Mini-implant-based Molar Uprighting and Forced Third Molar Extrusion Techniques

We are often confronted with routine impactions of third molars, canines, incisors and often bicuspids. Most often in molar cases particularly third molars the cases are treated with the extraction of the impacted tooth. However invariably cases arise where there are multiple molars involved and impactions affect more than one tooth at the given site. Impactions of second molars have been reported to have a .03 % incidence of occurrence. Often the arch space does not allow for retention and functional hygienic eruption of all molar teeth. The choice is then often made as to which tooth is to be retained and uprighted and which will be extracted. The growth of the tooth often starts with a preexisting angulation and self corrects as it erupts and follows the distal root inclination of the first molar. In cases where a third molar bud either forms anterior or cephalad to the second molar bud and develops out of sequence entrapment is very likely. Varied levels of impaction develop depending on space and timing. There are also some instances of third molar and second molar impactions where the teeth are deeply impacted in the mandible with increased risk of surgically induced fractures and paresthesias. Over the past six years the application of limited mini-implant(TAD) based orthodontics has become a predictable avenue for successful management of these complex cases. Implants allow for anchorage where forces of up to 1gram can be developed to move dentition without relaying on reactive dental anchorage. Our presentation will outline the techniques and show numerous cases of correction as well as discuss the limitations of the implant anchorage based techniques.