Impacted Mandibular First Molar: A Rare Riddle

Tooth impaction incidence is in the range of 5.6 to 18.8% of the population. Eruption failure of the first permanent molar is very rare; the prevalence is 0.01% of the population. The permanent molars are of particular importance in providing adequate occlusal support as well as coordinating facial growth. Failure of the eruption of permanent molars might lead to an array of complications like a reduction in the vertical dimension, extrusion of the antagonist teeth, a posterior open bite, inclination and resorption of adjacent teeth, and cyst formation. Various treatment modalities for impacted teeth include periodic observation, orthodontic relocation, and partial dislocation. More invasively, surgical exposure and extraction of teeth before prosthetic treatment may be performed. It is imperative to diagnose and manage the condition early, as delayed treatment may result in a myriad of problems, like a decreased force of the spontaneous eruption, a decreased percentage of treatment success, and a prolonged period of treatment, increasing the complications furthermore. Because of the importance of permanent molars, eruptive guidance is required before impacted tooth extraction. This article summarizes a case in which the surgical-orthodontic combined approach to the impacted mandibular first molar avoided the need for prolonged orthodontic treatment that would have required repositioning the deeply impacted first molar to the dental arch. As an outcome, patient satisfaction improves.