Jaw Deformity Issues

My 13-year-old daughter is dealing with some jaw deformity issues. She’s missing her two upper front teeth, one upper premolar, and both of her lower premolars 🙂 . So far, we’ve been bouncing between private clinics in New York City and Savannah. The specialists in NYC suggested she wear a removable appliance until she hits 16, then switch to fixed braces and implants once she turns 18. Their logic is that if we follow that plan, the single teeth would eventually shift to close the gaps, allowing the premolars to slide into place—but that still leaves this awkward gap between the singles and the premolars until she finally gets implants at 18. Honestly, that feels like an eternity to me; I can't even imagine how self-conscious she'll feel walking around with those gaps in her smile. Does anyone know someone who has dealt with something similar, or perhaps a better, more efficient way to handle this? Since she's just a young girl, I'm really worried about the whole bullying thing 🙂 . If you know of any good specialists in the Pacific Northwest area, please let me know.

Thanks

dustyrider96 said:My little girl is dealing with some jaw malformation issues... she's currently missing her upper central incisors, one upper lateral, and both of her lower second premolars 🙂. So far, we have consulted with private clinics in New York City and Savannah. In New York City, their suggestion was to use removable appliances until she turns 16, followed by fixed braces until she hits 18, at which point we would move toward implants. Their logic is that if we follow that path, the lateral incisors would eventually migrate to fill the gaps left by the centrals, but there would still be a noticeable space between the lateral and the first premolar (since she wouldn't get implants until she's 18!). To me, that timeline feels incredibly drawn out, and I can only imagine how self-conscious she might feel with those gaps in her smile... You know how harsh bullying can be among kids these days 🙂. Does anyone happen to know someone facing similar dental challenges, perhaps somewhere in the Pacific Northwest, who found a more efficient way to resolve this?

Thank you

One possibility is requesting a partial denture or a "flipper" so the gaps aren't visible while she waits... Another route would be moving straight to fixed braces and then immediately proceeding with a bridge once the orthodontic work is complete. A third option involves discussing a plan with an orthodontist to close the spaces entirely by reshaping the lateral incisors to look more like centrals, combined with placing crowns on the fourth teeth to mimic the appearance of the missing premolars—though I'm uncertain how ideal that would be from an aesthetic or functional standpoint given how many teeth are missing. While theoretically possible, it really depends on the specific oral anatomy and what the patient is comfortable with... It might be best to seek a second opinion 👍

This kind of case calls for a multidisciplinary approach involving orthodontics, pediatric dentistry, and prosthodontics—you might want to look into the options at the Harvard School of Dental Medicine. Personally, I’d lean toward moving the teeth first to create enough room for implants down the road. Once that space is cleared, you could probably use a space maintainer to hold everything in place... this is just my two cents, though, as I'm not a specialist myself.