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How do we solve trans-alveolar impaction? A 10-year-old boy with two impaction teeth on the upper arch. Especially for the left canine, it is a trans-alveolar impacted tooth, and the position is relatively high. The first, Diagnosis and Treatment Plan. Since the patient is 10 years old, both impaction teeth are still in root formation stage, which gives us a very important message that they both have eruption potential. Following that, we evaluate the direction of the impaction teeth by CBCT X-ray. CBCT X-ray provides us a clear vision of the impacted teeth location. In this case, you may see the direction of the 23 is not towards the occlusal plane. 15 is towards it, but without enough space for it to emerge. For the 1st step, open coil springs were used to create space. And after 9 months, the space was well prepared. Then we organized a small surgery to save the 23 first. We confirmed the position with the CBCT again, and then we made a flap to find the canine. In this case, we used full flap elevation. And after the flap reflection, we found the crown of the 23. Then we removed the surrounding bone to expose more contour to have better vision. The next step, we had extended the flap a bit more because we wanted to place the bondable eyelet with power chain on the buccal side of the tooth. Once we had attached it, we confirmed the eruption path of the impaction. Pay attention here. To help relieve the burden of this poor impacted canine, you just need one carbide bur to trim some bone of the eruption path, which can make the 23’s life way easier and eruption faster, since there are less obstacles on the eruption path. Then we placed the screw and the 3D lever arm. Make sure the direction of the 3D lever arm is outward, backward, and downward. After we hooked the power chain to the arm, we combined the arm with the wire by ligature, which acted as a self guard to prevent over-pulling the tooth. For the suture, we used close eruption technique in this case. We continuously tracked the impacted 23. And after 6 months, the 23 had came into sight. Usually, we need torquing spring to correct the torque of the tooth. In a total of 18 months, the high impacted canine was well positioned. Till this point, if you were really concentrated in the past few minutes, then you may notice there is something missing that I haven’t mentioned yet. Yes, there are 2 impacted teeth in this case. And do you see the little miracle happen? The second premolar had erupted. All we had done was just wait and see. The only thing we did here was just create the space with open coil spring and wait for it to spontaneously pop out, and then we bond the brackets. So for the final result, we spent a total of 21 months, and both impactions were corrected. We can see the teeth are all in acceptable alignment. Therefore, age and direction are the first priorities to analyze while we encounter impaction because it will determine whether we need surgical intervention or not. In this case, we had two different situations, and the treatment was totally different. To make it even clearer, we have summarized all the key points by timeline in this slide. Don’t forget to take a screenshot and continue following us. We look forward to seeing you again. Thank you.
