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CASE REPORT

Molar Uprighting simplified
Prashanth C.S I, Dharma R.M II, Akshai Shetty K.R III Case Report
The patient is a 15 year old male who presented with the chief complaint of crowding of upper front teeth. Extraoral examination revealed convex profile , acute nasolabial angle, recessive chin and a steep mandibular plane angle. Intraorally patient presented with class II molar relation on the right, and an end-on on left side with an overjet of 5mm. There was posterior crossbite in relation to 15, 16 & 45; 46& 35,36 and an anterior crossbite with respect to 12 &42;22&32.

ABSTRACT
Impaction of the lower second molar is a common problem, and a very challenging one for the orthodontist . Here is a case report of uprighting of a mesioangular impacted mandibular right permanent second molar. Though various treatment options were available, uprighting with traction from RME in the opposite arch was chosen. This method assumes significance, because cases which require RME usually present with a need for uprighting of lower molars, where this technique can be employed simultaneously to upright the impacted or tilted lower molar and decrease the treatment time considerably. Since anchorage is derived from the RME appliance,the usual untoward reciprocal effects on the adjacent teeth associated with cases of molar uprighting are avoided.
Key Words: Rapid maxillary expansion, Uprighting, impacted molar

Cephalometrically, patient was found to have skeletal class II jaw bases with vertical growth pattern, proclined upper and normally inclined lower incisors and an acute nasolabial angle with an upper lip strain of 2 mm. OPG revealed impacted mandibular second molar below the CEJ of mandibular first molar.

Introduction
Impacted or lingually tilted molars require uprighting . There are several approaches by which molar uprighting can be accomplished, like Australian uprighting spring, cantilever spring, push spring appliance, NiTi coil spring, Mini implant, forced eruption by elastics ,traction from removable appliances, surgical uprighting etc1-7,10. Rapid maxillary expansion (RME) is usually carried out for one month and kept in place for retention for 3 months.11-12The ideal procedure employed should allow the establishment of normal functional occlusal relationship without causing periapical or periodontal pathology13. The present article is an attempt to focus on a very simple yet efficient and effective way of disimpacting or uprighting a lower molar which can be easily employed in conjunction with routine orthodontic treatment procedures. The treatment plan chosen constituted of 2 phase therapy, Phase 1 constituted of bonded type of rapid maxillary expansion(RME) and lower molar uprighting while Phase 2 constituted of fixed mechanotherapy with MBT prescription. A bonded RME was used to correct posterior crossbite. To simultaneously upright impacted mandibular second molar , a hook fabricated from round stainless steel wire was incorporated on to the posterior aspect of upper right side of the RME appliance(Fig 1). Surgical exposure of mandibular second molar was done and two attachments were placed on the buccal aspect of mandibular second molar, which was the only accessible surface of the tooth.(fig 2)8,9,15-16 RME and uprighting of molar using blue vertical elastics were carried out simultaneously. RME was carried out for one month and kept in place for retention for 3 months.11-12

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IJCD • NOVEMBER, 2010 • 1(2)
© 2010 Int. Journal of Contemporary Dentistry

2010 • 1(2) 44 patient’s ability to control plaque accumulation in that © 2010 Int. During the same period the vertical elastics for disimpacting mandibular second molar caused lingual rolling. Fig 3: Vertical traction from hook in RME to the orthodontic attachment Discussion This case report describes a new method of uprighting molars which is simple.P.s reveal the uprighting of lower second molar. The specific benefits to be gained depend on the directions in which the molar moves. 7) Phase 2 was carried out with all first premolar extraction using an . both in the vertical and mesio-distal planes of space18-19.022 MBT prescription.G. so new attachments were bonded on occlusal surface of mandibular second molar and blue elastics were given in order to correct the angulation of the teeth being disimpacted which was continued for 2 more months(Fig 5)15-16. (Fig. Fig 4: Vertical traction from hook in RME to the orthodontic attachment with increased force . At this point RME was removed and posterior fixed bite plane was given to retain the expansion achieved . Uprighting tipped molars can benefit patients functionally. Later one more attachment was bonded on the buccal surface and red elastics were given from same attachment for a duration of 2 months(Fig 4). Later. efficient and less time consuming. The periodontal advantages of uprighting a mesially Fig 5: Changed vector of vertical force by applying elastic tipped molar include elimination of the pseudopocket force to the new attachment on occlusal surface that often forms on the mesial aspect of these teeth eliminating this pseudopocket may improve the IJCD • NOVEMBER.CASE REPORT Fig 1: Bonded RME appliance with hook Fig 2: Surgical exposure of mandibular second molar with bonded orthodontic attachment Initially blue elastics were given from attachments on buccal surface of mandibular second molar to hook in the right side of RME(Fig 3). red elastics were given for a duration of another 2 months from the hook incorporated in the posterior aspect of the fixed posterior bite plane(Fig 6). periodontally and for prosthodontic rehabilitation of mutilated cases.The comparison of pretreatment and posttreatment O. Molar uprighting usually presents difficulty in managing the unwanted reactionary force vectors associated. which if not taken care can produce deleterious effects on areas of dentition employed for anchorage17. Journal of Contemporary Dentistry 18-19 area .

D. Assoc.. H. and Lauweryns. 100:863-866.. and Burstone. 1997.. J. I. 1999.J.55:114–118. F. J.A. 3) Since the force vector is vertical.. 1459-1462 10. J. Fig 7: Pre and post OPG revealed achieved uprighting of mandibular second molar 3. AJODO Mar 321 . Roberts. and Kaiser. 130:381-385. References 1. O.. J.Skeletal and dental changes after maxillary expansion in the mixed dentition .: A simple technique for molar uprighting. 1980. E. 7. Tuncay.. Vol. 81:177-184.C. Varpio M.. ASDC J Dent Child. Wellfelt B. Mc aboy CP et al:Surgical Uprighting and repositioning of severely impacted mandibular 2nd Molar JADA.C.CASE REPORT Fig 6: Final uprighting using traction from bonded posterior bite plane eliminating this pseudopocket may improve the patient’s ability to control plaque accumulation in that area18-19. Weiland. 1992.P. Am. H.. 1980. K. 1982. Müge Sandikçioglu .. Simple method of uprighting like the one described in this article are quite effective and also take up less of treatment time as it can be used along with regular treatment mechanics. Lemmerman..H. and Berkowitz. 26:335-337. R. Dent.: Periodontal conditions in patients after molar uprighting. Dail. Disturbed eruption of the lower second molar: clinical appearance. Clin. J. Orthod. prevalence and etiology. and Peden.J. Lubow. Clin.: Uprighting molars without extrusion. F. Digiancinto. Orthod. M. 134. 43:156-162.Anthony Pogrel: Surgical Uprighting of Mandibular Second Molar AJODO 1995 Aug 180-183 9. 45 IJCD • NOVEMBER. Assoc. Capelluto. L.. Dent. 4. Cutcliffe. 2010 • 1(2) © 2010 Int.M.. Since the anchorage is derived from the bonded RME appliance. employing the best of the various treatment options available for molar uprighting can give desired treatments results. J. Journal of Contemporary Dentistry . and Droschl. 6. 31:119-125.327: 1997 Conclusion After considering the biomechanical aspects as demanded by the clinical situation.M. 2. and Oesterle.: A segmental approach to mandibular molar uprighting. Bantleon. 1982. R. J. 8.J. Biggerstaff. C.W. J. Am. 11. Dent.: Molar uprighting with T-loop springs.B. Prosth. 5. R. 47:373376. it can be considered more physiologic as it is in the direction of normal eruptive path. 1988.H. 2)Since anchorage is derived from RME no additional anchorage preparation required and reciprocal effects seen in other molar uprighting techniques are not seen. Chacker. J.. W.L. Shellhart. Orthod. The present simple technique has a few advantages over other molar uprighting/disimpaction techniques 1)Time saved as this method is employed in conjunction with regular orthodontic treatment mechanics. W.J.: Molar uprighting with crossed tipback springs. any further need for any anchorage preparation is eliminated. Prosth. Am. November 2003. J.: Periodontal and restorative aspects of molar uprighting. Kraal.W. J. Dent.C. R. J. Cooley.

Br J Orthod 1977. W. Treatment option for impacted teeth J Am Dent Assoc 2000. 14.M MDS.C. Monika Sawicka et al Uprighting Partially Impacted Permanent Second Molars. 2007 Email: toprashanthcs@gmail.. Dent. R.com 19.S.: Periodontal conditions in patients after molar uprighting. A Simple Method of Molar Uprighting with Micro-Implant Anchorage .302 I ) Prashanth C. Robin A. and Peden. 13. 43:156-162.CASE REPORT 12.R MDS M Orth R. Volume 1988 Oct 296 . Bangalore. Digiancinto. J. DAPM R V Dental College.E. 1980. Professor Department Of Orthodontics and Dentofacial Orthopedics. Vol 77.Surgical exposure and orthodontic traction of unerrupted teeth: A preliminary study. Prosth. DAPM R V Dental College. J. International Journal of Contemporary Dentistry http://edentj. Number 1.A. Hassan A. Professor Department Of Orthodontics and Dentofacial Orthopedics. JCO Oct 2002 : 592-96 Professor Department Of Orthodontics and Dentofacial Orthopedics. The Saudi Dental Journal. Mar 1999..About the Authors: DO. Craig Shellhart et al : Uprighting Molar Without Extrusion. III) Akshai Shetty K. Sandstrom et al. 17. J.S MDS. international general dental journal supporting academic freedom and open access.H. Bangalore.W. DAPM R V Dental College. Hunt NP. Journal of Contemporary Dentistry 46 . II ) Dharma R.com/ijcd is an independent. El-Abdin et al. Lemmerman. Frank C. Dail..4:211-12.J. 18.. January 1995 16. J. Correspondence Address: No 1.d. 2010 • 1(2) © 2010 Int. HYO-SANG PARK et al. Bangalore.Kraal. 18. JADA Vol 130. 131: 623-32 15. Angle Orthodontist. K. Direct traction applied to the unerupted teeth using acid-etch technique. Volume 7.Expansion of the lower arch concurrent with rapid maxillary expansion. IJCD • NOVEMBER. AJO.