Modifications of Rect-Spring to Enhance the Engagement of Ectopically Entrapped Molars with 2 Case Reports

Abstract

The Rect-spring appliance, used for the management of ectopically erupting molars, shows weak retention on mesially tilted molars. We present three modifications of the appliance for better engagement and their advantages. We describe cases of two 7-year-old patients with ectopically erupting maxillary first molars with a 2.2 mm and 2.5 mm depth of entrapment, respectively. The modified Rect-spring (mRS) was inserted between the ectopically erupting first molar and adjacent primary second molar, and exerted a distalization force with an interproximal wedging effect at the same time. After 3 months, the ectopically erupting first molars were successfully brought into proper occlusion. No discomfort was reported. The mRS is suitable for various locking cases except for severely tilted molars without requiring any laboratory procedures. We suggest it as the first choice for unlocking the first molars.

Ectopic Permanent Molars: A Review

“…Early intervention can help in preventing further complications that could affect the establishment of a balanced occlusion [ 29 ]. Therefore, delaying the treatment to a later stage is not advisable.…”

“…The treatment of ectopic molars and the time of intervention depend on several factors [ 30 ]. Although previous studies have agreed that by the age of seven 66% of ectopic molars are self-corrected, others have stated that spontaneous eruption will not happen if the first permanent molar is not fully erupted at that age [ 4 , 29 ]. Therefore, the initiation of the treatment should be started immediately after the diagnosis is established.…”

“…Also, it can cause an anterior open bite due to unfavorable distal protrusion. Careful planning is crucial before deciding the correct treatment modality for any ectopic molar case [ 29 , 41 ]. A summary of different treatment modalities and a treatment decision flowchart are included ( Table 2 , Figure 10 ).…”