impacted lower second and third molar

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4 years 3 months ago #59 by RemportBogi
It was my worry, too, Anne: the intention is absolutely right to upright both molars, but practically it is a very difficult task. Giorgio is right, if you don't even try you will not win.
The best would be to move both teeth in a unit, although I don't know if there is a clinical possibility to reach this, so I would separate the movement of these 2 teeth.
I would first pull the 37 forward with a line of action that is extrusion plus mesial movement until I can bond a bracket on the buccal side. Horizontal force component would be more than vertical at the beginning.
The problem is that you can bond something just on the distal cusps in this situation and if you have a more pronounced horizontal force component, you will have a ccw moment on CR that will make the tooth more horizontal- if it is not exactly under 8 and it is not preventing it from tilting more forward.
You will need 2 vector mechanics, too.
Regarding 38, if you manage to bond an attachment to the mesial cusp and you use a horizontal force, hopefully there is not too much ccw rotation on CR of 38. After a while you will be able to apply here 2 vector mechanics, too.

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4 years 3 months ago #61 by Renata Urban
Thank you for your help and that you found time to reply :)
Do you think it would be a good idea to bring it to our next clinical discussion? Because I cannot think of a way to treat it in the condition as it is.
Thanks again

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4 years 3 months ago #62 by Giorgio_Fiorelli
Renata, honestly if she was my patient I would study a way to connect the two teeth in a single unit,
call a surgeon and study a way- Leave the second molar free, maybe you can bond some material on the occlusal (Triad gel?) to connect the 2 molars.
Can we have intra-oral details of that area?

I am happy we discuss something here :)

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4 years 3 months ago #63 by anne_chanly
Hi Bogi,

Moving them as a unit seems like a good idea!

Anne

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4 years 3 months ago #64 by RemportBogi
Following Giorgio's path, I would have a CBCT done of that are. I would check the bony situation and the exact relation, position of the crowns. Maybe something could be metal printed and bonded. If the situation is good, you could bond something that connects the occlusal surfaces, has 2 long arms lingually+ buccaly, coming forward to apply the uprighting and mesialising force. Intrusion may come later.
Or, if the situation is unpleasant, bond Triad gel with a piece of wire :)
I like this discussion, I feel that I have to let my ideas fly to solve this case. Out of the box.
B)

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4 years 3 months ago #65 by Renata Urban
Hi my dear friends. I'm sorry for the late reply. I was trying to get more info from my colleague whose patient it is. I enclose the pictures.
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