Eruption Treatment of Impacted Teeth Following Surgical Obstruction Removal

Supernumerary teeth and odontomas are obstacles for spontaneous tooth eruption and may result in impaction. The aim of the study is to present a conservative treatment approach for impacted teeth following surgical obstruction removal by reviewing three treatment modalities: surgery only, which involves the surgical removal of the obstruction and the spontaneous eruption; surgery with immediate traction, which includes surgery combined with immediate active orthodontic brace cementation and traction; and surgery with delayed traction, which combines a surgical procedure of obstacle removal and orthodontic brace cementation with follow-up for the spontaneous eruption. The first two modalities require orthodontic traction either by an additional surgical procedure for orthodontic brace cementation, or combined with the surgical obstacle removal. With the third approach, clinical follow-up is performed via connected ligature wire elongation applied during the surgical procedure for the spontaneous emergence of the impacted tooth. Active orthodontic traction is only employed if the tooth fails to erupt. The visual follow-up via wire elongation serves as a reference during the emergence of the impacted teeth and reduces the need for radiographic examination. The surgical-orthodontic approach saves both further surgery and orthodontics (spontaneous eruption) or further surgery (in failure to erupt).