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    Conservative Management of Lower Second Premolar Impaction: Case Report

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    1) This case report describes the conservative management of a horizontally impacted lower second premolar. 2) The deciduous lower second molar was extracted, allowing 16 months for the impacted premolar to erupt into proper position. 3) Even unfavorably inclined premolars located deep can successfully erupt with a conservative approach of removing a deciduous molar and monitoring eruption over time.

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    Conservative Management of Lower Second Premolar Impaction: Case Report

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    yaelvata
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    1) This case report describes the conservative management of a horizontally impacted lower second premolar. 2) The deciduous lower second molar was extracted, allowing 16 months for the impacted premolar to erupt into proper position. 3) Even unfavorably inclined premolars located deep can successfully erupt with a conservative approach of removing a deciduous molar and monitoring eruption over time.

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    1) This case report describes the conservative management of a horizontally impacted lower second premolar. 2) The deciduous lower second molar was extracted, allowing 16 months for the impacted premolar to erupt into proper position. 3) Even unfavorably inclined premolars located deep can successfully erupt with a conservative approach of removing a deciduous molar and monitoring eruption over time.

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    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    33 views3 pages

    Conservative Management of Lower Second Premolar Impaction: Case Report

    Uploaded by

    yaelvata
    1) This case report describes the conservative management of a horizontally impacted lower second premolar. 2) The deciduous lower second molar was extracted, allowing 16 months for the impacted premolar to erupt into proper position. 3) Even unfavorably inclined premolars located deep can successfully erupt with a conservative approach of removing a deciduous molar and monitoring eruption over time.

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    Download as PDF, TXT or read online from Scribd
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    of 3

    CASE REPORT

    Australian Dental Journal 2000;45:(4):279-281

    Conservative management of lower second


    premolar impaction
    Anthony R Collett*

    Abstract In some cases, orthodontic traction and


    Lower second premolars account for approximately repositioning may be indicated. Exposure and
    24 per cent of impactions, excluding third molars, bonding can be technically demanding and extreme
    even though most reports in the literature relating to cases are best not exposed but, instead, managed
    impacted teeth address the maxillary canine, with with a wait and see approach.8 Becker recently
    relatively few reports on the lower second premolar.
    Conservative management involves surgical
    discussed two cases of surgical exposure followed by
    exposure of the crown, however, subsequent bonding of an attachment for traction.8 One of these
    premolar eruption is unpredictable. cases was a failed attempt at bonding and traction,
    A case is described in which removal of a underscoring the difficulty of access for bonding. If
    deciduous second molar was followed by eruption the primary molar and premolar are in close
    of an unfavourably inclined premolar located deep
    within the alveolus. Sufficient time must be allowed association, extraction of the molar may be all that is
    for eruption and in the present case 16 months required to allow for eruption. As long as tilting of
    elapsed before the tooth had erupted to the level of the premolar is slight and it is not too deep in the
    the occlusal plane. alveolus, removal of the deciduous molar will usually
    Key words: Lower premolar impaction, case report. result in premolar eruption.
    (Received for publication December 1998. Revised Jacobs documented six cases of successful
    March 1999. Accepted March 1999.) exposure and eruption.6 In all six cases, the axial root
    inclination favoured eruption. Andreasen illustrated
    successful and unsuccessful cases of exposure of a
    Introduction horizontally inclined premolar.3 A single case of a
    Lower second premolars account for approximately horizontally inclined premolar (long arch aligned
    24 per cent of impactions, excluding third molars,1,2 with arch) erupting without orthodontic intervention,
    with the overall frequency for lower premolar following extraction of the first permanent molar,
    impactions being 0.2-0.3 per cent.3 Aetiological was outlined by Howard.9 The mesial molar root
    factors for premolar impaction appear to include showed signs of resorption, inferring a distal
    arch length deficiency, ectopic position of the tooth migratory path for the premolar, which then
    germ, obstacles to eruption such as an ankylosed presumably took the path of least resistance
    primary molar, the presence of supernumerary teeth through the molar extraction socket. It has been
    or odontomas and genetic factors.3 Most reports in hypothesized that, following exposure, forces act on
    the literature relating to impacted teeth address the the tooth to direct it toward the exposed area; the
    maxillary canine, with relatively few reports on the tooth being carried along with the reparative
    lower second premolar. changes as the bone defect reduces in size.
    Conservative management with exposure of the In some cases where the premolar demonstrates
    crown has been advocated.3-7 The majority of reported significant deviation from its normal inclination,
    cases involved distally impacted premolars in which surgical repositioning of the premolar or
    the long axis was inclined to favour eruption if autotransplantation should be considered.3
    exposed. Surgical exposure is unpredictable and best
    limited to cases with no more than 45° tilting of the Case report
    long axis from its normal position.3 A 13 year old female presented for examination
    with radiographic evidence of a horizontally inclined
    *Specialist private practice in orthodontics. Associate staff member, lower right second premolar, with the unusual
    School of Dental Science, The University of Melbourne. feature of its long axis lying transversely. The
    Australian Dental Journal 2000;45:4. 279
    Fig 1. – The OPG showing the retained 85 and horizontally positioned 45.

    panoramic radiograph is reproduced in Fig 1. Of The patient failed to attend some check visits;
    note was a retained 85 and a horizontally inclined however, 10 months after the extraction the patient
    45. The crown and root apex could be easily palpated was reviewed and the premolar found to be partially
    on the buccal and lingual aspects of the dento- erupted. Sixteen months after the extraction, the 45
    alveolar ridge, respectively. The patient had very had reached the level of the occlusal plane. At this
    good dentofacial aesthetics with an overall Class 1 time, to detail its final position, the 45 was bonded,
    occlusion and well aligned arches (Fig 2). and a sectional archwire placed from 44 to 46.
    A conservative approach was outlined to the
    patient, consisting of extraction of the 85 and space Discussion and conclusion
    maintenance by means of orthodontic bands on the Ideal premolar positioning (Fig 3) was obtained
    44 and 46, with a sectional archwire to prevent with minimal treatment. The case serves to illustrate
    tipping into the edentulous site. In consultation with that even unfavourably inclined premolars located
    the general dentist, the extraction was performed. deep within the alveolus can successfully erupt with
    Surgical exposure through the socket was not a conservative approach such as removal of a
    attempted as there were concerns about uncovering deciduous molar. Patience is required and if
    and damaging the root surface due to the horizontal extraction of the retained deciduous molar is
    transverse orientation. The family was told that, if performed in the mixed dentition stage, and the
    the tooth failed to erupt, surgical exposure with tooth fails to erupt, any later comprehensive fixed
    orthodontic traction would be required and, if this appliance treatment can still be completed by the
    failed to mobilize the tooth, prosthetic management mid-teens. Importantly, earlier treatment with
    would be indicated. Due to the advanced root incomplete root development is more successful
    development (note other premolars on the where surgical repositioning or autotransplantation
    panoramic radiograph), surgical repositioning and are indicated. Comprehensive scientific studies of
    autotransplantation would not be viable treatment treatment modalities for impacted lower premolars
    alternatives. are lacking, presumably due to their low rate of

    2 3
    Fig 2. – Pretreatment right buccal view of occlusion illustrating excellent intercuspation of the teeth.
    Fig. 3. – Post-treatment view of lower arch. Note the well aligned right premolars. There are some mild rotations present in the untreated left
    quadrant.
    280 Australian Dental Journal 2000;45:4.
    occurrence. Although the overall success rates in 5. Cryer BS. The unpredictable lower second premolar? Dent Pract
    1965;15:458-464.
    cases such as that discussed above have not been
    6. Jacobs SG. The surgical exposure of teeth – simplest, safest and
    clearly documented, the deciduous extraction and best? Aust Orthod J 1987;10:5-11.
    monitor option may provide a non-invasive and cost- 7. Ohman I, Ohman A. The eruption tendency and changes of
    effective approach. direction of impacted teeth following surgical exposure. Oral Surg
    Oral Med Oral Pathol 1980;49:383-389.
    References 8. Becker A. The orthodontic treatment of impacted teeth. London:
    Martin Dunitz, 1998.
    1. Thilander B, Myrberg N. The prevalence of malocclusion in
    Swedish school children. Scand J Dent Res 1973;81:12-21. 9. Howard RD. Impacted tooth position: Unexpected improvements.
    Brit J Orthod 1978;5:87-92.
    2. Thilander H,Thilander B, Persson G.Treatment of impacted teeth
    by surgical exposure. A survey study. Sven Tandlak Tidskr
    1973;66:519-525.
    3. Andreasen JO.The impacted premolar. In: Andreasen JO, Petersen
    JK, Laskin DM, eds. Textbook and color atlas of tooth impactions.
    Diagnosis, treatment and prevention. Copenhagen: Munksgaard, Address for correspondence/reprints:
    1997:177-195.
    Dr Anthony R Collett
    4. Azaz B, Steiman Z, Koyoumdjisky-Kaye E, Lewin-Epstein J. The
    sequelae of surgical exposure of unerupted teeth. J Oral Surg 7 Dawson Street
    1980;38:121-127. Upper Ferntree Gully, Victoria 3156

    Australian Dental Journal 2000;45:4. 281

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