|Year : 2012 | Volume
| Issue : 3 | Page : 115-117
Innovative chairside technique for the correction of ectopically erupting permanent first molar
Seema Thakur1, Narbir S Thakur2, Swati Gupta3
1 Department of Pediatric and Preventive Dentistry, H.P. Government Dental College, Shimla, Himachal Pradesh, India
2 Department of Oral Pathology, H.P. Government Dental College, Shimla, Himachal Pradesh, India
3 Department of Prosthodontics, BBD College of Dental Sciences, Lucknow, Uttar Pradesh, India
|Date of Web Publication||27-Nov-2012|
Department of Paediatric and Preventive Dentistry, Government Dental College, Shimla, Himachal Pradesh
Source of Support: None, Conflict of Interest: None
Introduction : Maxillary permanent first molars are frequently found ectopic teeth in mixed dentition. If left untreated, it may cause serious sequel including early loss of the primary second molar, space loss, and impaction of second premolars. Clinical Innovation: This article describes a new successful innovative method for the correction of ectopically erupting maxillary first permanent molar in an 8-year-old boy. Discussion: Early correction of ectopically erupting permanent molars is an integral part of interceptive orthodontics. Several treatment methods have been suggested. Among these, the interproximal wedging techniques are the simplest but are not always appropriate or feasible. The other treatment modalities may be either complicated, expensive, or require impression taking, appliance delivery, and activation appointments. The following case illustrates a new chairside technique that eliminates the need of impression taking, appliance delivery, and activation appointments and is very simple.
Keywords: Distal tipping, ectopic eruption, impaction
|How to cite this article:|
Thakur S, Thakur NS, Gupta S. Innovative chairside technique for the correction of ectopically erupting permanent first molar. Dent Hypotheses 2012;3:115-7
| Introduction|| |
Ectopic eruption of the permanent maxillary first molars is a local disturbance characterized by eruption of these teeth under the distal undercut of the primary second molars and failure of the permanent first molars to erupt to the normal occlusal plane.  Early correction of ectopically erupting permanent molars is an integral part of interceptive orthodontics and is crucial for the proper development of a stable occlusion.
The aim of the treatment is to allow the permanent maxillary first molar to assume its correct position in the arch and to keep the primary molar in place until its normal exfoliation. Several methods of treating ectopically erupting first permanent molars have been suggested. Treatment modalities may be divided into two categories: interproximal wedging and distal tipping.  The following case illustrates a new simple distal tipping technique for the correction of ectopic eruption of the molar that eliminates the need for any laboratory work and the need for the activation and adjustment of the appliance.
| Clinical Innovation|| |
An 8-year-old boy attended the Department of Pediatric and Preventive Dentistry, HP Government Dental College, Shimla, India, for routine restorative treatment. On intraoral examination, the permanent maxillary left first molar was found to be impacted with only disto-occlusal surface visible, whereas the contralateral permanent first molar was fully erupted [Figure 1]. The intraoral periapical X-ray showed the permanent maxillary left first molar impaction and disto-buccal root resorption of the primary maxillary left second molar [Figure 2]. A diagnosis of the ectopic eruption of the permanent maxillary left first molar was made, based on the signs of localized delayed eruption, visual evidence of impaction, and radiographic confirmation of impaction. Because of the patient's dental age and premature root resorption of the primary maxillary left second molar, it was recommended that the treatment be initiated as soon as possible.
|Figure 2: Intraoral periapical X ray showing ectopically erupting 26 with premature root resorption of 65|
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A light cure composite dimple with a tunnel-like opening on the mesial side was bonded on the buccal surface of the permanent maxillary left first molar. A 0.016  Nickel Titanium (Prime Orthodontics, Inc.; Portland, USA) archwire segment was then bonded on the buccal side of the primary maxillary left second molar and extended beyond the dimple. With the help of bird beak plier, the free end of the wire was directed into the tunnel made in the dimple of the impacted first permanent molar. This created a loop that activated the archwire into a spring. A small amount of bonding material was placed in the opening of the tunnel to make the attachment more permanent [Figure 3]. The bonded NiTi archwire segment distalized and upright the impacted permanent molar. After 6 weeks the ectopic permanent molar was deimpacted and was erupted enough. The bonded wire was removed and the tooth was allowed to erupt. In another 10 weeks, the permanent first molar had erupted enough with the mesial marginal ridge almost at the height of the contour of the primary second molar [Figure 4].
Although the primary molar exhibited no mobility throughout the treatment, the root resorption that had occurred earlier will continue to be monitored. The patient's caretaker was instructed to let us know if the patient had any further symptoms or if the primary second molar was lost prematurely. One-year follow-up showed the patient symptom-free and the primary second molar continuing to function well [Figure 5].
| Discussion|| |
Ectopic eruption of the permanent maxillary first molars may be classified into two types: reversible (or "jump") and irreversible (or "hold").  It shows a variable prevalence that ranges between 1.8% and 6% depending on the population studied and more than four times in children with clefts. 
If left untreated, it may cause serious sequel including early loss of the primary second molar, space loss, and impaction of second premolars.  Bjerklin and Kurol found that the vast majority of the "jump" cases self-corrected by age of 7 years.  Therefore, treatment timing is critical for such cases. If the contralateral and opposing permanent molars and the mandibular incisors have not erupted and the patient appears to have a delayed eruption pattern, a period of observation is reasonable until the child reaches the appropriate dental age. 
Based on the signs of localized delayed eruption, visual evidence of impaction, and radiographic confirmation of impaction, a diagnosis of the ectopic eruption of the permanent maxillary left first molar was made. Because of the patient's dental age and premature root resorption of the left primary maxillary left second molar, it was recommended that the treatment be initiated as soon as possible.
The majority of methods devised to correct ectopic eruption, where the distal tipping technique has to be utilized, require band adaptation, laboratory procedures, multiple visits for appliance delivery, or activation of the appliance. There is no reported technique that omits all these steps. In this case, a simple chair side technique that utilizes orthodontic distal tipping was used. The nickel titanium archwire segment bonded as a loop is activated into a spring distalizing and uprighting the maxillary first permanent molar. After 6 weeks, the ectopic permanent molar was deimpacted and erupted enough. The bonded wire was removed and the tooth was allowed to erupt.
The advantages of this technique are:
One of the limitations of this appliance is that the part of ectopically erupting tooth should be visible so that bonding of the wire could be done and the adjacent primary second molar should not be grossly carious. Future studies are required to assess the performance of this appliance in cases of ectopically erupting mandibular permanent molars.
- The appliance is made in one visit.
- No impression or laboratory procedure is required.
- No bands need to be fit.
- No adjustments or activation is required.
- The appliance is self-cleansing.
- Minimal patient cooperation is required.
- Fabrication of the appliance is quite simple.
- There is minimal soft tissue trauma.
| Conclusion|| |
Early correction of ectopic eruption of the permanent maxillary first molar is crucial for the development of stable occlusion. This report presents a quite simple chair-side technique for the management of such cases.
| References|| |
|1.||Chintakanon K, Boonpinon P. Ectopic eruption of the first permanent molars: Prevalence and etiologic factors. Angle Orthod 1998;8:153-60. |
|2.||Needley MP, Krusky JB. Chairside Technique for the eruption of ectopic maxillary molars. J Clin Orthod 1998;33:637- 41. |
|3.||Young DH. Ectopic eruption of the first permanent molar. J Dent Child 1967;24:153-62. |
|4.||Kupietzky A. Correction of ectopic eruption of permanent molar utilizing the brass technique. Pediatr Dent 2000;22:408-12. |
|5.||Kurol J, Bjerklin K. Resorption of maxillary primary second molars caused by ectopic eruption of the maxillary first molar: A longitudinal and histological study. J Dent Child 1982;49:273-9. |
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]