Uprighting Second Molars

Surgical Uprighting of an Impacted Adult Second Molar

Occasionally, as children grow and the adult teeth gradually come into the mouth, the lower (and sometimes the upper) adult second molars do not properly erupt into the arch and become stuck, often times under the distal (back) half of the adult first molars. Many times, the adult third molar, or wisdom tooth, can also contribute to this problem as well.

It is important to realize that an Oral and Maxillofacial Surgeon can treat this condition, in conjunction with an Orthodontist. The normal age during which the adult second molars can be expected to erupt is around 11-12 years of age. Often times, if the second molars are not coming in, your child’s dentist may take a radiograph to examine the second molars. If they appear impacted, or unlikely to erupt on their own, they may refer your child to an Orthodontist or an Oral and Maxillofacial Surgeon. Ideally, the second molars should be surgically elevated before the roots finish forming to maximize the chance of success for the procedure.

In order to treat these impacted second molars, children will often need to be in braces. The Orthodontist will work with the Oral and Maxillofacial Surgeon to coordinate the treatment. The surgical treatment will often include removal of the developing wisdom tooth, some minor contouring of the bone around the second molar, and a surgical elevation of the impacted second molar. Often the procedure is done with intravenous sedation and local anesthesia in the office. The tooth will then be stabilized in the jawbone with the help of the braces or a small dental splint. In addition, the surgeon will sometimes place a bone graft in the portion of the socket created by elevating the crown of the second molar to allow the area to heal faster.

Following the surgery, your child will be on a soft diet for a few weeks while the tooth stabilizes. They will also be seeing the Orthodontist who will later begin to orthodontically move the tooth into its final alignment.

 

 

Figure 1: Preoperative State: Notice the impacted lower second molar caught under the third molar/wisdom tooth and the back half of the first molar

Figure 2: Immediate Postoperative State: Note how the lower third molars have been removed providing room to elevate the impacted lower second molar. Bone graft has been placed in the small defect that was created in between the first and second molar teeth.

Figure 3: 6 months Postoperative State: Note how the lower third molar sockets have filled in with bone and the second molar area has healed. The second molar is now a functioning tooth. Also, the teeth are in the final stages of alignment with the braces.