don't understand. Why are oral surgeons and orthodontists in general so scared of ankylosed teeth cases??? Is it just me? Why do most orthodontists choose not to pull this kind of tooth? Has anyone here had success with luxation of an ankylosed tooth? Has anyone here had braces, an ankylosed tooth, AND jaw surgery? Has anyone here had an ankylosed tooth on the bottom, and also a narrow bottom arch? Has anyone here had lower arch expansion? Your experiences with an ankylosed tooth, positive and otherwise are needed!

[rsprouse]

Hi AJ,

An ankylosed tooth is definitely one of the more difficult clinical conditions to manage in orthodontia. Not sure if you really understand what exactly it is, but the cementum (root surface of the tooth) fuses to the socket bone. In a normal healthy tooth the root surface is attached by a small ligament (PDL) that acts to anchor the tooth and to absorb forces like a little shock absorber. There is no cushion for an ankylosed tooth, just think of it as the bone and tooth being one entity.

In normal orthodontics when force is applied, you get all sorts of remodeling around the ligament of the tooth. The end result is the teeth move. There are treatment options for an ankylosed tooth, but they can be difficult. To me it sounds like a bit of a communication gap between you and your team of docs. Sounds like you either agreed to compromising your original treatment or it was thought to be in your best interest. That is not important, but you are in this situation now. Dentistry is just like everything else, there are those that specialize in certain specifics and those that have more experience with certain treatments. If there is a procedure or condition that is out of your scope then you should refer it to somebody with more experience. Sounds like your Ortho/OS are doing the right thing. The OS who referred you to somebody else did the right thing if s/he wasn't comfortable treating your difficult condition. I am sorry that your insurance doesn't cover the new OS, but if a clinician is not comfortable in his/her abilities or does not feel they can treat you properly like you deserve then they SHOULD refer you to somebody that can. It is in your best interest and long term health to go to the best especially for something like this.

So the long and short of it is that I recommend that you get on the same page as your team of Docs and decide if any potential treatment will be good for your based on the risks and rewards. There are treatment options for an ankylosed tooth, but they are incredibly difficult to deal with and they do require a lot of skill to handle. Let me know if you have any specific questions. Good Luck.

Best,
Rory

[aj]

Hi rsprouse,
Thanks for the comments! What specific types of treatments have you heard of for ankylosed teeth?

Thanks!

[Chaka]

Hello! I glad that I found your post. I have so much similar problem. 2.5 years in braces. My ankylosed tooth was mistaken as 'naughty' tooth by my small town orthodontist and after one year of torching it, reposition bracket on it my lower jaw became look like a snake. I've been suffering from neurological pain for more than 1.5 year. My right side lower jaws molars were dragged towards centre of my mouth by more than 1 cm (ankylosed tooth was acting as an anchor and pull all teeth on the wire towards its wrong position). Because my lower jaw got ridiculously narrowed my top one started collapsing after while. Nobody knows how to return my dislocated molars back. I've changed three orthodontists, became regular patient of neurologist. My face changes. I have halls in my cheeks like I haven't got teeth, I feel like I aged by 10 years. I've started the treatment at 34. I'm 37 now. I really would like to have a chat with you. May be we can lean something new from each other experience.
I'm scared, it's very difficult to trust any professional after such experience. I don't really know what to do. I would happy to extract this tooth if it's help to solve the problem.
I have records (photos and casts) before braces and now. And I feel like a person from the program 'victims of plastic surgery''. Cannot even describe jaw much my life changed within last two years

[leona]

Hi!
My name is Leona and I'm 18 years old. But for now let me say this: I am so glad I found someone who has dealt with a similar experience. In my opinion, chatting to like-minded people is very helpful and relieving.
I think, I got my first (removable) braces in 2007. In 2007, I was ten years old and back then everything seemed to be fine. My orthodontist started straightening my lower front teeth. It wasn't until a year later that I got my permanent braces. In December 2009, I somehow managed to slip, fall and... break my jaw. The fracture showed good signs of healing. After some months of having soups and mash three times a day - or let's say: after the healing process was finished, my ortho started fixing my overbite etc.
But there was one tooth that wouldn't move at all (- in fact there was another one that showed up after spending a year abroad ;) ) However, my dentist attached a chain to the (still gum-covered) tooth and my ortho tried to pull it down. Unfortunately it didn't move and the chain came off more than once ;)
After repeating the same "experiment" and measuring the distance between the gum (which was still covering the bracket that was attached to the tooth) over and over again, my ortho told me that the tooth was ankylosed and had to be extracted.
So I went to the hospital (remember: I went there by myself!) for some kind of physical pre-examinations. After waiting for a hours and hours, I was told that extracting my wisdom teeth (I was told to take the opportunity to let all five of them be pulled at the same time) and the ankylosed one would be to risky if I hadn't thought about a long-lasting solution that does not hurt the teeth next to the ankylosed one (-> dental bridge would "hurt" them). This is also why they refused to do anything and sent me home.
A few days later, in was called by my ortho. She told me that a hospital doctor told her that my parents (they haven't even spoken to him) and I (keenly) agreed to some kind of (obsolete) surgery technique: they would saw out a piece of bone that is connected to the tooth and try to move it by lifting it up every other day during a certain period of time (50 days).

And if I let them so, I would miss a LOT of classes... And in addition, I am not sure if my jaw would "survive" that because the former fraction is just "cartilaged". Then again, it sounds quite distressful and painful as well.

I can't understand why somebody would claim that I (as well as my parents) accepted some kind of "middle age" (<- okay that's overextraggerated) method without even being informed about it. I am glad my ortho called me. But nevertheless, I do feel as if I was about to serve as a guinea pig or some different kind of subject of experiment.

Oh, by the way, it seems as if I would not be able to have an ordinary implant because the bone would be too thin after extracting the ankylosed tooth.
What would you do?

I will definitely try to go to a different hospital because "it's quite difficult to trust a professional after such experience"

@ Chaka: thank you for these words - I think, I fell the same way. Do you have removable braces that could "return your dislocated molars back"? I have no idea.... but I think there are a sort of spring-like wires that might push them back...(?)
@ aj: what had happened to your tooth? Have you had any "success"?

Please excuse my poor English...
Greetings from Germany :)

[Christinegrace1988]

I am currently going through his my front tooth was chipped in half almost 12 years ago, and it's ankoylosed (sorry for spelling)
And all my other teeth are moving to where they need to be expect this one and basically my ortho said he can try to break it loose but my body could reject it and create a hole there (behind the tooth) we have put a lot of torque on it and it just doesn't move, so now he is going to try and push my teeth backwards instead of pulling them forward,

Has anyone had luck with getting an ankoylosed tooth to move? If so how was it done?

Thanks :)

[michelaaaa]

Hello, I'm a bit late to this thread but I thought I would add my successful ankylosis tooth story. I got braces at age 11 solely to aid in bringing my bottom left second molar that was ankylosis up to a normal position. My ortho and surgeon team did this by subluxating the ankylosis tooth and anchoring and upper tooth to the jaw to prevent it from being pulled down with rubber bands worn to pull of the bottom molar. With the combination of braces and rubber bands pulling the tooth up, my docs successfully fixed my mouth!

[brokenmouth37]

Hello, I'm not sure if anyone will end up seeing this as this post is quite old but felt like I had to share my story as well. I had my braces put on at the age of 13 in April of 2009. I had a generous amount spacing between teeth on top and bottom as well as a deep bite, small overbite and a baby tooth that never fell out (My upper right canine). My orthodontist, "Dr. A", told me the adult tooth was impacted and after my braces were put on I would get surgery to remove the baby tooth (tooth C) and place a chain in my gums fused to the adult tooth (tooth #6) to bring it down into place. I should also mention that my braces were paid for in full by the state of California, as my teeth were considered "bad enough" for state insurance to cover them.

This was NOT under a private insurance plan, this was under MediCal, which was the State insurance for California, for "poor" families. So I get my braces on, a few months later I get the surgery to begin the process of bringing tooth #6 into place. Everything is going well and about a year after surgery the tip of my canine tooth is showing through my gums. My orthodontist then believes the tooth can have a bracket placed and can be put in with the wire with my other teeth to fully bring it down into place. At this time my orthodontist also has shifted my midline over about one full tooth space to the left to allow for "as much room as possible to allow tooth #6 to come down into place. More months start to pass and tooth #6 hasn't moved at all since the bracket was placed, however, tooth #8 and #7 began to shorten and shift up into my gums towards the "evil tooth". Now my midline is completely off, my right front tooth is literally in the middle of my mouth, like a cartoon baby with one tooth and they have angled up so much it looks like 4 teeth are missing when I smile. My orthodontist continued this treatment plan, insisting the tooth had to budge eventually, he even went as far to cut away more gum tissue around the tooth to try and "break it free from all the thick scar gum tissue". Finally after more than 3 years of this he says the tooth is ankylosed and we take it out of the wire with the other teeth.

Then we began the process of trying to fix my midline after it was destroyed by the braces and ankylosed tooth. About another year goes by with "Dr. A", every visit he would apply a power chain on my front 4 teeth to try and bring them back over to the right and work on straightening my bottom teeth. Then one day I am notified by the clinic that "Dr. A" had been in an accident and would not be returning. A local orthodontist, "Dr. B" then took over. When he saw my mouth, and the fact that I had already been in braces for almost 6 years, he was mortified. He couldn't believe that "Dr. A" let this go on for so long without changing his treatment course when it clearly wasn't working. "Dr. B" then removed all of my brackets and reposition them as most were crooked and not in the optimal placement. He also took a series of X-rays, pictures and molds, something "Dr. A" never did! I had like one or two X-rays done by him in almost 6 years and "Dr. B" took 4 or 5 in a little over a years time. For the remainder of my treatment we worked on getting my midline as center as possible and rubber bands to help correct my bite and jaw. Due to the fact that this all happened during my formative years my jaw grew crooked to help compensate for that fact that all my teeth on my right side are shorter. I also have bone loss on my top right jaw surrounding the ankylosed tooth, so the right side of my face is much flatter than my left side.

Basically always have to take pictures from my left side lol. At the age of 20, in May 2016 I had my braces removed because I was moving out of state and there also wasn't much else I could do at this point in my treatment due to financial limitations. When I eneded my orthodontic treatment my bottom teeth were almost perfect, I was one wire away from the final wire. As for my top teeth, they were okay... my midline was still off and I had bigger than a thumb gap between my lateral inciser #7 and 1st pre molar #5, tooth #6 is in between there, but you can only really see it if I lift up my lip, but my bite was a bit better and I didn't have any other spacing on top except for the giant gap. I did discuss the multiple options for tooth #6 with my orthodontist and oral surgeons, such as adding composite and reshaping the tooth, but I wasn't a good candidate, as the tooth isn't really exposed enough. Or trying to luxate the tooth but success rate isn't all that great. And, of course extraction and placement of an implant or bridge. When I was in braces the luxation was pressed on me by surgeons and orthodontists and it's the route I was thinking of going, but now after not having braces for over a year and a half, I'm more wanting to go the route of extraction. I constantly have pain in tooth #6 as well as #7 and #8 and the area above my gums is always significantly colder than the rest of my mouth.

I have had one consultation since I had my braces removed at the Orthodontic Clinic at Roseman University in Henderson Nevada were I was evaluated by one of the head teachers and he told me that he wouldn't even want to place braces on me until I had worn an orthotic 24 hours a day for 6 months because of the condition of my jaw and even that may not be enough and I would still need jaw surgery. I also have lost my retainers since that consultation and my jaw and bite have only gotten worse. I've even began grinding my teeth again, which I haven't done since I first got my braces. Now I'm just at the point were I have no money to do anything about it and go between trying to forget about it and never smile again or spend countless hours searching the Web for a treatment plan. I'm just trying to take it one day at a time and get to a financially stable point were I can get braces put on again to fix my bite as much as possible then extract tooth #6-#10 and get implants. My front teeth are very small and not in the best condition after bone loss and 7 years of braces, so I figure just replace all of them if I can. However, even though my teeth are damged from 7 years of braces, dentists always say my teerh look great considering.

My thoughts go out to all of the others who have had to live an orthodontic nightmare as I have and hopefully our stories can serve as teaching examples to orthodontists so this stops happening. Much love from a lost girl in a little town in California.

[RuinedSmile]

Hi Everyone,

I have had a very similar experience with an ankylosed tooth and braces. I had braces for a relapse (stopped wearing retainer) that was only intended for a year, but was then stretched out to over three years. My teeth were initially in very good shape, this was purely cosmetic. The braces then caused an open bite that my then orthodontist was never able to correct. After causing a canted (slanted) bite and my jaw to shift to the left, the ortho then called it quits and discharged me from his office. He then said he was no longer responsible for correcting the open/canted bite, despite the fact that I didn’t have these problems prior to treatment. In California it is very hard to go after an orthodontist for medical malpractice and very few lawyers will take a dental malpractice case. After going on a few consults, it seems that there may have been an ankylosed tooth that caused the canted bite to form during braces. My previous orthodontist was never able to diagnose it correctly, and instead ended up misalignment my bite. The orthodontist kept telling me that he had the situation under control. Because one of the teeth may have been anchored to the bone, it also caused changes in my facial structure as well as facial asymmetry. The longer treatment went on, the worse my bite became. I now live with an open bite deformity as well as pain and pressure in my TMJ. Not only has it negatively affected the way my face looks, but I have to live with constant discomfort. I am also having a hard time finding someone to correct what was done to my face. If anyone reading this knows of a orthodontist that may be able to take on a case like this, or if someone was able to get a problem like this corrected, then please contact me. Having this information would be greatly appreciated.

Thank you

[RuinedSmile]

I can't seem to message with this account. My e-mail is: beepsix at yahoo.com

[djspeece]

I can't seem to message with this account. My e-mail is: beepsix at yahoo.com

You'll need to make 6-7 posts/replies before you have full capabilities. There's a sticky at the top of the forum.