An uprighting auxiliary for deeply impacted mandibular molars

Ectopic impaction of mandibular second molars is a rare and challenging dental anomaly, often requiring a multidisciplinary treatment approach.1-5 Solutions involving surgical repositioning alone have caused side effects that may affect long-term tooth vitality.6-11 Therefore, the accepted approach has been to combine orthodontic and surgical procedures, with careful anchorage planning to avoid undesirable vertical tooth movements.12-16 Skeletal anchorage has proven to be a reliable method of maintaining the archform while allow- ing segmental orthodontic treatment in these cases.17-25 Another alternative is to extract the impacted second molar and move the third molar orthodon- tically. Although such a method can simplify the orthodontic mechanics, it requires a more invasive surgical procedure. The success of the treatment plan will depend on proper timing and biomechanics. Three major factors complicate treatment of a deeply impacted molar: tooth’s center of rotation. an impacted tooth. To overcome these difficulties, we have developed an auxiliary system consisting of a sec- tion of mesh,* a 150g nickel titanium closed-coil spring,** and a titanium miniscrew. We call the system the G-Molar-Up.