A segmental approach to mandibular molar uprighting

Diagnosis and treatment in molar uprighting are discussed. The over-all objective in molar uprighting is ideal positioning of the molar which will eventually become an abutment tooth for a fixed prosthesis. The ideal position will provide an optimal periodontal environment for the molar(s). The specific objectives concerning protection against inflammatory periodontal diseases and occlusal traumatism, which together determine the optimal periodontal environment, are explained. Emphasis is placed on the biomechanics of molar uprighting which will achieve the desired periodontal treatment result. The specific technique recommended for the instances in which the molar is considerably angulated involves a segmental approach which utilizes a modification of the Burstone root spring. Proper application results in the dissociation of the correction of angulation and the extrusion of the molar tooth. When extrusion of the periodontally involved molar is required, then it should follow the correction of molar angulation. Other advantages of this approach involve the precision and ease of symmetrical preactivation, favorable load/deflection considerations, the low level of patient discomfort, and the reduced tendency of normal function distorting or dislodging the spring. This technique is compared by these parameters to other popular molar-uprighting techniques. It is recognized that a multidisciplinary approach to this type of dental therapy is ideal and that since treatment planning in individual cases varies greatly, each malocclusion and associated periodontal involvement should be evaluated on an individual case basis.