Management of unilaterally deep impacted first, second, and third mandibular molars

Abstract

Simultaneous impactions of first, second, and third permanent molars comprises a very rare clinical situation with diverse therapeutic approaches and is a difficult challenge for dentists. Early diagnosis and treatment of eruption disturbances contributes to optimal outcomes. This article reports the treatment of a teenager with severe impaction of right mandibular first, second, and third molars, which hinders the masticatory function and dental arch integrity. A decision-making process and a simple orthodontic technique are described. To shorten the treatment time and simplify the procedures, the impacted right mandibular third and second molars were orthodontically uprighted with an innovative tip-back cantilever. Subsequently, the deeply impacted right mandibular first molar was extracted with minimal obstacles. The combined surgicalorthodontic approach resolved a challenging clinical problem and eliminated the need for prosthetic or dental implant replacement of the impacted molars. Good occlusion, normal function, and a healthy periodontium of the patient were also achieved. (Angle Orthod. 2012;82:565-571.)

Impacted First and Second Permanent Molars: Overview

“…Teeth of the permanent dentition may fail to erupt either as a result of mechanical obstruction which could be idiopathic or pathological or because of the eruptive mechanism disruption [2]. According to Andreasen et al [4], three main causes have been involved in the eruption disturbances. These causes include ectopic tooth position, obstacles in the eruption path, and failures in the eruption mechanism.…”

“…As a whole, causes of eruption disturbances, particularly failure of tooth eruption, could be categorized into general and local factors. It may depend on syndromic and non-syndromic problems for both kinds of factors [4,6,12].…”

“…This asymptomatic pathology is most of the time a casual discovery and may incite various pathologic conditions of neighboring and opposing teeth, such as caries, periodontitis or roots resorption, and eventually malocclusions. And so, it is an unpredictable situation dentists have to keep up with through the use of proper clinical and radiological assessment [2][3][4][5].…”

“…This chapter copes with an overview of this pathology and aims (1) to recall the mechanisms of normal and disturbed eruption, (2) to define prevalence and etiopathogeny of impacted first and second permanent molars, (3) to shed light on the needs of earlier diagnosis, and ultimately (4) to bring the limelight on the treatment options.…”

Management of Unilaterally Impacted Permanent Mandibular First, Second and Third Molars

“…2,5 Various treatment options for an impacted tooth include extraction with or without prosthetic replacement or orthodontic space closure, surgical repositioning, transplantation and orthodontically assisted eruption with or without surgical uncovering. [6][7][8][9][10] While impactions of single teeth in a quadrant are routinely encountered by most orthodontists, multiple impacted molars in the same quadrant are an unusual occurrence and are likely to present as a highly challenging clinical situation. This article reports and discusses the management of a rare case of simultaneous unilateral impaction of mandibular first, second and third molars using a combined surgical and orthodontic approach.…”