Surgical Uprighting Research Articles

Comparison between orthodontic and surgical uprighting of mandibular molars: a systematic review.

To evaluate and compare the efficiency of orthodontic treatment and surgical uprighting of first and second mandibular molars. An electronic literature search in PubMed, Science Direct, Embase, Scopus, Web of Science, Cochrane Library, LILACS, and Google Scholar, as well as a hand search was conducted by two independent researchers to identify relevant articles up to January 2022. In addition, a manual search was done that included article reference lists, grey literature, and dissertations. The risk of bias of the included prospective and retrospective studies was assessed with the Risk Of Bias Tool In Non-randomized Studies of Interventions (ROBINS-I) assessment tool. A total of six nonrandomized clinical trials (non-RCT) evaluating the efficiency of mandibular molar orthodontic and/or surgical uprighting were included. The quality analysis showed certain defects of the Non-RCTs included and, according to the criteria used, the majority of the articles were judged to be of moderate quality. Based on the evidence, orthodontic and surgical uprighting appear to be effective treatment methods for mandibular molars. Surgical uprighting may be associated with more complications than orthodontic uprighting. However, the existing literature on the subject is limited, heterogeneous, and methodologically limited. Therefore, the outcomes should be interpreted carefully.

Surgical Management of Impacted Lower Second Molars: A Comprehensive Review.

Impacted lower second molars (ILM2) are rarely reported in the literature, but various studies have been done for its treatment. Apart from solely orthodontic approaches, different surgical management techniques were reported to have successful outcomes. Surgical intervention of ILM2 can help expose the tooth for further orthodontic purposes, simplifying complex treatment methods, and reducing treatment time. This review illustrates the comprehensive evaluation and updated methods of surgical uprighting, repositioning, and transplantation of ILM2 with future directions for better understanding and treatment planning in the clinical setting. The successful outcome of surgical intervention depends on case selection, root development of ILM2, careful surgical manipulation, and adherence to sound biological principles.

Surgical uprighting of partially impacted second molars

Eruption of mandibular second molars usually occurs around the age of 12. Incomplete eruption of second molars in such young patients can lead to loss of the molars, due to caries, root resorption or periodontal pathology. When a pathology of this kind develops, the treatment option for a mesially impacted molar is often to extract the tooth. If tooth eruption is, however, monitored closely by the dentist and/or orthodontist, early treatment can be considered in order to preserve the tooth. Partially impacted second molars can be placed in a functional anatomical position by surgical uprighting and repositioning. As long as certain conditions are met, this results in sound functionality with preservation of the full dentition. In cases of incomplete eruption, this treatment option should therefore be considered by dentists and orthodontists before extracting the second molars.

Surgical uprighting of impacted mandibular second molar: a narrative review

Early diagnosis of impacted mandibular second molar (MM2) is critical since treatment at a later stage can be complicated. It often requires a multidisciplinary approach. Surgical uprighting of impacted MM2 appears to be a safe, effective, and a reliable alternative to conventional orthodontic mechanics with minimal risk of morbidity or pulpo-periodontal problems. Timely diagnosis is critical and factors affecting treatment outcomes must be assessed for a successful outcome. Although surgical uprighting or repositioning is the most commonly prescribed option for MM2 management, there isn't a review of literature that discusses the etiology, assessment, and surgical management of impacted MM2 with an emphasis on surgical uprighting technique and comparing various factors that affect the outcome.

Surgical uprighting and repositioning of unerupted molars: Features and findings of a retrospective sample.

BackgroundSurgical uprighting and repositioning have been proposed to obtain a correct alignment of unerupted permanent molars. A retrospective clinical study was performed to verify the effectiveness of these techniques. Material and MethodsIn order for a case to be included in the study, adequate clinical documentation was required, including radiographic imaging before and after therapy. The degree of inclination of each treated molar was evaluated on pre-operative panoramic radiographs. ResultsFifty-two molars were studied. Molar involvement was more frequent in the mandible (45 cases=86.54%) than in the maxilla (7 cases=13.66%). The mean age of patients treated with completely formed molars was 17.28±2.86, while that of patients with incompletely formed molars was 12.89±1.75. The most frequent position was mesio-angular (39=75%) with a mean inclination of 31.61°±12.9° (range 5.57°-61.26°). Disto-angular molars had a mean inclination of -28.84°±6.49° (range -23.79°- -36.16°). Surgical uprighting was performed in 37 cases (71.15%), while surgical repositioning was performed in 15 cases (28.85%). Three cases were lost during the follow-up. The outcome was positive in the remaining 49 cases. Complications occurred in only 4 surgeries (7.69%). ConclusionsSurgical uprighting and repositioning are reliable therapeutic solutions for unerupted mandibular molars, with a favorable prognosis. Key words:Molar impacted, surgical repositioning, surgical up-righiting, tooth impacted, tooth unerupted.

Surgical uprighting of mandibular second molars: A single-group retrospective cohort study

The management of impacted, unerupted, or malpositioned mandibular secondmolars with orthodontic therapy requires special attention in order to achieve normal anatomic positioning within the dental arch. We present a surgical approach to managing these teeth combining exposure and surgically-assisted forced eruption. This retrospective single-group cohort study followed 260 impacted mandibular secondmolars. The molars were exposed and surgically uprighted. An orthodontic bracket was bonded to aid in orthodontic traction, and the wound was packed to prevent soft tissue growth over the crown of the exposed molar. Patients were followed for a minimum of 6months after uprighting, during which the following outcomes were measured: the degree of success of the eruption one the basis of the clinical occlusal relationship to the opposing dentition, radiographic evidence of bone fill, the periodontal status of the teeth involved, and tooth vitality. A total of 260 mandibular secondmolars were uprighted in 177 patients (83 female, 94 male) with an average age of 14.8years. Outcomes showed that 255molars (98.1%; 95% confidence interval, 96.3-99.8) were successfully uprighted. Complications included infection/abscess in 3molars and fractured root requiring extraction in 2molars. All remaining 255 teeth tested vital, 17 teeth had periodontal pocketing of more than 5mm, and 235 of the teeth had occlusal contact after healing. Surgically-assisted forced eruption with or without orthodontic forced eruption is a safe, successful, and viable approach to managing unerupted or malpositioned mandibular secondmolars in the adolescent population.

Up-to-Date Approach in the Treatment of Impacted Mandibular Molars: A Literature Review.

Eruption problems in the mandibular molars are rare, but they have to be diagnosed and treated early. Treatment of impacted molars is challenging due to a limited access and complexity of the mechanics that needs to be applied. Methods for managing impacted or tilted mandibular molars include orthodontic repositioning, surgical uprighting, and extraction with or without transplantation of the third molar into the extraction site. This review highlights the methods and clinical procedures of surgical and orthodontic uprighting procedures of mandibular molars with different degrees and levels of impaction. It further discusses the use of the ramus screw as a temporary anchorage device in the uprighting of horizontally impacted mandibular molars.

EVALUATION OF ECTOPIC ERUPTION IN TEETH’S OF CHILDRENS FROM 5 TO 12 YEARS AGE GROUP

Treatment is advised to guide the tooth into a more favorable path of eruption to minimize damage to affected dentition, preserve arch length, and to maintain function. Without intervention, sequelae can include premature loss of the anteriorly affected tooth, tipping and rotation of the ectopic molar, space loss and malocclusion. Treatment will depend upon the severity of the impaction. Mildly to moderately impacted molars can be guided easily with elastic orthodontic separators. More severe impactions require more complex treatment options, including potential extraction of the anteriorly affected tooth, removable or fixed appliances, or surgical uprighting. The present study was planned for evaluation of Evaluation of Ectopic Eruption in Teeth’s of Childrens from 5 to 12 Years Age Group.
 The present study was planned in Department of Orthodontics, Patna Dental College and Hospital, Patna. Total 50 childrens referred to Department of Orthodontics were evaluated for the ectopic eruptions. All the radiographs were compared in each patient, along all the usual followup time. To rule out the possibility of error due to radiographic magnification, the crown measurements in bitewing radiographs and in dental casts were compared, and no significant differences were present.
 Early intervention of ectopically erupting first permanent molars is very crucial to avoid complex orthodontic treatment later on. Ectopic eruption of individual teeth tend to occur as often bilaterally as unilaterally in the same arch, except for mandibular central incisors, first molars and mandibular canines. Early diagnosis and interception of ectopically erupting teeth will allow us in preventing more complicated malocclusions in future.
 Keywords: Eruption problems, Ectopic eruption, Permanent teeth, etc.

First and second permanent molars with failed or delayed eruption: Clinical and statistical analyses

The aim of this work was to analyze data of patients with failed or delayed eruption of first and second permanent molars, to assess the effectiveness of the treatment methods used. Epidemiologic and clinical data of 125 patients (mean age 14.08±4.04years) with 197 affected molars (30 first and 167secondmolars) were retrospectively analyzed. The treatment outcome was known in 161molars after patient drop-out (20 patients with 36molars). The cases were categorized into 8 groups according to the choice of treatment: orthodontic uprighting, surgical-orthodontic uprighting, surgical uprighting, surgical repositioning, surgical exposure, first or secondmolar extraction, third molar extraction, or removal of pathologic conditions. The overall treatment outcome was positive in 141molars (87.6%). It was positive in all cases treated with orthodontic uprighting (7molars), surgical exposure (10molars), surgical uprighting (38molars), and surgical repositioning (8molars), but it was significantly lower for surgical-orthodontic uprighting (34/48molars, 70.8%). The positive outcome was significantly lower for inclusion (52/68molars, 76.5%) than for early-diagnosed condition (11/11molars, 100%) and retention (78/82molars, 95.1%), and for total bone crown coverage (21/28molars, 75.0%) than for osteomucosal or mucosal crown coverage (120/133molars, 90.2%). This study demonstrates that an early diagnosis results in a better outcome regardless of the treatment used, with the number of cases with a positive outcome being higher in younger patients.

Ectopic eruption of the second premolar: an analysis of four different treatment approaches.

Ectopic second premolars may lead to impaction and loss of space in the jaws, and in rare cases even to resorption of the first permanent molar. The aim of this study was to analyse different treatment strategies of ectopic second premolars and if possible give guidelines on when to favour different treatment approaches. The study was a retrospective, non-randomised, outcome analysis of treatment on 41 ectopic second premolars in 37 patients (24 females and 13 males). In all cases oral examination, radiographs (pre-, peri-, and post) and full medical history were obtained. The treatment options included: (a) spontaneous eruption, (b) spontaneous eruption + extraction of primary tooth, (c) surgical exposure, (d) surgical uprighting, and (e) surgical uprighting + orthodontic extrusion. For evaluation each tooth was scored according to: (1) stage of root development, (2) distance between edges of the premolar and first permanent molar, (3) depth of impaction, (4) inclination, (5) horizontal position of the tooth. The level of significance was set to 5%. Only mild cases of ectopic second premolars are self-correcting. Based on the position of the tooth in the jaw different treatment options may be chosen, these may include: extraction of primary predecessor (impaction depth < 5mm, inclination < 55°), surgical exposure of tooth germ (impaction depth < 5.5mm, inclination < 95°) or surgical uprighting (impaction depth > 5.5mm with no inclination limit). If there is no sign of self-correction after a short observation period, it is important to consider active treatment to help guiding the tooth into the correct eruption pathway.

Surgical Uprighting Is a Successful Procedure for Management of Impacted Mandibular Second Molars

Impacted mandibular secondmolars can cause caries and root resorption on adjacent molars and can lengthen orthodontic treatment. Surgical uprighting is one management option. The purposes of this study were to 1) evaluate radiographic outcomes for surgical uprighting of impacted mandibular secondmolars and 2) propose an etiology for impaction. This was a retrospective cohort study of patients who had surgical uprighting of mandibular secondmolars and had preoperative and at least 12-month postoperative panoramic images and an age- and gender-matched control group of patients undergoing routine orthodontic treatment. Predictor variables included age, gender, impaction type, preoperative angle of impaction, preoperative periodontal bone level distal to an adjacent first molar, posterior eruption space, pathology, and concomitant extraction of the adjacent third molar. Outcome variables were change in impaction type, postoperative periodontal bone levels around the first and secondmolars, postoperative tooth angle and posterior eruption space, periapical radiolucency, pulpal obliteration, root resorption, and need for extraction. Descriptive statistics were calculated. The sample and control groups each had 16 patients. The mean ages at the first radiographs were 13±1.1 and 13.19±0.61years for the treatment and control groups, respectively, and the mean follow-up radiographs were obtained 2.4±1.4 and 2.3±0.82years later. No preoperative images showed pathologic lesions obstructing eruption. Postoperatively, all uprighted molars were Pell and Gregory type IA. The mean change in the angles of the uprighted teeth was 23.5±16.1° (P<.001). The mean distal bone levels of the adjacent first molar were 3.41±1.52mm preoperatively and 1.45±0.54mm postoperatively (improvement, 42.5%; P<.001). The preoperative posterior eruption space was 53.6% longer in the control than in the treatment group (P<.001), and the increase in this distance postoperatively was greater for the treatment group than for the control group (P<.001). Pulpal obliteration (n=6; 31.5%), periapical radiolucency (n=2; 10.5%), and root resorption (n=1; 5.3%) were seen on postoperative radiographs. There were 2 failures (10.5%). Surgical uprighting of mandibular secondmolars is a useful procedure with a low failure rate. Insufficient space for eruption is the likely primary etiology for impaction.

Surgical Uprighting of Mandibular Second Molars

Surgical Uprighting of Mandibular Second Molars

Autotransplantation and surgical uprighting of impacted or retained teeth: A retrospective clinical study and evaluation of patient satisfaction

Objectives. This retrospective clinical study aimed to determine the success rate of autotransplanted impacted or retained teeth along with a patient satisfaction survey and to analyze the influence of relevant clinical and radiographic parameters. Subjects and methods. Fifty-seven teeth (37 canines, 10 molars, seven premolars, three incisors) in 45 patients (median 15 years) were evaluated over a mean of 1.6 years. The success criteria were pocket probing depth ≤3.5 mm, mobility grade ≤ II, Periotest ≤30 and complete alveolar bone healing. The influencing parameters were oral hygiene, smoking, periodontal screening index, occlusal/proximal contacts, horizontal position, dental age, pulp obliteration and degree of displacement. Furthermore, bone height was measured. Results. The overall success rate was 74%, along with a high patient satisfaction. The survival rate was 96% after a mean follow-up of 1.6 years. The favorable factors were proper oral hygiene, non-smoking, good general periodontal condition, proximal contacts and pulp obliteration. An increase in or maintenance of bone level was found in 96%. Conclusions. Autotransplantation of impacted or retained teeth is an appropriate treatment, if orthodontic alignment has failed, especially in growing patients.

Residents' journal review

Residents' journal review

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

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

Correction of Mesially Impacted Lower Second Molar

Impaction of the lower second molar is not a common problem, but it is very challenging for both orthodontist and oral surgeon. We report the case of patient who complained of a delay in eruption of both the upper and lower second molars. A panoramic radiograph revealed the presence of all permanent teeth and a severe mesial inclination of the left lower second molars and developing third molars. A removable appliance with an uprighting spring was fixed mouth. After two months, a miniscrew was applied maxillar posterior buccal area. And then, an elastic chain was put between miniscrew and lower second molar. Within a period of 4 months the tooth was completely upright. After 5 months, a panoramic radiograph revealed complete uprighting of the tooth, with bone regeneration. Orthodontic uprighting techniques using miniscrews are more advantageous and offer better long term prognosis than surgical uprighting. The timing of treatment and the biomechanics involved determine the success. doi:10.4021/ jmc272w

Correction of Mesially Impacted Lower Second Molar

Impaction of the lower second molar is not a common problem, but it is very challenging for both orthodontist and oral surgeon. We report the case of patient who complained of a delay in eruption of both the upper and lower second molars. A panoramic radiograph revealed the presence of all permanent teeth and a severe mesial inclination of the left lower second molars and developing third molars. A removable appliance with an uprighting spring was fixed mouth. After two months, a miniscrew was applied maxillar posterior buccal area. And then, an elastic chain was put between miniscrew and lower second molar. Within a period of 4 months the tooth was completely upright. After 5 months, a panoramic radiograph revealed complete uprighting of the tooth, with bone regeneration. Orthodontic uprighting techniques using miniscrews are more advantageous and offer better long term prognosis than surgical uprighting. The timing of treatment and the biomechanics involved determine the success. J Med Cases. 2011;2(6):236-239 doi: https://doi.org/10.4021/jmc272w

Surgical uprighting of mandibular 2nd molar: A case report

Impaction of the lower second molar is not common a problem, but it is very challenging for both orthodontist and oral surgeon. Presented here is a case report of surgical uprighting of a mesioangularly impacted mandibular left permanent second molar. Though various treatment options are available, surgical uprighting appears to be quick and easy procedure with minimal morbidity and good long term prognosis.

A retrospective overview of treatment choice and outcome in 126 cases with arrested eruption of mandibular second molars

The purpose of the present retrospective study was to analyze treatment choice and outcome in patients with retention/impaction of the mandibular second molar. Radiographic material, from three large clinics, from 106 patients (60 males and 46 females) with 126 retained/impacted permanent mandibular second molars treated during the years 1985-2005 was evaluated for treatment choice and treatment outcome. Follow-up questionnaires were sent to dentists in cases where treatment outcome could not be determined from the radiographic material. Clinical evaluation was not possible as the patients were no longer associated with the clinic where they were treated. The cases were categorized into six groups: (A) no treatment; (B) orthodontic treatment; (C) surgical exposure of the second molar; (D) removal of the third molar; (E) removal of the second molar; and (F) other treatments. The various treatment choices performed during 1985-2005 showed acceptable results in 66 of the cases. In 23 cases, the results were unacceptable. In 37 cases, the radiographic material could not document the outcome nor was evaluation of the final outcome possible due to the patient's young age. Remarkable are the high percentages of unacceptable treatment outcome, 25.9% in group D (removal of third molar) and 23% in group E (removal of second molar). As the material was collected before new advanced methods of surgical uprighting and new methods of orthodontic uprighting had been introduced, these percentages are expectedly lower today. Even so, it is highly recommended to focus especially on these two groups in future studies on treatment outcome.

Surgical uprighting and repositioning of severely impacted mandibular second molars

Impacted second molars can create problems with esthetics, masticatory function and dental arch stability. Treatment options include surgical extraction, surgical uncovering with orthodontic-assisted eruption and surgical uprighting. The authors review the literature concerning surgical molar uprighting, and present a case in which the procedure was performed successfully to treat an impacted second molar in a female adolescent. The authors surgically repositioned a horizontal, right mandibular second molar that was partially impacted in bone. The patient was followed up for three years, during which time she was free of complications. Surgical molar uprighting has been shown to be a predictable and reliable procedure. When a molar tooth is severely impacted, surgical uprighting provides a viable option when other treatment modalities are contraindicated.