Case Study 41 – Crowding

This patient’s upper first permanent molars (maxillary first permanent molars) were impacted/stuck under the back edge of the upper primary second molars (distal of the maxillary primary second molar). He had a retainer on his upper teeth which was used to push his upper first molars back. Also, we flossed a “separator” between the contacts of the teeth to further address the impactions. Within about 2 months, his upper first permanent molars were out from under the edge of the upper second primary molars. He waited until all remaining primary teeth were gone and all of his permanent teeth were present before he eventually had a second phase of orthodontic treatment. By moving the upper first permanent molars out from a position of impaction, he was able to preserve the upper primary second molars. Preservation of the upper primary second molars meant that he had primary teeth to hold space for the eventual eruption of his upper second premolars (adult teeth).

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