Orthodontic uprighting of severely impacted mandibular second molars

Abstract

The prevalence of impacted second molars is low, varying from 0% to 2.3%. The etiology of an impaction can involve systemic, local, and periodontal factors, as well as a developmental disruption of the tooth germ. A number of surgical and orthodontic treatment options have been suggested in the literature, including leaving the tooth in situ, removing the impacted second molar, orthodontic uprighting, and autotransplantation. Removal of third molars has been suggested as an adjunct for space creation. This article presents the treatment of a girl with bilateral severely impacted mandibular second molars as well as an ectopic maxillary left canine and severe crowding affecting both the maxillary and mandibular arches. Her treatment was successfully completed with fixed preadjusted edgewise appliances (0.022 × 0.028-in slot size) and MBT prescription (APC precoated Gemini Brackets; 3M Unitek, St. Paul, Minn), along with the removal of 4 first premolars. The maxillary left canine and the mandibular second molars were surgically exposed. The treatment mechanics show that even severely impacted second molars can be uprighted by routine straight-wire techniques, which are easy to apply. The center of rotation of the second molar lies in the bifurcation of the roots of this tooth, and this biomechanical property was used to its full advantage. The techniques applied comprised bracket repositioning, bypass of brackets, conversion of molar tubes to brackets, thermoelastic copper-nickel-titanium archwires, and a push-coil spring. Other orthodontic treatment mechanics, which require complex sectional or segmental techniques, auxiliaries, or artistic wire bending, that have been suggested in the literature were not used here. The third molars were not removed.