Please activate JavaScript!
Please install Adobe Flash Player, click here for download
ePaper created 2018-03-23, 14:32:14 | version 1.38.0
33Dental Tribune Middle East & Africa Edition | July - August 2014 ortho tribune Manal Al Halabi, BDS MS Diplomate, American Board of Pediatric Dentistry Postgraduate Pediatric Program Director Direct +971 4 424 8602 Dubai College of Dental Medicine Dubai Healthcare City - Bldg 34 Dubai, UAE www.dcdm.ac.ae Contact Information Management Of Ectopically Erupted First Permanent Molars ByDrManalAlHalabi,BDSMS; PostgraduatePediatricProgram Director at Dubai College of DentalMedicine E ctopic eruption of the first permanent molar occurs due to the abnormal me- sioangular eruption path of the molar resulting in an impaction at the distal prominence of the primary second molar’s crown. It can be suspected if asymmet- ric eruption is observed or if the mesial marginal ridge is noted to be under the distal promi- nence of the second primary molar. Ectopic eruption can be diagnosed from bitewings or panoramic radiographs, Fig 1, 2. The prevalence of this condition is reported to be up to 0.75%1. The ectopic eruption is more common in cleft lip and palate patients1 . Ectopic eruption of permanent molars is classified into two types. There are those that self- corrector“jump”andothersthat remain impacted. In 66 percent of the cases, the molar jumps2 . In most of these self-corrected cases, the condition goes un- noticed and is discovered later by evidence of resorption of the distal root of the second primary molar in routine radiographs. A permanent molar that presents with part of its occlusal surface clinically visible and part under the distal of the primary second molar normally does not jump and is the impacted type3 . Non- treatment can result in early loss of the primary second mo- lar and space loss, molar impac- tion, undetected caries and ab- scess formation1 . Aetiology The aetiology of this condition is multifactorial, some of these factors might be: - Alteration in the chronology of bone growth at the tuberosity region - Small or posteriorly positioned maxilla. - Larger second primary molars and first permanent molars. - Unfavorable second primary molar crown morphology - Abnormal eruption angle “me- sial” of the first permanent mo- lar - Heredity - Cleft lip and Palate Treatment considerations Treatment depends on how se- vere the impaction appears clin- ically and radiographically. For mildly impacted first permanent molars, where little of the tooth is impacted under the primary second molar, elastic or metal orthodontic separators can be placed to wedge the permanent first molar distally4 , Figure 3. For more severe impactions, distal tipping of the permanent molar is required. Tipping ac- tion can be accomplished with brass wires, removable appli- ances using springs, fixed ap- pliances such as sectional wires with open coil springs, Figure 4, sling shot-type appliance3 , Fig- ure 5, a Halterman appliance5 , Figure 6, or surgical uprighting6 . After the distal tipping of the permanent molar, attention should be given to the condition of the second primary molar. Distal root resorption might lead to early loss of the tooth. Close monitoring of the situation is necessary and the provision for space maintenance by means of an upper bilateral Nance appli- ance should be considered if the second primary molar is lost. In instances where the distal tipping of the first permanent molar is not possible due to lack of patient’s cooperation or other limitations, the distal prominence of the second pri- mary molar can be reduced to alleviate the problem. Some loss of space will occur in this situation. Full coverage by a stainless steel crown might be needed if the primary second molar is compromised. References 1. Chintakanon K, Boonpinon P. Ectopic eruption of the first per- manent molars: Prevalence and etiology factors. Angle Orthod 1998;68(2):153-60. 2. Young DH. Ectopic eruption of the first permanent molar. ASDC J Dent Child 1957;24:153- 62. 3. Gehm S, Crespi PV. Manage- ment of ectopic eruption ofper- manent molars. Compend Cont Educ Dent 1997;18(6):561-9. 4. Warren JJ, Bishara SE, Stein- bock KL, Yonezu T, Nowak AJ. Effects of oral habits’ duration on dental characteris-tics in the primary dentition. J Am Dent Assoc 2001;132(12):1685-93. 5. Halterman CW. A simple technique for the treatment of ectopically erupting first perma- nent molars. J Am Dent Assoc 1982;105(6):1031-3. 6.Terry BC, Hegtvedt AK. Self- stabilizing approach to surgical uplifting of the mandibular sec- ond molar. Oral Surg Oral Med Oral Pathol 1993;75(6):674-6. Figure 1: A panoramic radio- graph showing ectopically erupted upper right and lower right first permanent molars. Figure 4: An ectopically erupt- ed first primary molar correct- ed by an open coil spring fixed orthodontic appliance. Figure 6a Figure 6b Figure 6cFigure 5: Bilateral ectopic eruption of the upper first per- manent molars treated by a sling shot type appliance. Figure 6: a) showing a Hal- terman appliance in place b) showing the tooth movement after one month of treatment and c) showing the up righting of the molar after 2 months of treatment. Figure 2: A periapical radio- graph showing ectopically erupted upper right first per- manent molar. Figure 3: A plastic orthodontic separator is placed to attempt to correct a mild ectopic erup- tion in the upper right first permanent molar.