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Part 2. Maxillary Molar Impaction

Upper Maxillary Molar Impaction, Part 2

Dr. Michel Champagne, BA, DMD, MAGD, IBO, CDE  

In our last blog, we discussed the upper first molar impaction under the second primary molar (E) in cases where the ”E” showed advanced resorption with excessive mobility requiring extraction of the ”E”. Today, we will focus on treatment options when the ”E” is not mobile. We will describe our options following the KISS principle (Keep It Simple Stupid), starting the discussion with the simplest options. We may have 2 options:

The first possibility will occur when the clinician can insert the tip of his explorer under the contact point between the ”E” and the upper ”6”. In such a situation, among others, we will have the following options:

  1. The insertion of a band separator between the primary and the permanent molar, The separator will have to be replaced every week until correction. This may necessitate 2 or 3 five minutes appointments to open the contact and most of the time it will have to be followed by the placement of a few brackets to finalise the position. Total chair time will run around 90 minutes (Images 1a-1b).
  2. The insertion of a brass wire instead of a band separator. It will have to be tighten every week using an hemostat to keep adequate pressure on the teeth. The same protocol mentioned in ‘’1’’ may follow. Estimated chair time is also around 90 minutes (Images 2a-2b).
  3. The insertion of a pre-fabricated de-impactor either in SS or NiTi also followed by  protocol ‘’1’’. For the pre-fabricated one in NiTi, even if it necessitates no tightening, you will need weekly supervision but no reactivation is necessary. The one in SS should be reactivated as needed followed also by the protocol in ”1” (Images 3a to 3e).
  4. The insertion of a sectional .014 CuNiTi wire approximately a length equal from the distal of the 6 years molar to the mesial of the first primary molar. Insert one end of the wire under the contact point puncturing the gingiva if necessary. The wire should extend far enough in the palatal direction to avoid its dislodgement without puncturing the palatal mucosa. Once this first end is well in place just push the remaining wire length on the buccal surfaces of the two primary molars and bond the wire directly to these buccal surfaces. Schedule the patient in 2 weeks and reevaluate. This procedure will take 30 minutes of chair time and may be followed by the same protocol as in ”1” for better alignment.  For me, this is always my first choice. It is quick and very effective. Total chair time is approximately 30 minutes (Images 4a-4b).

This procedure may also apply to the mandible for the de-impaction of first or even the second molar. For some patients with any of these options, a light pain medication for the first day may be necessary.

Band separator

       The separator  must cover the occlusal surface as seen in ”b”

Image 1a                                                             Image  1b

Brass Wire

      The wire must be tighten  every week using an hemostat

Image 2a                                                           Image 2b

Prefabricated De-impactor


Image 3a. Pre-fab NiTi                   Image 3b. Pre-fab SS                              Image 3c. SS In place                                   Image 3d. SS Activation



Image 3e. SS De-impactor in place and activated

Chairside Fabrication using a .014 CuNiTi


Image 4a. Buccal View                                        Image 4b. Occlusal View

For the second possibility, when it is impossible to pass under the contact point, we will discuss it in our next blog.