Conventional wisdom and the surgical exposure of impacted teeth.
OBJECTIVE
To provide evidence against the notion that direct contact between the crown of an impacted tooth and alveolar bone is an impediment to orthodontically assisted eruption of teeth.


METHODS
The Department of Orthodontics at the Hebrew University-Hadassah School of Dental Medicine, in Jerusalem, Israel, and the private practices of the authors.


METHODS
Patients reported were those affected by impacted teeth, including individuals who were normal healthy patients, with and without resorption of the adjacent incisor roots, as well as individuals suffering from Cleidocranial dysplasia and increased bone density, and individuals with autogenous and synthetic bone grafts. A closed eruption surgical technique was used in which only a small window was opened into the dental follicle of the impacted tooth, leaving a maximum amount of bone covering much of the crown surface. Orthodontic extrusion forces were then applied.


RESULTS
For all teeth, enamel-to-bone contact did not prevent a rapid response to the extrusive forces.


CONCLUSIONS
Radical removal of bone during the exposure of an impacted tooth is unnecessary and potentially may be harmful in terms of the periodontal prognosis of an otherwise successfully treated outcome.
Department of Orthodontics, Hebrew University-Hadassah School of Dental Medicine, Jerusalem, Israel. adrianb@cc.huji.ac.il
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A
Becker
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Casap
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Chaushu
D000539:Alveolar Process / Q000473:pathology / Q000601:surgery; D015519:Bone Density / Q000502:physiology; D001861:Bone Regeneration / Q000502:physiology; D018786:Bone Substitutes / Q000627:therapeutic use; D016025:Bone Transplantation / Q000502:physiology; D002972:Cleft Palate / Q000601:surgery; D002973:Cleidocranial Dysplasia / Q000150:complications; D003481:Cuspid / Q000473:pathology / Q000601:surgery; D003795:Dental Sac / Q000601:surgery; D005881:Gingiva / Q000473:pathology; D006801:Humans; D007180:Incisor / Q000473:pathology; D008297:Male; D010513:Periodontal Ligament / Q000473:pathology; D012391:Root Resorption / Q000503:physiopathology; D013524:Surgical Flaps; D019228:Tooth Crown / Q000473:pathology; D014087:Tooth Movement Techniques / Q000295:instrumentation / Q000379:methods*; D020390:Tooth Socket / Q000473:pathology; D014095:Tooth, Impacted / Q000601:surgery* / Q000628:therapy
D018786:Bone Substitutes