An adolescent patient with multiple impacted teeth

Multiple impacted permanent teeth is uncommon and rarely reported in the literature. This article reports the treatment of an adolescent patient with multiple impacted teeth without systemic disease. A 9-year 2-month-old boy complained of a delay of eruption of the first molars. All first molars were unerupted, and the left deciduous second molar was a submerged tooth. The panoramic radiograph showed all permanent teeth except the incisors were unerupted and, especially for the first molars, spontaneous eruption was not expected. His medical history was uneventful. A lingual arch appliance and a segmental arch were placed on the mandibular and maxillary dentitions, respectively, to guide eruption of the impacted first molars. After traction of the first molars, eruption of the impacted lower premolars was induced. Furthermore, at 15 years the impacted mandibular second molars were also positioned properly by use of the lingual arch with auxiliary wires. After achieving traction of the impacted teeth, tooth alignment was initiated using multibracket appliances after the bilateral extraction of the second premolars. After 22 months of treatment with multibracket appliances, an acceptable occlusion was achieved with a Class I molar relationship. After 2 years of retention an acceptable occlusion was maintained without any relapse in the occlusion. Since a delay in the treatment of impacted teeth may induce secondary problems such as root dilacerations and ankylosis, it is highly recommended to perform early treatment of multiple impacted teeth during adolescence.