Irreversible ectopic eruption of maxillary first permanent molars may lead to crowded permanent dentition when it is overlooked. The situation usually requires active treatment. In the presented irreversible ectopic eruption cases, distalization and uprighting of maxillary first permanent molars were achieved using removable orthodontic appliances

Altay, Nil

Güngör, H. Cem

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Marquette University e-Publications@Marquette School of Dentistry Faculty Research and Publications Dentistry, School of Spring 1998 Ectopic Eruption of Maxillary First Permanent Molars: Treatment Options and Report of Two Cases H. Cem Güngör Marquette University, hcem.gungor@marquette.edu Nil Altay Hacettepe University Follow this and additional works at: https://epublications.marquette.edu/dentistry_fac  Part of the Dentistry Commons Recommended Citation Güngör, H. Cem and Altay, Nil, "Ectopic Eruption of Maxillary First Permanent Molars: Treatment Options and Report of Two Cases" (1998). School of Dentistry Faculty Research and Publications. 545. https://epublications.marquette.edu/dentistry_fac/545 Ectopic eruption Ectopic eruption of maxillar first per1nane 1t molar : treatment option and re_port of tw ca es H. m ung r* / ii llny** Irreversible ectopic emption of maxillan• flr,'il pa111w1em m11lars m11y lead 1a ·rowtletl p1•rmcmem de11ririo11 when ii is ,walooked. The il11alio11 11 11alll' requires nc1iv trn,rmem. 111 rile f. n·.,·,wE•tl irrever ·ibl e ·top, · empri m ens' .. disral1.:mio11 and 11pr1ghti11g o ma.\ 11/an• fin/ pc'rmu11mt mulu , were a hieved u •in> re1110vabll• orth,nfo111i<' u11p/in11ce.,. J linPedialr nt _ ): -11 --16. Jl9, j- rnnt. Dcpa rtm nl of arull f Den1i try. • ii ltay DD PhD ~ Pediatric Dcn11s1ry. Hacc11cp ni Ankara. Turke . Dr. II em un •or. Re ~ean:h • I I i: llt:pc ni.-~r.,i1 . al root of th · primar_ molar. re ·ultin fr m uch a clo!>c onta I het we~n made lini-c n<l primary m I~ r is an intra r I clue for mo. l of th~ e lo pi ca e . ' lo"\! e •r. ite\' ing and periapical rru .. h graph~ · n .. lhe afest 111 ans to c nfirm diag.no ·i.. 1 ITER TUR rupti n ha been n::ported in U1e literature. ' i 1h revcrsibl > type. 1~ in , hich the ctopi ll · erupting pi!rITh nenL m lar fr it · If p ntane u ly from a I eked p ·ition and erupt into occlu ion. ' The other t pe i irrev rsibk:. •~ whi h i. h, ra terized b a p rmanent molar, tba1 remain in lo ked po iti n until an a ti e treatment i pro id ·d r premalur c •foliati n or se nd primary molar o cur. • ung • has reported lb t ·ixt · ix p rcent r cc top1c 1.:ruption ·. hi h h ob erved. , er rhe re ersiblc typ , indicatin -' no kind of treatment wa needed. Ir r ·rsib l r pe of e lopi rupti n u uall requires a ·ti e tn:atment. [f the iluation i undetected r left unlreat din uch . the in re f oral fluid t the re ma lead lo pulpal inflammation o r peri-dontal u cc · . "· 1• uralgic pain ha al · o b n reported in irreversible ca ·e . 15 Toe prevalenc of th ect pie eruption of the maxi l­iar fir ·t permanent mola vari b t, een 2 - 5.99% . which ha · been explain cl by the numb r of the chi I~ 1 17 dren ·1udied, the age and carie ra te. 4 ui, 12· " high arie rate, re ulting in art extracti n uld ha 21 1 Toe Journal of Clinical Pedlatrlc Dentistry Volume 22, Number 3/1998 Ectopic eruption In rder to b lock d per­donti band The Journal of Clinical Pediatric Dentistry Volume 22, Number 3/1998 212 Ectopic eruption Figure 1. Pretreatment periapical radlographs of the patient. Note severe resorptions on the distal portions o the second primary molars caused by the ectopically erupting firs permanent molars. of the ca e, clinical Lreatmcnt plan and pati nt c mpli­ance. f r menti n d. are t o pali nt in wh m lhe di taliza ti n nd uprighting f ectopi ally erupting maxillar permanent molar · were a c mpli h d usin remo able applianc CA ER POR Ca e J gure 2. Maxillary removable appliance for bi!ateral distallzation and uprighting of the perman nt molars. th gum and c nlour d ace conta t , ith the m ar and ele en-The Journal of Clinical Pediatric Dentistry Volume 22, Number 3/1998 213 Ectopic eruption Figure 3. lntraoral view after the completion of active treatment. Figure 4. Pretreatment periapical radlograph of the maxillary left Notice the sufficient space for eruption of the second premolars. posterior area, demonstrating the severe resorption or the second primary molar. Figure 5. Maxillary removable appliance for correction of the ectopic first permanent molar. A guide wire of 0.6 mm Is placed in the acrylic plate for controlled activation of the spring. comp nenl f the appliance. v hich wa con i f an dam· clusp to th right first permanent mol, r and a labial bow, wa a imple antiJever pring f 0. 7 mm rt hod nlic wir n the I fl ide ( 1g. -). The patient wa reminded to wear the appliance for tw nt -four hour dail . CLivation ( the pring wa made at t n-da int rval . fter three and a half month , th ectopic perman nt molar wa ob crved to be di talized and uprighted ati fact ril (Fig. 6). At th nd of the acti tr atm nt fi d pac maintain-applied. 10 n r p rt d that eel pie eruption could be a ign of inad quate arch-length, which could re ull in a Figure 6. Occlusal view after the distal movement of ectopic molar. Sufficient space has been maintained for eruption of the second premolar. cro, d d permanent d nt111on and uld requir orth dontic treatment al a later date. •-~··· 111 Kurol and 1Bjerklin 12 ha tated thaL the t pe f ect pie eruptjon coul b reliabl e tabli hed afl r lbe age f e n. Henc , .it eem rea onab!c to tak intercep1ive and/ or correctj e mea ure if any ign f If-correction could not be detec1ed y the nd of the ven ear of age. Furth rmore ec topic II erup1ing fir I p rmanent molars are not good candidate f r elf-c rrecti n , hen th er , n are partially i ibl in th moulh and acti tr atmenl for pace regaining is required. ~-11 When an erupting permanent fir t molar bee m s lock d under the di tal a pect f th c nd primar molar. pa I has air ad urr d and the am unt of lo increa e along , ith the rity of impaction. "" Thu , the treatment planning i ba ed n th e erity The Journal of Clinical Pediatric Dentistry Volume 22, Number 3/1998 214 Ectopic eruption of lock and the amount of re orption of th ec< nd pri­mary molar. 11 GeJliJ1 " has tared Lbe extra tion of the ec nd primary molar hould be don when e ere damage occur du to the ectopic eruption of fir t per­manent molar. He ha al a ugge ted an active appli ­ance to regain the pace lo s followed by placing a pas-ive pace maintainer. In the pre ented ca e . tr atment plan invol ed the extraction of the econd primary molar and di Lal1 z:1• tion of maxillary fir t permanent molars with remov­able appliance . If molar di talization with n remov­able appliance i the chosen form of trea1men1, 1he upporting t eLh and gingi al Lissu become Je . u -ceptible to trawna, provided Lhat th appliance i fab­ricat d corre ti . From the tandpoint of anchorage r qufrement , the clinician • hould bear in mind that fir l permanent molars are very r istant to the force acting lo move them distally. Kurol and Bjerklio have reported 11 ~J that, jn bilateral ca e , the reciprocal force which acti• ated spring generate may di place tbe plate and ther fore, the use of remo able appliances hould be limited t unilal rat ectopic eruption ca e . However. Kennedy and Turley "' ha e propo ed the u e of Adams cla· p to both second primar molar · in bilateral ca e tating that if additional anchorage i required, Adam· cla p to the c ntral inci or r a labial ow can olve the problem. Where po sible. i.e .. in unHateraJ cases, rel nlion from the unaffected per­manent molar c n be achiev d using an Adam· clasp, and thereb , minimizing the ri k of anch rage lo . 11-Patient compliance i another major factor, affect­ing the ·uccess of treatment with a rem vable appli­ance. De pile ·everal di advantage mentioned before, eparating wire or fixed appliance do oot require the cooperation., and ther fore. ma be qujte u eful in chil­dren , wh pos managem nt problem . Yet, the pati nts reported herein were d monstrating willing­ness to wear removable appliance . and th outcome of treatm nt confirmed the cooperation. They both reported little or no di comfort from the activation of the pring that were performed every ten da . in e the appliances ere removable one , care of th appli­anc never came out to be a problem. CONCLUSIO Although each ase f e topically erupting permanent molar hould be con idered indep ndently, the fol­low-up of the e ca e ·uggest that removable appli­ance , when properly de igned and fabricat d, are ·afe and eff ctive mean of regaining lost pace and e tab­Ii hing proper molar alignment in irrever ible ectopic eruption ca e . ACKNOWLEDGEMENT Dr. Zafer Cchreli i appreciated for hi h lpful advice and m ti va tion in the making of thj arti le. REF RE CE L. Rnghm:har M. Bocring, G. Vi ·ni.. A, St<c<ganga B. Erupt1 n di~rurhance · nf permanent molars: a view. J Oral Pathul Med 20: 159-166. 1991, u.:n S. Chan J. Tay F Ectopic crupti n f the maxillary pt-rma­ncnl tir)l 1111,Jtir: Inc effe<' l vi 1ncreasc<l me ial angulu1ion on ,in.:h length . JADA 111 : 447-4 l. 1985. -, . Bjcrklin K. Kurol J. Valentin J. Ect pie eruption Clf 01 ii! 1-y fi r\l r ~srm11ncn1 molar~ and a nci:it i 11 with olhtlr 1001h .mu dcvd pmc111al J1s1urbances. ur J Orthod 14: 3n9-375. 1992. -1 . Young DI l. Ectl)pic crupli\ n 11f the (ir I permanent molar. J Dent hilLI 2-1 · 1:J- 1(12. L9'i7 5. Darbyshire PA Flm1in P, Me er LR. Upnghung of cmop,cally e11i p1 ing mol,trs m chilJro:-n Quinte cnce Int 19: 291 -21>3 . 1<188.o. roper J '· · ct J•ir eruplion or a manuihular wt pcr­mruIe!ll molii r· rcpnrl o l '.In unu ual ca e. J Dent Child 59: 2.. • ~O. JW2. 7. Duncan , K. A hrnfl Ml I. F.ct r 1c crurt1u11 of !he mandihula1 fir., 1 permanent m,,hir. J AD 1 102:o"' l-ti: -l I 181. It Lin T, clopic lly erupl mg mr111Jihulur fi l'<I r~m,a11u nt m la1 · 1rcat nwnI uf a ca. c. J ' Jin P ·tli:irr Dent ~ I , ;1-_~J . 1996. 9. Ba artlo R ~- ir;Jm,k LR. lill WE. ew cnttccpl in thc lrt:af men1 uf c:C\np1c:illy erupting, maxill.1n fi l p<'nnall<.:OI 1110!.1 .. J DcntChilt.i.t6~1 -Plli. lLJ79 IQ. Pulver F. 111~ ..:110I0!,!V ,,ntl pr~•v;1kncc of ertupic eruption ,1f lhc maxill.iry flr 1 permnnenL mul.1r. J t>lll hil,J l:i . LJX- 1-l-h. I 9fi8, 11. Harri on LM . Mkhal AC lreulmcnl 1•f cct r1c.a lly ..:rupling permanent molars. Dent Clin ' rth m _s: 57-67 19 ' .J., 12. Kurol J, Bjerkltn . Eewr1c eruption uf n1axiilarr fir,t perm • nent molars-. a re, it>1 J Dent Chi ld 5.): _UlJ-.I-1. I '11!1i 13. enn RJ. Ecrnp1c eruption of permanent fi,-..t 11mlars: ,1 cli nic;i l technique. ] Pcdotl Ill: ~d -H8. l'l -5. 14. Mc0(\nalJ R . Hcnnv n DK. very DR. Ot:nli lry fo r the child and ad lescen1 . McOunalJ R : /\vt:r)' OR. 5th eJ. V Mosby Co. Philadelph ia . pagc -761- '05, 19 '7. 15. Schm::id r P . Dummett 0 . T.--eo.tmcnl of e~l pie permnneni mtilar eruption: case rt.:plirt Quintc ~.:nc Int 7: 45'1-462. 1 s·. 16. Bjerklin K. Kur I J. ~c1opii: eruption of the maxi llary filST pcr­m,inent mola r: e ll ,logic factor$. t\m J rthoJ 84: 147-155. 19$3. 17. Kimmel A. ellin M - . Boh110n:m H t. 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J Dent Child 31 : 16-18. 1964. Ectopic eruption 24. h, rma P , Rypel ctopic cn1p1ioa f permanent mol r and their clini al management ( I ). Quimc ence lnl 9: 47-52. 1978. 25. Hortman treatment for I p1call , erupled fiN permancn1 molars. J D •nL Child 51 : 63-366, 19 . 26. e w WK. The applic tion of tooth paration in clinical pcdodonti J Deni hild 51 : 4 30, l _7_ Hu ng \ J. hilden. , K. liniCllJ aid in placing rn wire · to trc t ectopi nlly erupting permanent fii ·1 molar:,, Pcdiat Dent 17: 122-123. 199-. 2 . Humphrey P. A simple technique for correcting an ectopicall erupting fir t permanent molar. J Dent hild 29: 176-178. 1962. 29. roll TP, Barne JI. An cid l'lch compo ite re in rctnineu wire for correcli n of an ectopicall • cruptin permanent first molar. Pedia1r Deni 4: 61-63. I __ .\0. II TP. orrection of 1r L permanent m lar ectopic eruption Quint ence Int I : 1239-1246, 1\184. 31. Gr per J . implified treatmenl of om:cung an eel picall) erupling maxillary fir I permanent molar. J nl 1ld 52: 37 -376, 19 5. 42. 43. 4-1. Adam The Journal of Clinical Pediatric Dentistry Volume 22, Number 3/1998 216 

Ectopic Eruption of Maxillary First Permanent Molars: Treatment Options and Report of Two Cases

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