Impaction of second lower left molar

51 Rating(s).


Posted on By Matko Oguic In Orthodontics

This is a case of 13 years old patient who came in our clinic for orthodontic therapy with the presentation of impacted left lower molar.
What would you suggest to be the best approach for this patient?

Thank you in advance!

DDM Mikuličić Ana

OPG

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13 Comments

Surgical exposure of 2nd molar with placement of a TAD (transitional anchor device) in the premolar area to assist with anchorage for root torque. regards Dr. Salama


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My plan as I told Dr. Pohl that consulted me the case. You can either surgically reposition the lower left second molar (probably the simplest way). But has the risk of ankylosis. We have done at least five lower severly inclined second molars in this way with our OMFS. Second option would be to try to upright it with a TAD as anchorage. The best place for the TAD between lower 4 and 5 and use a TMA sectional spring or a Zachrison Bar. Other option would be a TAD in the retromolar area with pulling mechanics. More difficult TAD placement. As it might need a punch plus drilling prior to TAD placement. We have done it in the three ways mentioned by me. Probably would go to a Zachrison Bar against a TAD placed between the lower 4 and 5


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Zachrison Bar


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Dear Dr. Salama and Dr. Hirschhaut,
thank you for your very generous advices! I'll talk to the patient about all the possibilities and will let you know the final treatment plan, hopefully posted also here as a documented case.
Best regards,
DDM Ana Mikulicic


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Great discussion...that is what XP is all about. Miguel, great options. Thanks Maurice


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Matko,

Great advice By Maurice and Miguel - Miguel I like the bar -I assume you design this prior to surgery? when do you activate ? and estimated length of treatment? stainless steel ? mechanics?

Matko, tell me your thoughts of the mandibular 2nd molar as it delayed in development-
Lastly in my hands I would treat the maxillary 2nd molars also with a luxation procedure at first

Cheers,

Richard


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Dear Dr.Martin,

in my opinion TAD in the premolar area seems as a probably best option. When I first saw the x-ray and had been asked about thoughts on surgical repositioning, the first thing that came across my mind was how to "extract" the tooth without damaging the crown since the angle is almost 90 degrees...
Hopefully we'll see a fully documented case here and learn something new.

Best regards,
Matko


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Part is Niti and part is stainless steel Richard. Glad to add to everybody and to learn from everybody Maurice. Take care my friends. Miguel


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Dear Miguel and Dr. Salama,

very good, thank you so much.
TAD in the premolar area seems to me the best option.
Miguel, thank you for detailed description.
Surgically reposition has a risk of ankylosis. Additionally, the vertical ridge dimension is limited, it could be a problem.
Great advices, great discussion. Ana, please document the case and progress, so we can all learn from it.
Best regards
Snjezana


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Dear dr. Pohl, dr. Hirschhaut, dr. Salama and dr. Richard

Thank you so much for the great discussion and advices.
I'll let you know about the progress.
Best regards,
Ana


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I love the TAD idea, but I have yet to see successful use of TAD in a case of this magnitude and difficulty. Good luck! Best regards. Chuck


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One way to kickstart the uprighting is to place a rectangular Ni-Ti wire under the contact point and bond it to the occlusal of the molar mesial to the inclined tooth. You can do that during surgical exposition.
As the wire wants to upright it will rotate and elevate the tooth. You`ll have to control the vertical movement by the system demonstrated by Dr Hirschault.
Of course for TMJ stability, you should place a composite pad on the contra-lateral molar.
A 14 by 25 Ni-Ti wire was placed on this case, and the molar was enagaged after 2 to 3 months.


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Laurent,

very thoughtful

Cheers,

Richard


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