Which Lower Front Tooth Should Be Taken Out?
Mr. Huang, in his early fifties, has an abscess (Fig.1 <) near the root tips of two bottom front teeth (R, L). These two teeth are crooked. One of them should be gone (1 2). Which one, right or left? It appears that the abscess is closer to the left than the right. A rubber stick is inserted into the abscess (Fig.2 *) to see where it ends up. In fact, the tip of the rubber stick stops over the root tip of the left front tooth (Fig.3 *). Since the regular X-ray does not show the bad tooth for sure, three-D CT is taken. All the images (Fig.4-8) demonstrate that the right front tooth also has root tip infection, but it is smaller than that of the left one. The root space of the right is larger (Fig.6 between arrowheads) than that of the left (Fig.7). It is easier to do root canal for the right front tooth than the left.
In summary, to get rid of infection and get good alignment, the left front tooth should be taken out, while the right gets root canal (Fig.9 red line). Once there is a space, the remaining teeth will shift by themselves and the space will be closed automatically, i.e., without braces (Fig.10 arrow).
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Xin Wei, DDS, PhD, MS 1st edition 06/01/2014, last revision 06/01/2014