The clinical management of ectopically erupting first permanent molars

Resident’s Name: Anna Haritos Date: April 2, 2009
Article title: The clinical management of ectopically erupting first permanent molars
Author(s): Kennedy, David B. et al
Journal: Am. J. Orthod.Dentofac. Orthop.
Volume (number): 92 (4)
Month, Year: October 1987
Major topic: ectopically erupting first molars
Minor topic(s): n/a
Type of Article: literature review
Main Purpose(s): to review the literature on ectopically erupting 1st permanent molars; to discuss a variety of treatment approaches along with a diagnostic rationale and clinical guidelines.
Overview of method of research: literature review
Findings:
*clinical signs: canting of the occlusal plane of the 2nd primary molar
* causes: - skeletal involvement (lacking arch length, smaller maxilla, retroposition of maxilla relative to cranial base); - large molar width - steeper angle of molar eruption
* self-correction: - 66% of 1st permanent molar cases (less so in left-lip/palate) - resorption of disto-buccal root of 2nd primary molar
* intervention techniques when entrapment of permanent molar is 1 mm or less: - surgical uncovering of unerupted impacted permanent molar (no documented clinical trials) - placement of separator (brass ligature, elastic separator, spring-type de-impactor) with reciprocal anchorage * intervention techniques when entrapment of permanent molar is 2 mm or more: - active appliance therapy (band on 2nd primary molar with active spring or arm to the distal) aka Humphry appliance
* loss of 2nd primary molar due to extensive resorption: - space regaining: removable appliances, external traction (cervical headgear), contraindicated if missing 2nd premolar - space closure: especially useful when there is significant arch length shortage * disk distal of 2nd primary molar and then monitor for future extraction * extract 2nd primary molar and then place space maintainer until make future decision
Key points/Summary: 3-4% of the population experience ectopically erupting 1st permanent molars; this is occurs at a higher frequency in siblings as well as in children with cleft lip and palate. There is no sex or race variation. Many resorbed 2nd primary molars remain in place until exfoliation. First treatment goal is to distalize ectopically erupting 1st permanent molar. Must consider skeletal pattern, Angle classification and facial profile.
Assessment of article: Make a copy of the chart on page 338 – It’s great