Management of unilaterally deep impacted first, second, and third mandibular molars

Simultaneous impactions of first, second, and third permanent molars comprises a very rare clinical situation with diverse therapeutic approaches and is a difficult challenge for dentists. Early diagnosis and treatment of eruption disturbances contributes to optimal outcomes. This article reports the treatment of a teenager with severe impaction of right mandibular first, second, and third molars, which hinders the masticatory function and dental arch integrity. A decision-making process and a simple orthodontic technique are described. To shorten the treatment time and simplify the procedures, the impacted right mandibular third and second molars were orthodontically uprighted with an innovative tip-back cantilever. Subsequently, the deeply impacted right mandibular first molar was extracted with minimal obstacles. The combined surgical-orthodontic approach resolved a challenging clinical problem and eliminated the need for prosthetic or dental implant replacement of the impacted molars. Good occlusion, normal function, and a healthy periodontium of the patient were also achieved. (Angle Orthod. 2012;82:565-571.)