Other Impactions

The only other impactions to be considered in a general form are first molars. These may impact in soft tissue and it is sometimes worth considering occlusal exposure where a first molar has not erupted. This usually occurs in the upper arch and can be accepted if the oral hygiene is good with minimal caries experience. Impacted molars of this type quite frequently self correct before or during eruption of the second premolar. There may also be primary failure of eruption and if the tooth fails to move with orthodontic traction this is usually a good indication that the tooth will not move. First molars may also impact into second deciduous molars as they erupt and the options then are to try and move the molar distally with a headgear or removable appliance, to consider using separators (brass wire) to relieve

Fig. 26 Dental pantomogram of a patient with all four second deciduous molars submerging. Those which are below the contact point (upper right second deciduous molar) should probably be removed in order to aid eruption. The others should be observed

the impaction or ultimately to remove the second deciduous molar if any of these methods fail to relieve the impaction.

It is clear that the biggest single contribution that can be made to the treatment of impacted teeth is to improve diagnostic skills and define care pathways with clinical protocols. Early referral does not harm, a late referral will increase the burden of care for patients and practitioners.

1. Ericson S, Kurol J. Early treatment of palatally erupting maxillary canines by extraction of the primary canine. Eur J Orthod 1988; 10: 283-295.

2. Power S, Short M B E. An investigation into the response of palatally displaced canines to the removal of deciduous canines and an assessment of factors contributing to favourable eruption. Br J Orthod 1993; 20:215-223.

3. National Clinical Guidelines. Faculty of Dental Surgery, Royal College of Surgeons of England, 1997.

IN BRIEF

• The osteoblast is the pivotal cell in bone remodelling and the link between the osteoblast and osteoclast recruitment and activation is now established

• Excessive orthodontic forces cause inefficient tooth movement and adverse tissue reactions

• The mechanisms which prevent root resorption are not fully understood but it remains a consequence of any orthodontic treatment. The extent and degree of root resorption cannot be predicted but some indicators are available

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