Uprighting tilted upper and lower second molars

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Posted on By Miguel Hirschhaut In Orthodontics

A 15 year old male comes in with impacted upper and lower second molars. Patient has third molars producing a wedge effect in both arches. Treatment consisted of third molar removal and second molar uncovering in all quadrants. Bonding attachments to second molars for bringing them into the arch. Venezuelan team: Orthodontist: Miguel Hirschhaut, Periodontist: Ricardo Almon, Oral Surgeon: Julian Barriuso




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12 Comments

Thank you for sharing and inspiration, great management and result!
Best regards
Snjezana


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Miguel. Big League Orthodontics for sure! You da man. All the best. Chuck


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Thanks Chuck. Just a hard worker. You are a good friend. Miguel


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Glad to add to your colleague's prevously posted case Snjezana. Looking forward to the resolution of your case. Kind regards, Miguel


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Miguel,

Great work- How long has case been in progress?

I see this quite a bit in my practice but I ask my orthodontists to send kid over around 13 so I can get third third molar off the back of the 12 yr molar and when the root development is about 50% which is same process for canines and bicuspids


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Hi Richard. We are curently about 13 months in tx. It should take about the same of any ortho case around 20 months. Regards, Miguel


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Glad to hear that.But can you tell me how much time takes in this treatment?
Though I see this a considerable amount in my training period.


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The same of any ortho case. Roughly 20 months


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The presence of tipped and/or ectopically positioned permanent molars is a common dental problem, and while affected dentition may not be initially detectable, it will present during routine radiographic examinations. An ectopic eruption of a permanent first molar often results in either an unerupted or partially erupted tooth. In these cases, the permanent first molar tips mesially, and is thus unable to erupt due to physical entrapment by the distal contour of the deciduous second molar.
An ill-fitting stainless steel crown on a second deciduous molar can also prevent the permanent first molar from erupting by creating a “ledge” that entraps it. Figure 1A through Figure 1C illustrate an ectopically erupting tooth #3 molar that is caught under the ledge created by the stainless steel crown on #A, and its subsequent uprighting with an elastomeric separator and placement of a maxillary space maintenance device.

The ectopic position or tipping of an unerupted or partially erupted second permanent molar, and the subsequent inability of that tooth to erupt into the dental arch, is also frequently seen in clinical practice. This is caused by tooth bud malposition of a second molar or crowding from the presence of a third molar in close proximity to the second molar. Regardless of the etiology, a number of negative outcomes may result, including:

Failure of eruption or partial eruption of the permanent second molar
Gingival inflammation around the partially erupted molar or pericornitis involving the unerupted second molar
An osseous defect (most likely anatomical in nature) on the mesial root of the unerupted second molar
Resorption of a root surface by the crown of an unerupted second molar
High incidence of caries both to the distal surface of the first molar and the mesial surface of the partially erupted second molar
Difficulty in restoring caries lesions
Hypereruption of an opposing tooth.
For more information, visit at http://etoms.com.


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Excellent result! Have you considered "2nd molar replacement" as an alternative tx option? By removing 2nd molars, upper 3rd molars will drop into position most of the time, lower 3rd molars can also be managed in an easier way.


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Yes Ming, we have done it very rarely in the upper arch only. However so many conditions need to be present to do it. Here is one of the few ones I have ever done. Need perfect root form and angulation of the third molars to consider it and has to be a teenager. I would not attemp it on an adult with 3rd molars positioned in the arch. Since there is a posibility of space remaining after all has been moved. In this case patient had a Class II and we use the space to distalize the upper 1st molar. Good question. Regards, Miguel


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