Fig. 18 Fig. 19 Fig. 21 Fig. 20 This process is slow so expect the Turbo nitie wire to be needed 6-10 months. It will perform optimally if an upper MBT TM cuspid bracket prescription is used. These will have the most negative torque prescription available. (Fig. 21) is raised no enamel or mini-mal enamel is visible. Palatal bone must be removed to locate these impacted teeth. Unless you are particularly adept at oral surgery, these cases often should be referred to an oral surgeon because of the complica-tions with surgical access, moisture control, and patient management. Because so many of the complica-tions associated with impacted cuspids are cases where the cuspids are impacted within the alveolus it may be best to “share-the-risk” with a surgical specialist. (Fig. 22) Occasionally a vertically Fig. 22 impacted tooth within the alveolus can be best exposed with a buccal surgical access: bone may need to be removed but the buccal surgical access is typically uneventful once hemostasis is established. (Fig. 23) Here is an example of post-op intructions given to the patient after the surgery: POST-OP INSTRUCTIONS AFTER SURGICAL EXPOSURE ᕡ Do not rinse mouth vigorously during the first 24 hours follow-ᕣ Impacted within the alveolus By far, these are the cases that present with the most complications! These are cases that most likely have damage to the adjacent teeth caused by the eruption follicle of the impacted cuspid. And often these cases require more than three years to treat and are unrewarding to all involved. In these cases, after a palatal flap 28 Winter 2019 JAOS
Journal of the American Orthodontic Society Winter 2019: Page 28
