J. Brian Queen, DDS

Allahndra,

Like you I also had a cap on one of my baby molars until I was in my thirties. Most likely the cap is on a lower baby molar just in front of your permanent six year molar as this is statistically the second most congenitally missing tooth behind the Maxillary lateral incisor. Leaving the tooth as-is is no problem as long as you don't have any restorative work in the same quadrant; and please don't leave it there if you have orthodontics.

By the way, I think people with congenitally missing teeth are higher along on the evolutionary arc :)

Ives thanks for the question,

Your case is challenging. I'm assuming that the Dentist who is doing the orthodontics is going to reposition the out of alignment lateral incisor. The length of time to erupt and reposition a lateral incisor correctly is a function of it's position in relation to the other teeth and distance it needs to travel.

As space opens up for the anticipated laterals, it is common to attach simulated teeth on the arch wire for aesthetics. Once the major movements are done, but while you still have on the brackets and wires, the implants will need to be placed and timed to restoration of the implants and debracketing of the orthodontic appliance.

It's been my experience that cases like yours, with missing laterals, experience a higher implant failure rate. I don't know if the literature points that out or not, it's just been my professional experience of 31 years in practice also doing my patients orthodontics and implants together. The longest case I have seen similar to yours, from start to finish was five years; with 3 implant surgery failure to integrate mixed in.

Good Luck

Hi Jennie, sorry you're having these problems. First lets address the Vivera and TMJ issue; your teeth can feel unsettled after orthodontic treatment for years after the treatment regardless of the TMJ issue. More than likely your teeth are shifting during the day, when you are not wearing your retainer, and then when you put the retainer in at bedtime the teeth shift back to the post ortho position and you repeat this daily. With my TMJ/bruxing- orthodontic patients I substitute a hard night guard with an Anterior ramp for the retainer; it does double duty as a retainer and a TMD treatment device

I tell all my adult orthodontics patients that the retention phase of orthodontics will be more challenging than the active movement phase. Your teeth like and got used to the position they were in all for all those years  and want to relapse back to the original position they were in. As a matter of fact, if the adult patient is contemplating orthodontics and are nonplussed and dismissive about the retention instructions I usually won't do the case.

With all that said, I would schedule a consultation appointment with the dentist who did your orthodontics and explain you are not happy with the result even though you have followed their instructions for the retention phase judiciously. Its possible to do a refinement set of aligners and then ask the dentist for fixed retention and a TMD splint. Good luck

Your question does not include enough information or pictures to accurately answer your question. Some patients have skeletal maloccusion. Skeletal maloccusion means the upper and lower jaw do not fit together properly resulting in the teeth or bite being off. I see people with straight teeth but poor bite due to the upper and lower jaw not aligning. Most Orthodontist offer a complimentary consultation and will tell you in general terms how to treat your mouth. Good luck

Maxillary First molars statistically have the highest failure rate after endondontics of any tooth in the mouth. If a conventional root canal fails on the Mx first molar; I counsel my patients to extract the tooth, graft bone in the socket and then proceed with implant and restoration after 3-4 months. Time is critical after the extraction as bone that is not stimulated will atrophy and possibly require additional procedures to buttress bone prior to implant placement.