Orthodontic Treatment of Impacted Teeth, 4th Edition, 4th

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 Maxillary second premolars
Infra‐occlusion of deciduous teeth and its influence on
premolar successors
Infra‐occluded teeth cause arrest of vertical bone growth
References
13 The Root Form of Impacted Teeth
Normal root development
The aetiology of hooked root apices
The ‘hooked root’ theory of tooth impaction
Abnormal root form
Fake causes
References
14 Rescuing Teeth Impacted in Dentigerous Cysts
Dentigerous cysts
Radicular cysts
Treatment principles
The prognosis of teeth that have been severely displaced by
cysts
Eyelets or brackets?
Conclusions
References
15 Impacted Teeth in the Adult Patient
Neglect and disguise
What does the literature say?
The impacted maxillary central incisor
Maximizing the anchor unit with fewer teeth
Implant anchorage
References
16 Lingual Appliances, Implants and Impacted Teeth
 The context of impacted canines vis‐à ‐vis the lingual
appliance
Differences in treatment approach engendered by the use of
lingual appliances
Canine traction, eruption and alignment
Finishing procedures
Anchorage considerations
Integrating implants with lingual appliances
Conclusion
References
17 Clear Aligners in the Treatment of Impacted Teeth
The beginning of an era
Mechanical principles of the aligner
Digital planning software
Managing impacted teeth with clear aligners
Methods of regaining space with clear aligners
Impacted tooth traction while using clear aligners
Clear aligner intra‐oral elastics interface
References
18 The Anatomy of Failure
Why is it important to know the cause of the failure of the
tooth or teeth to erupt?
Patient‐dependent factors
Radiologist‐dependent factors
Orthodontist‐dependent factors
Surgeon‐dependent factors
Mid‐treatment alternate consultations – second opinions
References
19 Traumatic Impaction
Acute traumatic intrusion (intrusive luxation)
 Spontaneous re‐eruption
Manipulative/surgical repositioning and splinting
Orthodontic reduction
Orthodontic treatment considerations
Indications for the different types of orthodontic appliance
Conclusion
References
20 Extreme Impactions, Unusual Phenomena, Difficult Decisions
Case 20.1: Monster tooth, supernumerary tooth, impacted
central incisor and the maxillary midline
Case 20.2: Bilaterally impacted maxillary canines in a patient
suffering with aggressive juvenile periodontitis
Case 20.3: Labially impacted maxillary canine at the level of
the nasal floor
Case 20.4: The inaccessible canine
Case 20.5: Severe trauma in infancy: repairing the damage
with orthodontics
Case 20.6: Labial to the lateral incisor and lingual to the
central incisor
Case 20.7: Three adjacent impacted molars
Case 20.8: Five unerupted teeth in the walls of a dentigerous
cyst
References
21 Cleidocranial Dysplasia
Clinical features and dental characteristics
Diagnosis
Treatment modalities
Recognition of the clinical features
What about the skeletal class III relationship in cleidocranial
dysplasia patients?
 What management protocol can be used to achieve this level
of compliance?
Erupting the permanent teeth
Surgical therapeutic measures
Orthodontic strategy
Preparing the patient
The Jerusalem approach in clinical practice
Extreme tooth movement
Retention of the treated result
Orthognathic surgery
References
Index
End User License Agreement

List of Tables
Chapter 1
Table 1.1 Apexification age of individual tooth types.
Chapter 3
Table 3.1 Colour code convention.
Chapter 4
Table 4.1 Typical effective dose from radiographic
examination.
Chapter 5
Table 5.1 Immediate effects of closed and open exposure
treatments on quali...
Table 5.2 An instrument tray for a team approach.
List of Illustrations
Chapter 1
Fig. 1.1 The advanced root development of the canines and
premolars indicate...
Fig. 1.2 A 12‐year‐old patient with root development
indicating the late den...
Fig. 1.3 The mandibular left second deciduous molar is
retained (extraction ...
Fig. 1.4 Root apices are closed in all first molars, all
mandibular and thre...
Fig. 1.5 No closed apices. Dental age assessment 7–7.5 years.
Fig. 1.6 Late‐developing second mandibular premolars with
retained (not over...
Fig. 1.7 The left mandibular premolars are prematurely
erupted, with insuffi...
Fig. 1.8 Space loss in a 10‐year‐old child, due to an impacted
maxillary rig...
Fig. 1.9 (a) Chance finding of mesiodens in a 4‐year‐old child.
(b) Chance f...
Fig. 1.10 An 8‐year‐old child exhibits an unerupted maxillary
left central i...
Chapter 2
Fig. 2.1 Lasso wire encircling the neck of an impacted canine
(circa 1971)....
Fig. 2.2 Threaded pins set into prepared holes, drilled and
tapped into the ...
Fig. 2.3 As the impacted tooth is about to erupt, the high‐
profile Siamese e...
 Fig. 2.4 Eyelets welded to a pliable band material base, backed
by steel mes...
Fig. 2.5 A direct tie using a very short length of elastic thread.
Fig. 2.6 (a) The slingshot elastic. A palatally impacted canine
has erupted ...
Fig. 2.7 (a, b) The use of nickel–titanium auxiliary wire as the
active elem...
Fig. 2.8 An indirect anchorage system. (a) Extra‐oral view to
show tipped oc...
Fig. 2.9 Zygomatic plate. (a) An onplant plate. (b) The plate is
held in plac...
Fig. 2.10 The bonded magnet ‘backpack’.
Chapter 3
Fig. 3.1 (a) Buccal cantilever for extruding a canine. In
practice, an eyele...
Fig. 3.2 (a) The passive cantilever, made of rectangular wire,
extends from ...
Fig. 3.3 (a) For illustration purposes only, a combination of the
beta‐titan...
Fig. 3.4 (a) The biomechanical force system generated by a
cantilever is a c...
Fig. 3.5 (a, b) Ballista spring. The active configuration may
differ in vert...
Fig. 3.6 (a, b) Using an elastomeric chain is relatively simple
and cost‐eff...
Fig. 3.7 (a) Short vertical elastics exhibit a greater vertical
component of...
Fig. 3.8 (a) Sliding mechanics with a NiTi open‐coil spring
threaded over a ...
 Fig. 3.9 (a) When aligning a high canine using a continuous
and fully engage...
Fig. 3.10 (a–c) Changing the position of the V bend will create
totally diff...
Fig. 3.11 (a) The passive configuration of the alpha–beta
spring has to be m...
Fig. 3.12 (a, b) A 0.016 in. main arch is combined with a 0.016
in. von der ...
Fig. 3.13 When inverting a left upper canine bracket, it has to
be kept in t...
Fig. 3.14 The use of a Correx tension gauge is recommended to
measure/contro...
Fig. 3.15 Khouri Bendistal pliers are reliable tools for bending
wire ends a...
Fig. 3.16 The Sander Memory Maker allows NiTi wire
adjustments in all planes...
Chapter 4
Fig. 4.1 The angle of the central ray in a true occlusal view of
the lower j...
Fig. 4.2 A diagram showing incisor inclination, receptor
position and centra...
Fig. 4.3 (a) The periapical view shows an impacted left
maxillary central in...
Fig. 4.4 The left periapical view, oriented for the central
incisors, shows ...
Fig. 4.5 A diagrammatic representation of the parallax
method. If the observ...
Fig. 4.6 The vertical tube shift method using a panoramic
radiograph and per...
Fig. 4.7 The lateral tube shift method using a panoramic
radiograph and a la...
 Fig. 4.8 The enlarged premaxillary segment of a panoramic
radiograph showing...
Fig. 4.9 On the dry skull, the roots of the maxillary incisor
teeth can be s...
Fig. 4.10 (a) The true lateral cephalometric radiograph shows
both canines s...
Fig. 4.11 The true lateral and true occlusal views, taken
together, provide ...
Fig. 4.12 A dilacerated central incisor (arrow) seen in a lateral
cephalomet...
Fig. 4.13 Bone peeling in 3D. (a–d) Progressive bone peeling
and how it may ...
Fig. 4.14 A view of the multi‐planar reconstruction screen for
Case 1, as pr...
Fig. 4.15 Automatic segmentation, artificial intelligence (AI)
driven. The s...
Fig. 4.16 Diagnosing resorption, cross‐sections. The lateral
incisor #12(7) ...
Fig. 4.17 Diagnosing resorption with multi‐planar
reconstruction. The long a...
Fig. 4.18 Diagnosing resorption with multi‐planar
reconstruction (MPR). The ...
Fig. 4.19 Multi‐planar reconstruction for an incisor that is
almost horizont...
Fig. 4.20 First mandibular molar embracing inferior dental
canal. (a) 3D bon...
Fig. 4.21 Multi‐planar reconstruction view. Arrows indicate
the invasive cer...
Chapter 5
Fig. 5.1 (a) A 16‐year‐old female exhibits an unerupted
maxillary left canin...
 Fig. 5.2 (a) Soft tissue impaction of maxillary central incisors.
(b) Apical...
Fig. 5.3 Following exposure, attachment bonding and packing
the unerupted to...
Fig. 5.4 (a) A high buccal canine exposed by circular incision
in the very w...
Fig. 5.5 Crescini’s tunnel variation of the closed eruption
technique. (a) A...
Fig. 5.6 Cone beam computed tomography (CBCT) imaging
slices of a palatally ...
Fig. 5.7 Treatment for the right buccally impacted maxillary
canine was perfo...
Fig. 5.8 Treatment for the right palatally impacted canine was
performed wit...
Fig. 5.9 A case treated by the author in the mid‐1970s, before
the era of th...
Fig. 5.10 (a) The initial records of the dentition showing the
narrowed V‐sh...
Fig. 5.11 A case of bilateral palatal impaction of maxillary
canine treatmen...
Fig. 5.12 (a) Mild palatal displacement of the right maxillary
canine locate...
Chapter 6
Fig. 6.1 (a) Abnormal lip morphology, absence of philtrum and
midline positi...
Fig. 6.2 (a) Clinical views of a 9‐year‐old boy with a bulging
ridge form du...
Fig. 6.3 (a) The anterior intra‐oral view with teeth in
occlusion and the un...
Fig. 6.4 An abnormally sited central incisor, whose root apex is
close to th...
Fig. 6.5 (a, b) Frontal and occlusal clinical views of a patient
with a dila...
Fig. 6.6 (a) The anterior section of a lateral cephalogram
shows the sagitta...
Fig. 6.7 (a) An occlusal view of Johnson’s (modified) twin‐wire
arch, to sho...
Fig. 6.8 Impacted central incisors due to unerupted
supernumerary teeth. (a)...
Fig. 6.9 The development of maxillary canine ectopia adjacent
to an impacted...
Fig. 6.10 The tangential view shows severe labial
displacement of the root o...
Fig. 6.11 A ‘classic’ dilacerated incisor.
Fig. 6.12 A diagram to show how a vertically directed force
through the deci...
Fig. 6.13 (a) An extreme rarity: bilateral classic dilacerations
of both cen...
Fig. 6.14 A diagrammatic illustration of the progressive
alteration in the o...
Fig. 6.15 Dynamic development of a ‘classic’ dilaceration. (a) A
periapical ...
Fig. 6.16 (a, b) The occlusal and anterior views of the
maxillary dentition ...
Fig. 6.17 (a) The initial malocclusion of the patient before
commencement of...
Fig. 6.18 (a, b) The initial diagnostic periapical radiograph and
anterior s...
Fig. 6.19 (a) A periapical radiograph showing partially
completed crown deve...
Fig. 6.20 (a) A 9‐year‐old child has lost alveolar bone height
following tra...
Chapter 7
Fig. 7.1 Periapical view of the maxillary canine area shows
impaction of the...
Fig. 7.2 (a) A 3D cone beam computed tomography (CBCT)
view showing the apic...
Fig. 7.3 Lingually displaced lateral incisors and buccally
displaced maxilla...
Fig. 7.4 (a, b) Periapical views of bilaterally impacted canines,
each assoc...
Fig. 7.5 (a) Panoramic view of a patient in the mixed‐dentition
stage with a...
Fig. 7.6 (a) Periapical view of normal incisors at age 3 years.
Note the deg...
Fig. 7.7 (a) In the early stages the unerupted canines are
mesially directed...
Fig. 7.8 Late‐developing dentition showing spacing, small peg‐
shaped lateral...
Fig. 7.9 Lateral incisor anomaly in patients with palatally
displaced canines...
Fig. 7.10 A series of periapical radiographs of an untreated
girl, taken bet...
Fig. 7.11 (a) Anterior section of a panoramic view of a 10‐
year‐old boy with...
Fig. 7.12 Panoramic view of a 12‐year‐old girl with a palatally
impacted lef...
Fig. 7.13 Odontoma causing impaction of the canine.
Fig. 7.14 (a) Intra‐oral view of an 8‐year‐old child with an
unerupted left ...
Fig. 7.15 Maxillary canine/first premolar transposition. An
example of bilat...
Fig. 7.16 Despite the absence of crowding, the canine has
erupted in an abno...
Fig. 7.17 The left side of a case of bilateral hereditary primary
tooth germ...
Fig. 7.18 (a) Eruption status of the canine on the ipsilateral
(affected) si...
Fig. 7.19 A dentigerous cyst surrounds the crown of an
impacted canine. Note...
Fig. 7.20 Periapical view of maxillary incisor area in a 63‐year‐
old female,...
Fig. 7.21 The impacted canine crown is surrounded by a large
dentigerous cys...
Fig. 7.22 Palpable canines (a) labially displaced (arrow); (b)
palatally dis...
Fig. 7.23 (a) A panoramic view of the dentition of a boy aged
11 years, show...
Fig. 7.24 (a) A case diagnosed from this panoramic view as
exhibiting right‐...
Fig. 7.25 (a) A case of early crowding treated by extraction of
four deciduo...
Fig. 7.26 (a) The left side of a case with bilateral maxillary
palatal canin...
Fig. 7.27 (a, b) A palatally impacted right canine was adjacent
to the peg‐s...
Fig. 7.28 (a–c) A class II, division 2 case with crowding in the
maxillary a...
Fig. 7.29 (a–c) Inadequate space for unerupted permanent
canines with inter‐...
Fig. 7.30 A standard preformed archwire illustrates the
narrowed and flattene...
Fig. 7.31 Creating space by distal movement. (a–e) The initial
clinical view...
Fig. 7.32 Bone support levels in the treated canines (light
bars) compared w...
Fig. 7.33 (a, b) Intra‐oral views of the initial condition. (c)
View of the ...
Fig. 7.34 Using an eyelet for eruption and rotation. (a, b) With
the canine ...
Fig. 7.35 The periapical view of an extreme example of group
2 canines. The ...
Fig. 7.36 (a) The coil spring on the archwire had created space
for the cani...
Fig. 7.37 (a) The active palatal arch in its passive mode, lying
several mil...
Fig. 7.38 (a) Initial treatment had created space and a heavy
base arch, car...
Fig. 7.39 (a, b) With the eruption of the canine into the mid‐
palate, the ey...
Fig. 7.40 (a) The initial intra‐oral view of the teeth in
occlusion. (b) The...
Fig. 7.41 (a) A group 3 canine was exposed with an open
procedure and healin...
Fig. 7.42 (a) Minimal exposure and eyelet attachment bonding
of the palatal ...
Fig. 7.43 A case treated by the author circa 1972, using an
approach recomme...
Fig. 7.44 (a) Crescini’s ‘tunnel’ approach. Note the
preservation of the buc...
Fig. 7.45 Direct traction vs. two‐stage traction in the group 3
canine.
 Fig. 7.46 Acute periodontal pain from prematurely attempted
buccal movement ...
Fig. 7.47 (a) A group 3 canine exposed and viewed from the
occlusal aspect t...
Fig. 7.48 (a) The active palatal arch in place to erupt a group 4
canine tha...
Fig. 7.49 (a, b) A maxillary canine/first premolar
transposition, treated to...
Fig. 7.50 (a, b) Canine/lateral incisor transposition seen intra‐
orally and ...
Fig. 7.51 Anterior, left side and occlusal screenshots from the
video clip o...
Fig. 7.52 (a) Intra‐oral views of a 12‐year‐old male with a left
maxillary i...
Chapter 8
Fig. 8.1 The canine in the line of the arch. (a) The palpable
bulge in the s...
Fig. 8.2 (a–c) Extreme mesial inclination of a line‐of‐the‐arch
impacted can...
Fig. 8.3 A maxillary canine has erupted in an abnormal
location. Is this pri...
Fig. 8.4 Cone beam computed tomography transparency
presentation of 3D scree...
Fig. 8.5 (a) A mesio‐angular, labially impacted maxillary
canine (#23) is hi...
Fig. 8.6 (a, b) Clinical views showing an over‐retained
deciduous right maxi...
Fig. 8.7 3D screenshots of the high left maxillary canine, which
is labial t...
Fig. 8.8 The ‘window of opportunity’. (a) The anterior section
of a panorami...
 Fig. 8.9 (a, b) A general panoramic view and a 3D cone beam
computed tomogra...
Chapter 9
Fig. 9.1 (a) Right‐side molar region of a panoramic radiograph
of a 6.10‐yea...
Fig. 9.2 An extreme example of resorption of the entire root of
the central ...
Fig. 9.3 (a) A section of the panoramic view of a female patient
aged 12 yea...
Fig. 9.4 (a) The panoramic view of the anterior maxilla in this
13‐year‐old ...
Fig. 9.5 Root resorption, space opening and spontaneous
eruption. (a) The le...
Fig. 9.6 (a) A poorly executed panoramic radiograph of a
female patient aged...
Fig. 9.7 (a) Initial clinical intra‐oral views of the dentition. (b,
c) Sect...
Fig. 9.8 The anterior portion of a panoramic view. (a)
Resorption of the lat...
Fig. 9.9 Enlarged dental follicle and no apparent incisor root
resorption. (...
Fig. 9.10 (a) Intra‐oral view of the teeth in occlusion before
treatment, in...
Chapter 10
Fig. 10.1 An impacted canine had resisted attempts to
mechanically erupt it....
Fig. 10.2 (a) Periapical radiograph showing the central
incisors at approxim...
Fig. 10.3 The ‘red herring’ case. (a) An apparently simple class
I malocclus...
 Fig. 10.4 An advanced invasive cervical root resorption lesion
in an impacte...
Fig. 10.5 (a) The maxillary right first premolar is impacted
and is apparent...
Fig. 10.6 (a) A longitudinal slice of an infra‐occluded right
mandibular mol...
Fig. 10.7 (a) The practitioner’s intra‐oral photographs taken
approximately ...
Fig. 10.8 (a) From the pre‐treatment records of the patient.
The blue dotted...
Fig. 10.9 A typical ‘pinhole’ pre‐eruptive intra‐coronal
resorption lesion i...
Fig. 10.10 (a) A panoramic view of the mixed dentition, with a
lingual holdi...
Fig. 10.11 Unerupted second mandibular molar with large
semi‐lunar pre‐erupt...
Fig. 10.12 (a) A dilacerate central incisor with a ‘small’ pre‐
eruptive intr...
Fig. 10.13 (a) The initial photographic intra‐oral records. (b)
Pre‐treatmen...
Fig. 10.14 Periapical radiograph of a 63‐year‐old patient with
bilaterally i...
Chapter 11
Fig. 11.1 A bilateral case of impacted first permanent molars,
with complete...
Fig. 11.2 Although this appears to be a unilateral case of left
molar impact...
Fig. 11.3 (a) Incomplete eruption of the maxillary first
permanent molar, du...
Fig. 11.4 A series of six panoramic views covering a nine‐year
follow‐up of ...