Impacted Permanent Molars: Rare but Complex Orthodontic Challenges

Impaction of first or second permanent molars may occur due to obstruction, ankylosis, lack of adequate space, abnormal eruption path, posterior failure of eruption or from reasons unknown. The impacted tooth may develop an abnormal root, cause damage to adjacent teeth and lead to asymmetric dental and skeletal relations. Treatment planning poses difficult questions: Why has the tooth not erupted? What are the alternatives? What is the prognosis? Surgical exposure is usually required, followed up by observation alone, or augmented by extrusive forces, with or without surgical luxation. Auto-transplantation, surgical repositioning, decoronation or extraction remain possible alternatives. Improper planning leads to failure and may jeopardize the neighboring teeth. The goal of this presentation is to equip clinicians with evidence-based strategies to enhance treatment outcomes in these challenging impaction cases.