Читать книгу Orthodontic Treatment of Impacted Teeth - Adrian Becker - Страница 97

It is common to find mesial impaction of a third molar, beneath the distal bulge of the second. It is less common to find a mesial impaction of a mandibular second permanent molar, beneath the distal bulbosity of the first permanent molar. The two situations, however, have similar characteristics. In their mildest form, they both present a condition that may sometimes respond merely to surgical intervention and packing. This is carried out by the exposure of the occlusal surface of the tooth and the deliberate and forceful wedging of a pack in the area between the two teeth and leaving it in place for 2–3 weeks. During this period, the pressure caused by the pack will often succeed in eliciting a small distal movement of the impacted molar, possibly causing it to erupt more freely when the pack is removed. The degree of control that is available to the operator in judging the amount of pressure to be applied is minimal and the extent to which the pack interferes periodontally is impossible to assess. Therefore, damage to the periodontium of the two adjacent teeth becomes a distinct possibility. Success in bringing about an improved position of the tooth may exact a cost in terms of the health of its supporting structures.

As an alternative to the use of a pressure pack, some orthodontists advocate the use of brass wire [16] or elastic separators, in order to apply a similar disimpacting force. Simple remedies of this kind may be effective in situations where the discrepancy is minor. However, in many of these types of cases the brass wire and the elastic separators will need frequent tightening, replacement and renewal. Briefly stated, the method is unreliable at best.