Management of a Horizontally Impacted Maxillary Second Premolar : A Case Report

Abstract

We report the case of an 11-year-old boy, who presented with difficult eruption due to a horizontally impacted maxillary premolar. Radiographic examination revealed a horizontally embedded maxillary left second premolar tooth embryo in close proximity with the first molar root. Treatment consisted of distal movement of the first molar to secure the eruption path, followed by opening and traction of the embedded tooth and improvement of torsion using a multi-bracket device. The direction of traction was determined based on dental computed tomography images. Subsequently, favorable results were obtained by guiding the tooth into the dentition without leading to root resorption of the adjacent teeth and abnormalities in periodontal tissues. The patient had a history of ipsilateral extraction of an odontogenic cyst, and based on his previous reports, the maxillary left first and second premolars showed marked distal tilting of the tooth axis, possibly due to expansion of the cyst.

In pediatric dentistry, it is important to identify factors that interfere with normal oral development at an early stage through regular intraoral examinations and radiographs. Interventions at the appropriate time are necessary to minimize invasive treatment.