Rob Veis, DDS, Los Angeles
Tooth position affects aesthetics, phonetics, occlusion, muscular activity, and temporomandibular joint function. Malposition of any tooth can also create a change in the local environment, encouraging the onset of caries and periodontal disease. Specifically, the mesially inclined second molar is one of the most common dental maladies in the adult population. Without timely replacement or provisions for space maintenance, the second molars drift mesially and tip. When this occurs, arch integrity is lost and teeth begin to shift.
Molar uprighting can be accomplished using either a fixed or a removable orthodontic approach. A variety of fixed appliances have been proposed to upright tipped molars. These appliances can be separated into an active and stabilizing or anchor unit. The uprighting of mesially inclined molars can also often be accomplished with a removable appliance.
As always, proper appliance selection and application requires a well-thought-out and thorough diagnosis and treatment plan. During tooth movement, the clinician must accept responsibility for keeping the treated area free of inflammation. This will require regular maintenance throughout treatment. If an implant can be integrated to replace the missing molar, an interim partial or a banded space maintainer bridge would be appropriate methods of stabilization. If a fixed bridge is the treatment of choice, it will act as its own final retainer.