Sam's story: short version
Aug 2006 (age 8.6) Sam chips his 2 front teeth on the counter in the bathroom. Sam's pediatric dentist doesn't know how to bond back the chips, they are bonded back the next day at UCSF.
April 2009 (age 11.2) All 4 baby canines are pulled in order to help the permanent ones descend. We see Sam's dentist's sister, an orthodontist in Palo Alto, who first is convinced #6 and #27 will come down, then, a year later,
wants to start by doing a 'expose & bond' immediately without starting braces. Her office is very much a conveyor belt, so we go to a couple of orthodontists for second opinions.
Feb 2011 (age 13) We choose orthodontist Dr Andrew Wong, Newark. We choose Dr Wong because he says he is very hands-on and that if surgery is necessary he has it done by a periodontist, which makes it less traumatic. Start of braces.
(Oct 7, 2011) Expose & bond of # 6 and #27 (Fremont, CA)
(age 13.8) #6 and # 27 have not emerged, maybe #27 has moved slightly.
We are first sent to the periodontist, who immediately throws up her hands, the upper canine is out of her reach. She sends us to Dr Tsu, oral surgeon, Fremont, comments on irregular shape of #6 on pano, but doesn't call it 'resorption' or indicate that it could be a progressive situation.
April 2012 (age 14.2) The teeth have still not emerged (maybe #27 moved a little), so Dr Quo gives us a referral for extraction &'education on implants' by Dr Tsu. (Dr Quo doesn't inform us that you can’t put an implant in a 14-year-old.)
May 2012 (age 14.3) Second opinion at UCSF: Dr James Chen, orthodontist, and Dr Janice Lee, oral
surgeon. Dr Lee orders CBCT. Dr Chen continues traction.
5/10/2012 CBCT (UCSF) (25 microsieverts). Dr Chen doesn't comment on CBCT, says it was for surgeon. Dr Chen not concerned about resorption, 'we see that sometimes'.
(Sep 21, 2012) Expose & bond of #6 and #27 (UCSF, CA)
(age 14.7) Dr Lee does the second 'expose & bond').Turns out she never looked at the CBCT. She didn't see the irregularly shaped crown of#6 on pano before surgery #1. She thinks the previous surgeon caused the damage, until this is pointed out. At surgery she also finds resorption on crown of #27.
May 2013 (age 15.3) Dr Chen asks Dr Lee for advice, but she doesn't respond back. Dr Chen asks Dr Johnson for advice. He recommends 'stiffer wire'. When then doesn't help, Dr Chen then wants Dr Johnson to do a coniotomy, but a couple of weeks later Dr Johson says he can’t do it.
July 2013 (age 15.5) I ask Dr Chen about PEIR after reading about it in Dr Andrew Becker’s Bulletin. Dr Chen knows nothing. I contact Dr Adrian Becker, orthodontist in Israel, about the PEIR. He suggests that the resorption be mended in situ, his theory is that PEIR, similarly to ICRR, impedes eruption.
Aug 2013 (age 15.6) Dr Chen cancels the next day’s appointment, saying he is leaving for China.
Dr Nelson, UCSF, takes over, says #27 will emerge, questionable about #6.
He hears about Dr Becker's theory. Endodontist and oral surgeon at UCSF know nothing of PEIR.
8/29/2013 CBCT (UCSF), 15 microsievert.Discussions on whether pulp is engaged or not. Nothing conclusive.
Nov 2013 (age 15.9) Dr Nelson gives up on #27. He can't find a surgeon who is willing to try Dr Becker's
suggested intervention: fixing the resorbed crown in situ.
(March 5, 2014) Expose & bond of #6 and #27(age 16.1)
We go to Jerusalem where Dr Becker & Dr Zeltser, surgery with expose & bond, but also mending the defects in crown. #27 starts moving.
April 2014. (age 16.2) Dr James Chen(#2, same name as UCSF orthodontist) orthodontist, San Mateo, continues traction.
June 2014 (age 16.4) Dr Chen informs via email that he won't continue helping. We are without orthodontist!
DIY traction is kept on #27 until the bonding breaks.
July 2014 (age 16.5) Dr Kai, orthodontist, Fremont, takes over. #27 erupting, #6 stuck. Dr Kai thinks apicotomy, as described by Dr Puricelli, oral surgeon in Brazil, sounds like it's worth a try. I also found Dr Jae Hyun Park promoting it at the AAO meeting 2014.
(Sep 16, 2014) Apicotomy and block osteotomy of #6
(age 16.7) Dr Stephen Schendel and Dr Rishi Gupta, oral surgeons, Palo Alto, does an apicotomy and ‘block osteotomy’ of #6.
9/17/2014 Visit with Dr Kai in order to see that traction is applied directly post surgery. Dr Kai says the traction on #6 is good just by leaving the elastic that he put in pre surgery and that Dr Schendel left in place and put a dental pack around.
9/26/2014 Dr Gupta removes dental pack. He says since the elastic was embedded, there was no traction on the tooth. Traction delayed 13 days, which might be reason for the failure.
Oct 2014. (age 16.8) #27 fully erupted. #6 has not moved.
2/18/2015 (age 17) Dr Giannotti mends the crown of #27 according to Dr Becker's recommendations.
March 2015 (age 17.1) Seek advice of Dr Lakha, oral surgeon, Palo Alto and Dr Donald Beck, prosthodontist,
San Mateo. Dr Lakha doesn't think age matters for implant, but Sam is still growing, we want to wait with extraction & implant until maxilla growth done. Plan series of cephalograms.
3/17/2015 CBCT (C-Dental, San Mateo) 160 microsievert. No comments by Dr Lakha and Beck. Dr Becker in Jerusalem uses it to enhance it with 'Anatomage'. Finds signs of ICRR on #6, thinks new surgery could work; we find it undoable under the circumstances.
2/24/2016 (age 18) Braces off after Drs Kai and Beck spend 16 months on adjustments for the implant. (Unfortunately it was missed in spite of Dr Becker's notes, that Dr Becker put in a sleeve over the wire as a spacer that would not allow the space to close to 9 mm.) Dr Giannotti finds 4 cavities. (Sam had no cavities up until the braces were put on.)
2016 The bonded chips on Sam's front teeth come off and have to be repaired by Dr Beck.
9/13/2016 CBCT : TMJ (C-Dental, San Mateo). Dr Kai thinks Sam’s right TMJ looks abnormal on pano. According to Beamreaders it’s an illusion on the pano. CBCT normal.
Nov 2017 Need to mend chip on #8 again after Sam eats pizza.
(Dec 15, 2017) Extraction of #6, bone grafting.
(age 19.10) Dr William Bohannan, oral surgeon, Burlingame.
He remarks on a ’thru-and-thru’, as if a drill made a hole through the bone, that he tried to graft, but it's a problem. Also the lengthy treatment and multiple surgeries has affected bone cover on #5 and #7. Sam is next told that he also might need to extract premolar to have the implant for #6 work. Have to wait for decisions after pano/CBCT.