Question:

My daughter is 8 and her canines are erupting. She lacks a bit of space, but no other significant issue. Should I treat her now with expansion and opening spaces for the canines or I can wait a year or two to see how it goes?? What do you think?

Answer:

The case in question involves an 8-year-old child with minimal space for tooth eruption and no other significant dental issues. The primary concern is whether to initiate treatment now with expansion to create space for the canines, or wait a year or two to observe how the situation progresses.

A third option, which is recommended in this scenario, is to acknowledge the lack of space but not rush into treatment immediately. Instead of full treatment right away, a more conservative approach is proposed. The concern with waiting too long is the potential loss of leeway space as premolars begin to erupt, leading to crowding if things drift forward.

The suggested plan is to order aligners for the child, but only have them worn at night. Attachments could be placed on the six-year molars (first permanent molars) and possibly on a few baby teeth in the anterior, provided those teeth aren’t about to fall out. This could include the primary molars on one side or both. Additionally, attachments might be added to some upper premolars, helping to lock the aligners in place.

This approach serves the function of using the aligners as a lower holding arch, preventing space loss and keeping the teeth in good positions as they continue to develop. The child could be given a year’s worth of nighttime trays, consisting of 26 active aligners with 4 passive aligners. These trays would only be worn at night, maintaining the current position of the teeth and ensuring no further crowding occurs.

If the aligners stop fitting properly before the end of the 26-30 aligners, a new batch could be provided. The goal of this approach is not to achieve significant movements, but to maintain space and prevent worsening of the situation. The treatment should be mild, with minor movements as needed. If additional adjustments become necessary, having attachments on the posterior teeth (such as molars) can allow for slight modifications.

Ultimately, this plan prevents premature loss of space, ensures the child is set up well for future treatment, and avoids the risks associated with waiting too long without intervention.