I would like to get invisalign on my top and bottom teeth. The problem is that I have a baby tooth to the left of my left canine. I have had it covered with a crown. The dentist told me that if I had invisalign then the baby tooth would fall out and I would be missing a tooth! How embarrassing, right? She suggested that they pull down the permanent tooth (which is nestled in my gum) and then do braces. IS IT POSSIBLE to just do the invisalign with my crowned baby tooth and then consider an implant (if the baby tooth falls out) when the invisalign is finished?
Doctor Answers (5)
Retained baby tooth and invisalign
The main issue with retained baby teeth is that typically do not have an intact periodontal membrane and are therefore not able to be be moved with ortho. The decision to use surgery to bring down the impacted tooth depends of the position of the tooth. For an implant to be successful you will have to know where the impacted tooth is in relationship to where the implant placement is planned. This can be a difficult decision based on age, position of teeth and long term goals. You also need to know the costs of each treatment plan.
1. invisalign alone (if baby tooth falls out then you have implant and crown fee later)
2. full ortho (this could be the only cost if you can bring down impacted tooth)
Invisalign and Impacted Tooth
A lot depends on how old you are and how badly impacted your unerupted permanent tooth is. Your best long-term plan is to get rid of the crowned baby tooth. Again, depending on your age, there is a chance that your baby tooth is permanently fused to your jawbone and will not move with Invisalign or conventional braces. If you want to replace the baby tooth with an implant you will still more than likely need to remove the impacted permanent tooth so as not to be in the way of the implant. Doing Invisalign and ignoring the impacted tooth is like sweeping dirt under a rug. That tooth will most likely need to be addressed at some point because your crowned baby tooth will more than likely not last the rest of your life. While there is not a clear cut answer to your problem, if it were my mouth, I would extract the baby tooth, and depending on your age (the older you are the more difficult it will be), I would attempt to pull the permanent tooth into proper position. Once the permanent tooth is fully erupted you can finish the orthodontic treatment with either Invisalign or conventional braces.
By the way, Invisalign is great for doing orthodontics with a missing tooth because in the area of the missing tooth a fake tooth can be built into the clear aligner masking the missing tooth. We do Invisalign frequently with missing teeth (often front teeth) knowing that upon completion of Invisalign we will be placing an implant to replace the missing tooth.
The common challenge of an impacted cuspid with Invisalign treatment
First of all, Kudos to Dr. Robert Waxler, St Louis Orthodontist for his great answer! I would just add to his answer that if the impacted cuspid is not very badly angulated up in the gum, Invisalign has been used in successful treatment of these cases. The cuspid would still have to have oral surgery to place an attachment on it creating a way to pull it down with rubber bands. I realize that this is pushing the envelope of what Invisalign is capable of, but I now am doing cases that I would not have dreamed of doing just a couple short years ago. If this approach has any appeal, you will need to find an adventurous orthodontist with a lot of Invisalign experience. Good luck to you.
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The impacted canine may pose a problem
Retained baby tooth
Sounds like you have an impacted permanent canine with a retained baby canine tooth. The older you get,, the harder it is to bring the permanent tooth into its proper place...and eventually you will lose the baby tooth. I think you would be much better off to get the impacted tooth in as soon as possible, but, if you really wanted to avoid this for now it might be possible to leave the baby tooth in and just align the teeth with Invisalign
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