A mesially impacted mandibular second molar. Treatment considerations and outcome: a case report

Posterior Available Space for Uprighting Horizontally Impacted Mandibular Second Molars Using Orthodontic Microimplant Anchorage

Treatment of horizontally and deeply impacted mandibular molars is challenging for both orthodontists and oral surgeons because of the limited access and anchorage control. We report on two patients who had horizontally and mesially impacted mandibular second molars (MM2s). Both patients were treated by a surgical orthodontic approach, and the crowns of the impacted teeth were brought into the arches by closed forced eruption. Mesially impacted MM2s were uprighted with orthodontic microimplants, inserted in the retromolar area, and then moved into their ideal position. The first patient was in an active growing stage, while the second patient was beyond the active growing stage. Therefore posterior available space (PAS) should be analyzed before treatment of impacted MM2s to prevent periodontal problems after uprighting of impacted teeth. If PAS is not enough for uprighting impacted MM2s, alternative treatment should be considered based on the stage of growth.

Evaluation of the periodontal status of uprighted mandibular second molars using microscrews placed in the retromolar area: A comparison of two surgical techniques

Objective

Permanent mandibular second molar impaction can lead to dental problems including periodontal pockets. In this study, uprighting of impacted mandibular second molars was carried out. Two surgical techniques were compared for time taken to upright the impacted mandibular second molar and if any periodontal pocket was formed on the distal aspect of the uprighted molar due to the surgical removal of bone distal to the impacted second molar after uprighting.

Materials and Methods

A total of 20 subjects with impacted mandibular second molars were chosen from our orthodontic practice for this study. All the second molars were mesio-angularly impacted and unerupted. The subjects were divided into two groups. Group I comprised ten subjects with the cementoenamel junction (CEJ) of the unerupted impacted second molar apical to the level of the alveolar ridge. Group II comprised ten subjects with the CEJ of the unerupted impacted second molars at or coronal to the level of the alveolar ridge. 1.8 mm diameter and 10 mm length self-drilling microscrews (3M Unitek temporary anchorage devices) were placed into the retromolar area distal to the impacted second molars. Groups II and I underwent surgical exposure of the impacted second molars and placement of 10 mm length microscrews. In Group I subjects, bone was removed from the entire distal aspect (furrowing) of the impacted second molar. Group II subjects did not undergo any removal of bone on the distal aspect of the impacted second molars. One button each was bonded on the buccal and lingual surfaces of the surgically exposed second molars. Elastomeric chains were attached from the microscrew head to the buccal and lingual buttons so as to bodily upright the molar. After complete uprighting, a single examiner (periodontist) who was blinded to the type of surgical technique evaluated the periodontal status of the second molar by clinical probing of the sulcus depth (SD). The comparison of the significance of the difference of average duration and average SD between the two study groups was tested using Mann–Whitney U-test (a nonparametric test). The value of P < 0.05 is considered to be statistically significant.

Results

Average duration of uprighting was significantly longer in Group II compared to Group I (P < 0.001). SD on an average is significantly deeper in Group I (furrowing) as compared to Group II (no furrowing) at distal surfaces (P < 0.001 for all distal sites). Average SD did not differ significantly between Groups II and I at mesial surfaces (P > 0.05 for all mesial sites).

Conclusion

In Group I subjects, uprighting was hastened in comparison to Group II subjects where the CEJ was at or coronal to the alveolar bone. The furrowing of the bone does cause a deepening of the SD on the distal surface of the second molar, but this is not clinically significant. This deepening cannot be termed as a periodontal pocket as it is well within normal limits.

Use of miniplates as a method for orthodontic anchorage: a case report

Introduction:

Temporary anchorage devices (TADs) have been developed to be used as direct adjuncts in orthodontic treatment and have facilitated treatment of more complex orthodontic cases, including patients with dental impaction.

Objectives:

This clinical case reports the applicability of TADs in the orthodontic treatment of a patient with impacted mandibular second molars. Surgical and orthodontic procedures related to the use of miniplates were also discussed in this study.

Conclusions:

The use of temporary anchorage devices, such as miniplates, can be suggested as an alternative to treat patients with impacted mandibular second molars.

Eruptive abnormalities in orthodontic treatment

In the course of orthodontic practice, it is inevitable that one will encounter what is termed here eruptive abnormalities. These abnormalities include teeth that are impacted, ectopically erupting, or transposed. Hyperdontia and hypodontia are also included for consideration. The treatment plans developed to address these anomalies must take into account the space needs of the patient and how one can best gain, maintain, or redistribute that space. Also, soft tissue reactions to the movements also should be considered.