J Dent Rehabil Appl Sci.  2017 Mar;33(1):25-33. 10.14368/jdras.2017.33.1.25.

Orthodontic upright treatment for mesioangular impacted lower second molar

• Choi B
• Jeong D
• Lim S
• Gang S

• KMID: 2377056
• DOI: http://doi.org/10.14368/jdras.2017.33.1.25

Abstract

The lower 2(nd) molar eruption is beginning to mesiolingually, then rotate to distobuccally so it has a tendency to be tilted and impacted mesially. Signs and symptoms of impacted 2(nd) molar are similar to impacted 3(rd) molar's. However, treatment plan for impacted 2nd molar is different from that of impacted 3(rd)'s. The former is the preservation and uprighting of 2(nd) molar so that it could act to recovery of mastication, symmetrical facial growth, maintaining the symmetry of dental arch, stable occlusion, while the latter is the extraction of tooth. If the uprighting treatment is planned, most proper protocol of treatment and the additional treatment opition should be applied with consideration for it's crown exposure, present of 3(rd) molar which interrupt the uprighting process, extrusion of opposite tooth. Although it could not improve the esthetic result, it could prevent many dental problems. Therefore, uprighting for impacted lower 2(nd) molar is meaningful treatment.

Keyword

impaction of lower second molar; minor tooth movement; orthodontic uprighting treatment

MeSH Terms

Crowns
Dental Arch
Mastication
Molar*
Tooth
Tooth Movement

Figure

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  Fig. 1 Pretreatment panoramic radiograph (A), intraoral photograph (B). There were shown mesial angulated impaction of #47. Especially, alveolar bone resorption was shown at #47 mesial side in panoramic view.

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  Fig. 2 Intraoral photographs during treat of mesioangulated impaction of #47. Each images was cropped. (A) .018 standard tube was bonded on #47 occlusal surface by rotated 90°then, auxillary wire was engaged. (B) .022 molar tube was bonded on #47 buccal surface at rightly position. A chicane NiTi spring was delivered for continuous uprighting process. (C) After gross uprighting process, continuous main arch wire was engaged. (D) After treatment. The mesioangulated #47 was uprighted to right position.

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  Fig. 3 Pretreatment periapical radiograph (A), intraoral photograph (B). Periapical radiograph was shown mesial angulated impaction of #47, #48 was developed at distal side of #47. Remarkable periodotal or carious lesion were not shown. The ulcerative lesion by erupted #47’s distal cusp was shown at #46 distal side in intraoral photograph.

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  Fig. 4 Intraoral photographs, periapical radiographs during treat of mesioangulated impaction of #47. Each intraoral photographs were cropped. (A) & (B) After gingivectomy, occlusal surface of #47 was exposed. A lingual button was bonded on most mesial side, Modified Humpery appliance was cemented on #46 and tractional elastic module was engaged. (C) & (D) After gross uprighting process, lingual button, Humpery appliance’s lever arm were removed. .018 standard tube was bonded on right position of #47. Partial .016 × .022 SS wire and open coil was delivered. There were no periodontal problem, root resorption of #47. #48 was developed normally at #47 distal area. (E) After treatment. The mesioangulated #47 was uprighted to right position. Slightly gingival swelling was shown at #47 distal surface.

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  Fig. 5 Pretreatment panoramic radiograph (A), intraoral photograph (B). Panoramic radiograph was shown mesial angulated impaction of #47, #48 was developing at closed distal side of #47.

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  Fig. 6 Intraoral photographs, panoramic radiographs during treat of mesioangulated impaction of #47. Each images were cropped. (A) 1 year later after #48 extraction. (B) Mini-implant was inserted at most anterior-inferior border mandibular ramus, then 0.3 mm dead soft SS wire was connected to mini-implant. Elastic chain was engaged between 0.3 mm wire and lingual button that was bonded on #47 occlusal surface. (C) & (D) After gross uprighting process, lingual button, mini-implant were removed, then a .018 standard tube was bonded on right position of #47, continuous arch wire was engaged. (E) MEAW was used at finishing stage. (F) After treatment. The mesioangulated #47 was uprighted to right position.

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  Fig. 7 Pretreatment panoramic radiograph (A), intraoral photograph (B). Panoramic radiograph was shown almost horizontal angulated impaction of #47. Fully developed #48 was erupted at right distal side of #47. It was occluded #17. Deep caries lesion was shown panoramic view, intraoral photograph.

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  Fig. 8 Intraoral photographs, periapical radiograph during traction of #48. Each intraoral photographs were cropped. (A) After #47 extraction. .022 SWA bracket bonded on #44 - 48, then .016 × .022 Niti was engaged. (B) After initial alignment, .019 × .025 SS with helix loop was engaged for distal tip-back moment during mesial traction procedure by elastic chain. (C) Traction process of #48 was almost finished. (D) After treatment. #48 was tracted to #47’s position. (E) Periapical radiograph after traction of #48. The long axis of #48 was well controlled. However, slightly root resorption was happened.

Reference

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