Soft Tissue and Occlusal Management in the Surgical Uprighting of Impacted Molars: Technical Note

Abstract

A The treatment of impacted mandibular second molars (Fig 1) is a common problem faced by oral and maxillofacial surgeons and orthodontists. Bringing the impacted tooth into its correct position in the dental arch is important in the prevention of caries and periodontal problems on the distal root of the first molar and in preventing arch-length discrepancies. Orthodontic uprighting, with or without the use of temporary anchorage devices, has limitations, including a lack of access to the crown for the placement of an orthodontic appliance and the difficulty in applying appropriate directional force. Other variables that affect successful orthodontic uprighting include the experience of the orthodontist, the age of the patient, the degree of root formation, and the depth of the impaction. Surgically assisted uprighting provides access to bond an orthodontic bracket, decreases the need for complex mechanics, and significantly shortens orthodontic treatment time. Complications of surgical uprighting include the possibility of root fracture, devitalization resulting in inflammatory or replacement resorption, and the possible need for endodontic therapy. Numerous publications in the literature have reported high levels of success for this procedure, with minimal morbidity. Several techiques have been described, with the primary diference being whether or not the third molar is emoved to allow distal movement of the second