Complicated crown fracture 704 AND malocclusion

RE: Complicated crown fracture 704 AND malocclusion

Evelyn Barbour-Hill — Mon, 22 May 2023 20:40:15 GMT

Emily, yes, I think it's fairly obvious that you want to extract 704 asap, as you've already noted.

I'm sorry to be pessimistic but I think 304 is extremely unlikely to migrate into correct occlusion spontaneously (it's already locking into a pit on the upper jaw) and I'm afraid in my opinion from what I can see ball play does not stand a good chance of correcting it (though ball play is always a good thing to instigate and can do no harm).

So you could wait a very short period (a month?) and then, unless it's been lucky and is correcting with ball play, you need to choose between orthodontic movement and tooth shortening. Now, this is a little controversial, but in my opinion tooth shortening is generally the treatment of choice unless there is some factor positively against it. However it looks from the photos as if orthodontic movement would be quite practical. Whether it is in the best interests of the patient's welfare we could debate for hours.

What exactly is "bite work"? I can assure you that a dog can mangle hideously a wrongdoer's forearm, or seize the clothing of a drowning child, just as effectively with a slightly shortened tooth.

From the photos, and as you don't mention 404, I am assuming that the occlusion is otherwise normal.

RE: Complicated crown fracture 704 AND malocclusion

Martin Hamilton — Mon, 22 May 2023 20:14:37 GMT

I would extract 704 ASAP - it is both physically blocking any movement of 304 and is a source of infection. Once 704 is extracted, I would have the owner begin ball therapy (http://www.toothvet.ca/PDFfiles/ball_therapy.pdf) in the hope that it helps guide movement of 304 into the correct position. If there is stilll a malocclusion present in a month or so I'd get a second opinion from a dentist to discuss other methods of orthodontic movement (temporary crown extensions, inclined plane etc).

RE: Complicated crown fracture 704 AND malocclusion

Rob Davis — Mon, 22 May 2023 20:13:24 GMT

Hi Emily,

I would agree that 704 needs to come out asap. It's always difficult to assess these fully from photos, but it looks to me as though the jaw length is ok (and I assume that 404 occludes normally). Post extraction I would want to monitor this every couple of weeks to see what happens to 704. If it doesn't shift sufficiently to occlude normally then given that he is to be used for bite work then orthodontic movement may be possible (probably either temporary crown extensions or and incline plane), and I'm guessing would be preferable to crown reduction and vital pulp therapy.

If you remember to update us it's always interesting to see how these turn out.