Presentations 2020: Ortho&Paeds

446 - When doing nothing is an option: An impacted mandibular second premolar case report and literature review

G Aruede K Smary N Yaqoob
Presented by: Glenda Aruede
Prince Charles Hospital

Introduction Impaction is defined as prevention of complete eruption into a normal functional position of one tooth by another. This can be due to development in an abnormal position, limited space within the dental arch, or obstruction by tooth, bone or fibrous tissue. This case presents a rare example of self-correction of a deep and horizontally positioned impacted mandibular second premolar (LR5) in a medically fit and well 14 year old male patient, with no history of previous trauma or orthodontic treatment. Methods The patient was referred by his dentist to the Oral and Maxillofacial department in 2017 regarding a retained deciduous lower right second molar (LRe) and an impacted lower right second premolar. An OPT was taken which showed the horizontally impacted LR5. A CBCT was requested in order to provide more detailed information and aid the decision for either monitoring or surgical intervention, which highlighted that the LR5 was disto-angularly impacted into the mesial root of the first molar, with no root resorption present. The origin of the ID canal was in direct contact with the inferior buccal aspect of the LR5 root apex. Results Treatment options, risks and benefits were presented to the patient and his parent including no surgical intervention with routine monitoring or surgical removal of the LR5 and LRe under general anaesthesia, with subsequent orthodontic or restorative treatment to close the space. The decision was made to leave the tooth in situ and monitor the patient in 2 years’ time. The patient attended for a review appointment in 2019. In the meantime, the dentist had removed the retained LRe and on examination the LR5 had spontaneously erupted in the correct position in the arch. Conclusion This case highlighted that self-correction of impacted teeth is unpredictable. It can be beneficial to monitor eruption in the event that high-risk surgery is the alternative option. Orthodontic and surgical treatment was no longer required.
Consent Statement: Written informed consent for publication of their clinical details and/or clinical images was obtained from the patient/parent/guardian. A copy of the consent form is available for review by the the meeting organisers..

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