Surgical Uprighting Mandibular Second Molars

The mandibular second molars can become impacted beneath the crown of the first molars and fail to erupt normally.  The incidence of mandibular  second molar impactions is between 0.3-0.4%.  Causes include decrease in arch length, premature eruption of the mandibular third molars, unusual angulation of the erupting second molars, pathology, and  supernumerary teeth blocking the mandibular  second molars.    

Treatment options include observation, surgical exposure only (tissue excision), orthodontic treatment to upright with or without exposure, surgical removal of mandibular second molars to allow for eruption of the third molars, and surgical uprighting & repositioning of impacted mandibular second molars.

The surgical uprighting of mandibular second molars usually requires removal of the adjacent third molar (wisdom tooth) to allow space for uprighting and repositioning of the second molar.  Ideal treatment time is when the roots of the mandibular second molars are between 1/2- 2/3 formed. Once the second molar is uprighted, it is usually stable but in some instances may require stabilization with orthodontic wire and bonding. 

The benefit of surgical uprighting is shortening of treatment time in comparison to orthodontic uprighting and salvaging of mandibular second molars that may otherwise require removal. Complications are unusual and relatively minor but may include infections or abscess formation, root fracture , and periodontal pockets.