Impacted second molars, which surgical treatment choosing?

Introduction

Delayed evolution of second molars is a rare phenomenon with an estimated prevalence in the mandible of 0 to 2.3%. Many etiologies have been proposed to explain these inclusions, among which the reduction of arch perimeter, distalization of first molar, mesio-angulated position of the second molar. However, the presence and position of the third molar does not seem to be a risk factor for this inclusion.

Materials and Methods

Several therapeutics options with surgical management have been proposed in the literature; surgical repositioning, surgical release of the crown more or less associated with orthodontic treatment, and sometimes avulsion of the second molar to allow the third molar development. There is no recommendation on this subject, the literature describing mostly retrospective studies and case reports.

Conclusion

This article presents the different therapeutic options in the treatment of second molar inclusions.

Ectopic eruption of the second premolar: an analysis of four different treatment approaches

PURPOSE

Ectopic second premolars may lead to impaction and loss of space in the jaws, and in rare cases even to resorption of the first permanent molar. The aim of this study was to analyse different treatment strategies of ectopic second premolars and if possible give guidelines on when to favour different treatment approaches.

MATERIALS AND METHODS

The study was a retrospective, non-randomised, outcome analysis of treatment on 41 ectopic second premolars in 37 patients (24 females and 13 males). In all cases oral examination, radiographs (pre-, peri-, and post) and full medical history were obtained. The treatment options included: (a) spontaneous eruption, (b) spontaneous eruption + extraction of primary tooth, (c) surgical exposure, (d) surgical uprighting, and (e) surgical uprighting + orthodontic extrusion. For evaluation each tooth was scored according to: (1) stage of root development, (2) distance between edges of the premolar and first permanent molar, (3) depth of impaction, (4) inclination, (5) horizontal position of the tooth. The level of significance was set to 5%.

RESULTS

Only mild cases of ectopic second premolars are self-correcting. Based on the position of the tooth in the jaw different treatment options may be chosen, these may include: extraction of primary predecessor (impaction depth < 5 mm, inclination < 55°), surgical exposure of tooth germ (impaction depth < 5.5 mm, inclination < 95°) or surgical uprighting (impaction depth > 5.5 mm with no inclination limit).

CONCLUSION

If there is no sign of self-correction after a short observation period, it is important to consider active treatment to help guiding the tooth into the correct eruption pathway.