impacted lower second and third molar

Hi dear all

This x-ray has been sent to me from another orthodontist. I don't have any other documentation. I would like to ask for your opinion on if and how would it be possible to upright the second molar. It is completely under the gingiva, partly under the bone too. See attached picture. I guess the third molar would have to be extracted.

Thanks for all your ideas

Renata

Or maybe extract second and keep third?

Hi Reni,
in my opinion 3rd molar extraction is needed if you want to be on the safe side to upright the 2nd. I don't think that extraction of the 2nd molar and keeping the 3rd molar would be an easy surgical process and why doing that?

RemportBogi wrote: Hi Reni,
in my opinion 3rd molar extraction is needed if you want to be on the safe side to upright the 2nd. I don't think that extraction of the 2nd molar and keeping the 3rd molar would be an easy surgical process and why doing that?

I would try to keep both. She is already missing the first molar. The question is: "is there an ankylosis?"

Hi Renata, I would also try to keep 37 and 38 if possible since she is missing 36, not sure if I'm talented enough to do it though :silly Maybe somehow try to first upright 38 to get it out of the way slightly and then bring 37 slowly mesially and uprighting it, possible movements may need to be done alternating between 37 and 38 in order to get out of that situation. ULQ may also need intrusion for some of the uprighting to occur. All the best! Anne

It was my worry, too, Anne: the intention is absolutely right to upright both molars, but practically it is a very difficult task. Giorgio is right, if you don't even try you will not win.
The best would be to move both teeth in a unit, although I don't know if there is a clinical possibility to reach this, so I would separate the movement of these 2 teeth.
I would first pull the 37 forward with a line of action that is extrusion plus mesial movement until I can bond a bracket on the buccal side. Horizontal force component would be more than vertical at the beginning.
The problem is that you can bond something just on the distal cusps in this situation and if you have a more pronounced horizontal force component, you will have a ccw moment on CR that will make the tooth more horizontal- if it is not exactly under 8 and it is not preventing it from tilting more forward.
You will need 2 vector mechanics, too.
Regarding 38, if you manage to bond an attachment to the mesial cusp and you use a horizontal force, hopefully there is not too much ccw rotation on CR of 38. After a while you will be able to apply here 2 vector mechanics, too.