Uprighting Impacted Mandibular Second Molar Using a Skeletal Anchorage: A Case Report

Abstract

The aim of this case report is to present an innovative combined orthodontic-surgical technique to disimpact mandibular second molar (MM2) using an orthodontic miniscrew and an elastic chain. The impact on the Oral health-related quality of life (OHRQoL) was also evaluated. Using the present techinique, it is possible to expose the impacted tooth, insert a self-drilling miniscrew in the retromolar area, and remove the bud of third mandibular molar. At the same time the orthodontic force is applied with the use of an elastomeric chain that connects the head of miniscrew and vestibular and oral buttons bonded on MM2. A close traction is performed for the whole treatment time without the reactivation of the elastic force. The use of skeletal anchorage allowed the disimpaction of impacted MM2 in a short treatment time (about three months) avoiding the typical biomechanical side effects of traditional orthodontic appliance and increasing the effectiveness of the treatment. Further studies are necessary to evaluate the real advantages and disadvantages of this combined orthodontic-surgical approach.

Surgical Management of Impacted Lower Second Molars: A Comprehensive Review

“…15 Of the two types, the direct anchorage was mentioned to be more favorable for immediate orthodontic loading. 46 An example of direct anchorage is from a 2020 case study by Altieri et al, 16 who used a miniscrew anchorage drilling in the retromolar area along with orthodontic assistance to upright bilateral ILM2. Similarly, Giancotti et al 47 in 2004 placed a 7-mm-long miniscrew in the retromolar triangle to upright a left ILM2 in the same day, with 50 g of force applied by the elastics.…”

“…5,20 In particular, ibuprofen can be given preoperatively or postoperatively for pain management. 16,93 Dexamethasone is a corticosteroid used to prevent postoperative pain, trismus, and edema after impacted third molar surgeries, 66,71 and its effect can be advantageous after ILM2 surgical procedures, specifically with surgical uprighting by luxation, miniplates, sectioning, and autotransplantations. The outcomes can be beneficial, since postoperative complications are anticipated.…”

“…[13][14][15] Several authors agree that surgery is an effective strategy in accessing, uprighting, and positioning impacted second molars. 5,16,17 These methods are deemed necessary since the result of manipulating impacted second molars, in general, can be unpredictable, and depends on timely detection and treatment. 7 The literature on ILM2 can be divided into two entities: surgical and nonsurgical.…”

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“…15 Of the two types, the direct anchorage was mentioned to be more favorable for immediate orthodontic loading. 46 An example of direct anchorage is from a 2020 case study by Altieri et al, 16 who used a miniscrew anchorage drilling in the retromolar area along with orthodontic assistance to upright bilateral ILM2. Similarly, Giancotti et al 47 in 2004 placed a 7mm-long miniscrew in the retromolar triangle to upright a left ILM2 in the same day, with 50 g of force applied by the elastics.…”