Impacted Premolar Research Articles

The Diagnosis and Management of Infraoccluded Deciduous Molars: A Systematic Review

The infraocclusion (IO) of primary molars, often seen in retained deciduous teeth, is a common condition that presents significant challenges for pediatric oral health. It occurs when primary molars are positioned below the occlusal plane due to the absence of permanent successors, leading to complications such as misaligned teeth, impaired chewing, and long-term dental health issues. Objectives: This study examines IO prevalence, diagnosis, and treatment approaches. Methods: A systematic review following PRISMA guidelines was conducted, searching PubMed, Web of Science, and Scopus for articles from the last 15 years. Nine articles were included for qualitative analysis. Results: IO was associated with several complications, including root resorption, altered eruption of adjacent teeth, and space loss within the dental arch. Clinical and radiographic evaluations are key to early detection. Severe cases often require invasive treatments, such as tooth extraction and space maintenance, while mild cases could be monitored. Conclusions: IO is prevalent in pediatric dentistry and can lead to significant dental issues if untreated. Early detection and intervention are crucial for preventing complications like tooth misalignment and impacted premolars. Tailored treatment strategies based on severity, along with increased awareness among dental practitioners, are essential to improve long-term outcomes for affected children.

Diagnostic Dilemma of Radicular Cyst Mimicking a Dentigerous Cyst

Abstract Radicular cyst is the most common odontogenic cyst of the jaw; however, its association with overretained deciduous teeth involving impacted permanent teeth is a rare entity and hence may pose a diagnostic dilemma. The aim of this report is to present a case of radicular cyst that mimicked the dentigerous cyst. A 31-year-old female reported to the department of oral medicine with the chief complaint of swelling on the lower left side of the face. Intraoral examination revealed over-retained carious 75. Based on the clinical features, differential diagnosis was given as a radicular cyst and a dentigerous cyst on radiographic examination; intraoral periapical revealed a cystic lesion involving the crown of the deciduous tooth. Cone-beam computed tomography further confirmed that the cystic lesion was not involving the crown of the impacted premolar. Hence, the three-dimensional radiographic evaluation of the lesion helps to rule out the differential diagnosis.

A cross-sectional analysis of prevalence of dental anomalies by CBCT images: An institutional-based retrospective study

Abstract Aim: To determine the prevalence of different types of dental anomalies using cone-beam computed tomography (CBCT) images among the Al-Hasa population in Saudi Arabia and compare these variables between genders and nationalities. Materials and Methods: A retrospective study involving 509 CBCT images, in which patients were grouped based on their gender and nationality. The presence of dental anomalies was determined through the evaluation of CBCT images. Version 28 of the Statistical Package for the Social Sciences (IBM Corp., Armonk, NY, USA) was utilized to analyze the data, chi-square tests and multivariate analysis of variance were used, and P value was fixed at ≤0.05. Results: Out of the 509 CBCT images reviewed, a total of 135 patients (26.5%) exhibited one or more dental anomalies. Impacted canines had the highest prevalence among all types of impacted teeth, with a rate of 9.2%. Impacted premolars and molars (excluding third molars) had a lower prevalence of 2.6% and 1.2%, respectively. Impacted incisors had the lowest prevalence of 0.8%. Among dental anomalies affecting the number, position, and shape of teeth, the prevalence rates are as follows: congenitally missing teeth (6.7%), supernumerary teeth (2.2%), dilaceration (8.1%), microdontia (3.1%), ectopic eruption (2.6%), rotation (1.8%), and transposition (0.2%). Conclusions: The prevalence of dental anomalies is relatively high, with impacted canines being the most prevalent impacted teeth excluding third molars, whereas dilaceration was the most common anomaly affecting the shape of teeth. The prevalence of anomalies did not differ significantly between genders, except for rotation. Additionally, there was no significant difference reported in nationalities.

Idiopathic External Cervical Resorption of the Impacted Second Premolar: A Case Report

The tooth impaction of the lower second premolars is an occasional condition but is still seen in clinical practice with a prevalence of 0.6–2.6%. The present case report describes a rare condition of the lower second premolar impaction. An 11-year-old female patient presented with the anteroposterior dental discrepancy, midline shift, and occlusal cant. Intraoral examination revealed the absence of the lower right second premolar with no space available for the eruption. X-ray examination revealed the impaction of tooth #45 in a vertical position, tilting of the adjacent teeth, and two-thirds root length development. The orthodontic treatment plan included space opening using a fixed appliance with a coil spring. The natural eruption of the tooth was expected according to dental age and root development. When the space was opened, no change in the position of tooth #45 was observed. Surgical exposure and active traction were performed. However, the intrusion and tilting of adjacent teeth were observed during the next appointments with no vertical change of tooth #45. Ankylosis was suspected as no tooth movement was recorded. The surgical luxation and osteotomy of the coronal alveolar bone of the impacted tooth were planned for the imminent forced eruption, which was expected due to the young age of the patient. Consequently, the crown of tooth #45 emerged and the bracket was placed. Further traction was planned to use a micro-screw. Following the traction, no vertical displacement of the tooth was observed in the subsequent appointments. Radiographic examination revealed radiolucency in the coronal third of the root. The patient was referred to the endodontist, and CBCT revealed external cervical root resorption in the late reparative stage. ECR in an impacted tooth, mimicking the manifestation of tooth ankylosis, can cause orthodontic treatment failure.

CBCT: The third eye in orthodontics

Accurate diagnostic imaging is essential to derive the correct diagnosis and treatment plan in orthodontics. In two-dimensional diagnosis, geometric distortion, superimposition of structures, projective displacements, and rotational errors are common. This case series, affirming that the CBCT is vital key in the diagnosis of some specific orthodontic conditions, and presenting five case reports which was difficult to diagnose it with two-dimensional radiograph. Case 1 includes horizontally impacted 21 with crown located labially, and root palatally with close proximity to nasopalatine canal, which was veiled in 2D orthopantomogram. Case 2 is an infrazygomatic implant case, the placement of which was debatable by seeing through the 2D IOPA radiograph. Here, CBCT removed the black curtain and proved its monarchy. Case 3 is a premolar impaction, which in 2D radiograph appeared like an iceberg, but its true anatomy was revealed by the CBCT. After this, the next case 4 is about the central incisor mimicking a canine in 2D radiograph, which was found to be supernumerary tooth on CBCT. Followed by temporomandibular disorder (5) which severity was brought to light by CBCT. The need for this case series is to wave the flag for CBCT in the orthodontic diagnosis which will help in delivering proper treatment plan and emphasis where it is essential to do CBCT.

Resorbed upper first permanent molars: a case study

This article describes a case of bilateral impaction of upper second premolars into the upper first permanent molars in a 12-year-old female patient. The extraction of both resorbed upper first molars, and subsequent orthodontic management is described. CPD/Clinical Relevance: This case highlights the importance of thorough assessment and radiographic imaging of impacted premolars even after they have erupted intra-orally. This is especially important when planning dental extractions as part of an overall orthodontic treatment plan.

Compound Odontoma Associated with Dentigerous Cyst

A 17-year-old female presented to the Department of Oral and Maxillofacial Surgery complaining of hard expansion with pain sensation in the posterior part of the left mandible for two weeks ago. She was healthy with an unremarkable medical history. Intra-oral examination revealed retained lower left deciduous molar (#75) with bony expansion on the left side of the mandible. Orthopantomograph (OPG) showed unerupted third molars as well as compound odontoma associated with dentigerous cyst include the cement-enamel junction of impacted lower left second premolar leading to mechanical obstacle of eruption and in turn impaction (Panel A). Under local anesthesia, two sided flap was raised, surgical removal of impacted tooth with cyst enucleation, and curettage of the surrounding odontoma tissues (Panel B) with preservation of the inferior dental canal (Panel C). Odontomas are hamartomas that presented as complex or compound odontomas; their etiology still unknown. Compound odontoma was a malformation having more orderly arranged dental tissue pattern that was rarely associated with dentigerous cyst of impacted premolars. The early diagnosis and management of odontoma and cyst are important for both surgeon and patient to avoid the need for surgical intervention and the need for future Prosthodontic restoration of extracted teeth. At the end of six weeks, results showed complete healing and the patient retained her normal sensation with good aesthetic outcome.

Trans-alveolar extraction with buccal flap of mandibular second premolar: case report

Many articles have explained the extraction of impacted premolars and canines, but there are still few explanations about li-nguoversion premolar extraction.Trans-alveolar extraction is usually used in cases of impacted teeth or teeth with unfavorable root shape, ankylosis, tooth malposition. Trans-alveolar extraction is atechnique commonly used in dentistry. Various flap op-tions can be used in this technique. In this article it is explained a 30-year-old woman came to the Dental and Oral Hospital of Hasanuddin University with the chief complaint of feeling uncomfortable when eating due to partially growing wisdom teeth and teeth growing towards the tongue. It was performed clinical examination and radiography revealed bilateral linguo-version of the second premolars and impacted third molars. The position of the second premolars was considered difficult be-cause of the obstruction of the mandibular first molars and first premolars. It was conducted transalveolar extraction with a flap in the buccal region under general anesthesia. So, it is concluded that clinical considerations and decisions in achoice of treatment affect the success rate and side effects of treatment. The choice of the buccal flap was carried out taking into account the position of the teeth,the relationship with neighboring teeth, and avoiding injury to the mental nerve that could cause the risk of paraesthesia.

Maxillary expansion and first molar distalization achieved simultaneously by using a palatal miniscrew-system appliance: Report of two patients

• Skeletal anchorage for expansion and distalization in children presented clinical advantages. • Complete distalization was obtained without producing known adverse effects. • Maxillary expansion and distalization of the first molar were concomitantly performed. • This approach may prevent premolar impaction and/or extraction. This case report describes the treatment of two children by simultaneous rapid maxillary expansion and distalization of the maxillary permanent first molar using an appliance supported by skeletal anchorage. There was extensive unilateral mesialization of the maxillary permanent first molar in both children, probably because of premature loss of the deciduous second molar, causing a Class II subdivision and insufficient space for the eruption of the second premolar. Unilateral posterior crossbite was also present in both patients. Two mini-implants were placed in the anterior region of the palate, and a diversified intraoral appliance was designed to concomitantly perform the expansion and distalization. In addition to successfully obtaining the two movements, a molar Class I relationship, space to allow eruption of the second premolar, and crossbite correction were achieved. This case report showed that the appliance made it possible to achieve these movements without producing the side effects usually associated with them.

Causes of lower premolar impaction in pediatric patients. Case series.

Impacted teeth are frequently observed in clinical practice. However, the presence of impacted premolars is a rarely reported dental anomaly. It is known of a genetic relationship between the presence of several dental anomalies in the same patient as well as in the same family. Among the anomalies associated with lower premolar impactions are palatal impacted cuspids and upper lateral incisors with alteration in shape or number. This investigation aimed to describe the causes associated with lower premolar impaction through a series of 6 cases, between 11 and 15 years of age. The results found suggest the causes associated with the impaction of lower premolars were prolonged retention of primary teeth, altered eruptive pattern, presence of supernumeraries, premature loss of primary teeth and delayed eruption associated with hormonal factors. It is concluded that the presence of premolar impaction points to an association of several causes that converge, observing not only one but several dental anomalies.

The Impaction of Mandibular second Premolar : Extraction or Relocation? A Case Report

Background: Decision to correct the Angle class I malocclusion with mandibular second premolar impaction need a special art and knowledge. The problem is what kind the treatment planning, extraction or relocation the impaction tooth. Case: A female patient, 16 years old, mesoprosopic and good proporsion of jaw with right mandibular second premolar impaction. Case Management: Treatment was initially using fixed orthodontic appliance followed by both arches expansion. Case was corected with MBT orthodontics philosopy platform. In the final treatment, molar and canine relation was obtained class I relationship, normal overjet and overbite. Conclusion: The results of this treatment indicated that mild impaction can be corrected without surgical exposure. Expantion using archwire and open coil spring is powerfull enough for this treatment. The right decision make the simplest method for the greatests results.

Resorption of maxillary first permanent molars by impacted maxillary second premolars: A case series

Although rare, resorption of the first permanent molar caused by impaction of the second premolar does occur. Three paediatric patients with impacted upper second premolars, distinct symptoms and signs of resorption are described. One case with clear resorption of the upper molar on initial presentation was managed immediately with extraction of the first permanent molar. Eruption of the impacted premolars was monitored in the other two cases, but symptom changes and sectional cone beam computed tomography (CBCT) highlighted resorption of the first permanent molars. In both cases the resorbed first permanent molars required extraction. Frequent clinical and radiographic assessment is imperative in such cases, along with consideration for the use of CBCT. CPD/Clinical Relevance: Many dental health professionals are unaware that resorption of maxillary molars induced by impacted premolars is possible, thus, this phenomenon is not monitored, resulting in misdiagnosis and avoidable patient morbidity.

Surgical Enucleation of a Dentigerous Cyst in a 12-Year-Old Child: A Case Report

Dentigerous cysts are the benign odontogenic cysts that surround the crown of an unerupted or impacted tooth and they account for approximately 20-24% of the jaw cysts. Dentigerous cysts involving impacted second premolars are rare. Here we report a case of surgical enucleation of an inflammatory type of dentigerous cyst associated with the impacted mandibular second premolar in a 12-year-old child. Nine-months follow up showed satisfactory healing of the defect with remarkable bone formation.

Retrospective Radiographic Survey of Unconventional Ectopic Impacted Teeth in Al-Madinah Al-Munawwarah, Saudi Arabia

OBJECTIVES: Ectopic unconventional impacted teeth are rare. These teeth erupt in an unusual direction with limited unconventional access and have increased surgical risks.
 AIM: This study aimed to investigate and assess the prevalence and distribution of rare ectopic impacted teeth at the Taibah University Dental College and Hospital (TUDCH), Al-Madinah Al-Munawwarah, Saudi Arabia.
 METHODS: The study designed through a retrospective radiographic cross-sectional survey involving the review and examination of 9000 archived digital orthopantomograms of patients who visited the (TUDCH) in the period from January 2014 to December 2019 and to analyze any associated factors.
 RESULTS: There were 63 ectopically impacted teeth, with an incidence of 0.7%. The age of the patients ranged from 18 to 68 years, with a mean of 32.4 ± 13 years. Regarding patient nationality, 68.3% were Saudis. The most common ectopically impacted teeth were the extra impacted premolars, with an incidence of 0.2%, followed by the inverted molars, impacted first or second molars, and buccoversion or lingoversion third molars, with incidences of 0.16%, 0.13%, and 0.12%, respectively. The mandible was affected with ectopic impaction more than the maxilla, with an incidence of 55.6%. There was no difference between the right and left sides. Impacted teeth in the sinus were the least common.
 CONCLUSION: The prevalence of ectopic impacted teeth was 0.7% among the surveyed patients at TUDCH, Al-Madinah Al-Munawwarah, Saudi Arabia. Hence, the oral surgeon must have readiness for such a challenging, increasing situation.

Prevalence and associated factors for mandibular Premolar impaction in various malocclusions

Teeth which fail to erupt to the level of the occlusal plane even after ⅔ rd root formation is completed are termed as impacted teeth. Prevalence of impacted teeth can vary from one person to another and also among populations. This study was aimed to evaluate the prevalence of mandibular premolar impaction in various skeletal malocclusion patients. This retrospective study included case records of 886 subjects who visited the orthodontic department of Saveetha Dental College from June 2019- March 2020. OPG and intraoral photographs of all the subjects were analysed to find the prevalence of mandibular premolar impaction. The present study reported the prevalence of impacted mandibular premolar at 0.5%. Out of the total 4 cases in which mandibular premolars were impacted, three patients had skeletal Class I malocclusion. The prevalence of premolar impaction was higher in females than males. No significant association between gender and premolar impaction was noted (p > 0.05). To conclude, though the prevalence of mandibular premolar impaction is low, it is important to diagnose early to avoid complications and plan treatment.

Guided Osteotomy and Guided Autotransplantation for Treatment of Severely Impacted Teeth: A Proof-of-Concept Report

IntroductionThe aim was to present a novel surgical technique using virtually preplanned 3-dimensional (3D)-printed templates for guided osteotomies. These were to ensure atraumatic uncovering of a severely impacted donor tooth including guided drilling of the recipient alveolus followed by a secure autotransplantation procedure. MethodsThis report presents an autotransplantation procedure of a 14-year-old patient with a severely impacted second premolar and extensive contact to the roots of the adjacent teeth and the inferior alveolar nerve. Autotransplantation of the impacted premolar was virtually performed using modified methods from guided implant surgery in order to prefabricate 3D-printed templates with the aid of a fully digital workflow. ResultsSatisfactory treatment could be achieved using surgical templates for guided osteotomies of the surgical access, guided drilling of the recipient site, and occlusal reference template ensuring autotransplantation in the appropriate 3D location of the graft. An atraumatic approach could be ensured with an extraoral time of 46 seconds by 1 fitting attempt; no injuries or altered sensation of the inferior alveolar nerve were present. A vital natural tooth could be observed. ConclusionsThis innovative technique uses for the first time a fully implemented digital workflow for guided osteotomies, guided drilling, and guided autotransplantation of a severely impacted tooth. 3D-printed templates could ensure a guided atraumatic approach and facilitate highly complex treatments by virtually implementing recommended guidelines in future autotransplantations.

Case report: Management of an impacted second premolar

Impaction of mandibular second premolar teeth may result from local factors such as abnormal positioning of the tooth bud and insufficient space in the dental arch. It can also be caused by ankylosis, early exfoliation, or prolonged retention of the primary second molars. Pathological factors such as alveolar cysts or odontomes have also been implicated. The recommended treatment for these cases varies according to case-specific clinical characteristics. This may include periodic observation, space maintenance, or surgical exposure with/without orthodontic traction or extraction. In this paper, the aetiology, diagnosis and treatment planning for mandibular second premolar impaction are reviewed. Furthermore, the treatment of one case will be presented.

Surgical Treatment of A Premolar Case Retained In Inverted Position by Extra Buccal Access

Dental impaction is usually asymptomatic. In most cases it is recognized by chance by general dentists or orthodontists, when a patient arrives your office for a routine check-up. Mandibular third molars are the most commonly impacted teeth. Very few studies have been done to assess the prevalence of impacted premolars in inverted position. This study aims to approach the planning, diagnosis and surgical treatment of a case of premolar held in reverse position through extra oral access. Key words: Tooth impaction; impacted premolars; pathology; migration; surgical treatment;

The orthodontic-oral surgery interface. Part one: A service evaluation and overview of the diagnosis and management of common anomalies.

Introduction: Complex dental anomalies often require multidisciplinary management in secondary care. These anomalies may present to general dental practitioners in the first instance, therefore it is important that all clinicians are aware of such anomalies and their management. / Aims: This service evaluation aimed to profile the dental anomalies presenting to the multidisciplinary joint dento-alveolar clinic at a district general hospital and to outline the management of the common anomalies. / Method: This two-part series details a service evaluation and profiles the dental anomalies presenting to the joint dento-alveolar clinic at a district general hospital. In addition, the features and management of the common dental anomalies are outlined. / Results: Fifty-four percent of patients were female, with a mean age of 17 years. The most common anomalies were impacted canines (49%), followed by supernumerary teeth (16%) and impacted premolars (10%). Other anomalies accounted for only a small percentage of referrals. / Conclusion: A wide range of anomalies presented to the joint dento-alveolar clinic. It is important for all clinicians to be aware of such anomalies, their diagnosis and management. Part one and two of this article therefore provide an overview of the common anomalies and highlight their management.

Current situation of clinical research on impacted premolars

Teeth impaction is a common developmental malformation in oral diseases. Impacted teeth are usually the canines, third molar, central incisors, premolars, and second molars. The prevalence of impaction of maxillary canines and mandibular wisdom teeth is higher than that of other teeth. Most recent studies have focused on the canines and third molars, but research on impacted premolars is limited. In clinical practice, the majority of orthodontic patients require premolar extraction. Thus, impacted premolars play important roles in orthodontic design and prognosis. This article provides an overview of recent research on impacted premolars and summarizes epidemiological features, localizations, and treatments, with the aim of guiding practitioners on orthodontic design and therapy.