Treatment Indications & Timings
Interceptive treatment indications:
➤ Early loss of deciduous molars
Early loss of deciduous molars will often require space maintainers to prevent space loss and the increased risks of ectopic premolars.
➤ Over-retained deciduous molar or obstruction
An over-retained deciduous molar, such as an ankylosed D or E, or obstructions, such as a supernumerary or cyst, can cause a deviation of the premolar eruption path. Removal of these obstructions are warranted for interceptive treatment.
➤ Radiographic signs of an ectopic premolar
Detecting a premolar which has deviated off its normal eruption path or the presence of an obstruction on a panoramic radiograph or similar should be investigated.
Comprehensive treatment indications
➤ Damage to adjacent teeth and structures
- Panoramic radiographs, periapical radiographs or CBCTs are effective imaging techniques to determine root resorption of adjacent teeth.
- Damage to adjacent teeth by root resorption requires intervention of the premolar ectopia.
➤ Crowding due to ectopic teeth
- Ectopic premolars which erupt are often displaced out of the arch form and a sign of severe crowding. This can be a significant handicap to the patient and a strong indication for treatment.
➤ Aesthetic concerns of ectopic teeth
- Buccally ectopic and erupted premolars may have a prominence in the patient’s smile line.
- There may often also be a midline deviation and associated crowding.
- These factors are all indications for orthodontic treatment.
➤ Trauma to soft tissues
- Ectopic premolars which erupt can cause localised trauma to surrounding alveolar mucosa, tongue or buccal mucosa on normal function. This can be a significant handicap to the patient and is an indication for treatment.
