More on Molar Eruption Problems

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

In our last publications, our attention was focused on molar repositioning of teeth when the occlusal surface was not available for bonding. Lets talk of situations where  the occlusal or buccal surface have erupted enough to be available for bonding. First on our list should be to evaluate the possibility of proper anchorage at the m’exila of the first permanent molar. The primary molars must have no mobility and normal root length. The first solution would be to place a tube on the first and second primary molars and also on the occlusal surface permanent molar (this is for cases where the buccal surface is not available for bonding). A 0.016 CuNiti is inserted in the occlusal molar tube and in the primary molar tubes with a 150 g coil between the E and the 6 (Figure 1).

A second option is to place a band on a solid second molar and ask the lab to construct and Halterman appliance, This appliance consist of a band on which a o,036 buccal wire is soldered. The wire passes on the buccal, not impinging on the mucosa to  reach the distal area of the permanent molar. An elastic chain between the hook on the Halterman and a button on the molar powers the appliance. Be careful to avoid the occlusion (Figure 2).

A third solution is to fabricate at the chair a U shape spring made of 0.016 x 0.016 with 4 helices. Th wire is compressed on itself and maintained compressed by a ligature wire. The wire will be bonded on the buccal surfaces of the 2 primary molars and  the first permanent molar in its compressed shape. Once bonded, the ligature is cut and the spring begins its activation to distalize the permanent molar. Second activation is possible if needed 4 weeks later and can be done directly in the mouth forming a gable bend with an optical plier (Figure 3a – 3b)

Figure 1

Figure 2

       

Figure 3 a                                                              Figure 3 b