Management of Delayed and Crowded Second Molars
People in the dental field are programmed to see crowding. We all admit to looking at people’s teeth when we meet someone on the street. It looks like overlapping anterior teeth. But what about crowding in the posterior. How does this present? Surely if crowding occurs anteriorly, it can occur posteriorly as well. Yet it becomes a little more difficult to describe.
Consider the 14-year-old patient who’s 12-year molars have yet to erupt. Are they just delayed? Should we just monitor this? How long should we wait for them to erupt? What is the solution?
One of our criteria for beginning orthodontic treatment at Shoreline is the eruption of the 12-year molar. We have found that it is one of the most successful ways of providing an excellent result in the shortest period of time for the patient.
To ensure the 12-year molar is erupting properly, we take into consideration the patients age, the angle of the long axis of the molar in the pan, and the position of the wisdom tooth. If for example, a patient is 14, the molar is tipped distally, and the wisdom teeth are stacked vertically or laterally to the second molar. This is a presentation of posterior crowding that will hinder the eruption potential of the second molar. In this example, monitoring eruption or even attempting to erupt the molar orthodontically can often prove to be unsuccessful
The most successful way to alleviate the posterior crowding, and the standard of care at Shoreline, is the early extraction of the wisdom teeth with elevation, or luxation, of the second molar at the time of oral surgery. The elevation of the second molar provides stimulus to the periodontal ligament to erupt and relieves the physical barrier by helping the 7 “jump” the height of contour of the 6.