Challenges and Solutions in Molar Verticalisation: A Comprehensive Perspective

Authors

  • Pablo Joel Azua Universidad Abierta Interamericana, Facultad de Medicina y Ciencias de la Salud, Carrera de Odontología. Buenos Aires, Argentina Author
  • María Isabel Brusca Universidad Abierta Interamericana, Facultad de Medicina y Ciencias de la Salud, Carrera de Odontología. Buenos Aires, Argentina Author https://orcid.org/0000-0001-9882-1912
  • María Laura Garzón Universidad Abierta Interamericana, Facultad de Medicina y Ciencias de la Salud, Carrera de Odontología. Buenos Aires, Argentina Author https://orcid.org/0009-0005-0312-6551
  • Atilio Vela Ferreira Universidad Abierta Interamericana, Facultad de Medicina y Ciencias de la Salud, Carrera de Odontología. Buenos Aires, Argentina Author

DOI:

https://doi.org/10.56294/hl2022155

Keywords:

biomechanics, malocclusion, mini-implants, Molar verticalisation, periodontal health

Abstract

Molar mesio-inclination represented one of the most frequent malocclusions in adults, mainly attributed to premature tooth loss. This problem affected both dental function and aesthetics, generating bone defects, periodontal pockets and occlusal interferences. Correction by molar verticalisation was essential to restore oral health and optimise prosthetic rehabilitation. The verticalisation process involved significant biomechanical challenges due to the need to apply precise and controlled forces. Devices such as cantilevers, T-springs and mini-implants were used, adjusting to the degree of inclination and periodontal conditions of the patient. Studies showed that the technique chosen depended on factors such as the severity of the inclination, the condition of the bone tissue and the position of adjacent teeth. Research evaluated the periodontal and biomechanical impact of these techniques. Although prolonged tilting did not significantly aggravate moderate periodontitis, plaque accumulation and inflammation were higher in tilted molars. Mini-implants proved to be the most efficient option, minimising periodontal stress and allowing better control of tooth movement. In conclusion, clinical success depended on a comprehensive evaluation that included the type of movement required, the forces applied and the design of the devices used. Proper planning allowed for improved occlusal and periodontal health, ensuring predictable and long-lasting results.

References

Márquez Reyes G, Olivera C. Verticalización de molares con sistema de cantilever doble: análisis de elementos finitos. OdontoInvestigación. 2017;25-39.

Zachrison BU, Bantleon HP. Optimal mechanics for mandibular molar uprighting. World J Orthod. 2005;6(1):80-7.

Martires S, Kamat NV, Dessai SR. A CBCT evaluation of molar uprighting by conventional versus microimplant-assisted methods: an in-vivo study. Dental Press J Orthod. 2018;23(3):35.e1-9.

Lundgren D, Kurol J, Thorstensson B, Hugoson A. Periodontal conditions around tipped and upright molars in adults: an intra-individual retrospective study. Eur J Orthod. 1992;14:449–55.

Wehrbein H, Diedrich P. Mesio-marginal findings at tilted molars: a histological-histomorphometric study. Eur J Orthod. 2001;23:663–70.

Turley PK. The management of mesially inclined/impacted mandibular permanent second molars. J World Fed Orthod. 2020;9(3S).

Tuncay OC, Biggerstaff RH, Cutcliffe JC, Berkowitz J. Molar uprighting with T-loop springs. J Am Dent Assoc. 1980;100(6):863-6.

Suri L, Gagari E, Vastardis H. Delayed tooth eruption: pathogenesis, diagnosis, and treatment. A literature review. Am J Orthod Dentofacial Orthop. 2004;126(4):432-45.

Sakima MT, Tatsuo PR. Técnica do Arco Segmentado de Burstone. Rev Dent Press Ortodon Ortop Maxilar. 2000;5(2):91-115.

Locks A, Locks RL, Locks LL. Diferentes abordagens para a verticalização de molares. Rev Clin Ortod Dental Press. 2015;14(4):32-8.

Raveli TB, Raveli DB, Almeida KC, Dos Santos Pinto A. Molar uprighting: a considerable and safe decision to avoid prosthetic treatment. Open Dent J. 2017;11:466-75.

Fu PS, Wang JC, Wu YM, Huang TK, Chen WC, Tseng YC, et al. Impacted mandibular second molars: a retrospective study of prevalence and treatment outcome. Angle Orthod. 2012;82(4):670-5.

Ho CJ, Lee YJ, Chiang CP, Lee MS. Halterman appliance used for uprighting ectopically erupted bilateral permanent mandibular first molars. J Dent Sci. 2019;14:206-8.

Pereira BSA, Seminario MP, Naveda R, Castanha JF, Garib D, Janson G. Mesioangulation of mandibular second molars: a case report. J Orthod. 2022;49(1):64-70.

Cheng JHC. Orthodontic uprighting of horizontally impacted second mandibular molar through innovative use of springs. J Dent Sci. 2023;18:939-41.

Barros SE, Janson G, Chiqueto K, Ferreira E, Rosing C. Expanding torque possibilities: a skeletally anchored torqued cantilever for uprighting "kissing molars". Am J Orthod Dentofacial Orthop. 2018;153:588-98.

Morita Y, Koga Y, Nguyen TA, Yoshida N. Biomechanical considerations for uprighting impacted mandibular molars. Korean J Orthod. 2020;50:268-77.

Shellhart WC, Oesterle LJ. Uprighting molars without extrusion. J Am Dent Assoc. 1999;130(3):381-5.

Tamer I, Öztaş E, Marşan G. Up-to-date approach in the treatment of impacted mandibular molars: a literature review. Turk J Orthod. 2020;33(3):183-91.

Park HS, Kyung HM, Sung JH. A simple method of molar uprighting with microimplant anchorage. J Clin Orthod. 2002;36:592-6.

Kim JW, Choi JY, Kim MJ, Bin X, Kim SH. A cone-beam computed tomography study on strategic uprighting of mandibular molars using a biocreative reverse curve system. Korean J Orthod. 2022;52(5):354-61.

Park JH, Choo HR, Choi JY, Chung KR, Kim SH. Evaluation of strategic uprighting of the mandibular molars using an orthodontic miniplate and a nickel-titanium reverse curve arch wire: preliminary cephalometric study. Korean J Orthod. 2021;51:179-88.

Chang C, Lin SY, Roberts WE. Forty consecutive ramus bone screws used to correct horizontally impacted mandibular molars. Int J Orthod Implantol. 2016;41:60-72.

Kim SH, Kook YA, Jeong DM, Lee W, Chung KR, Nelson G. Clinical application of accelerated osteogenic orthodontics and partially osseointegrated mini-implants for minor tooth movement. Am J Orthod Dentofacial Orthop. 2009;136:431-9.

Abrao AF, Domingos RG, De Paiva JB, Lagana DC, Abrao J. Photoelastic analysis of stress distribution in mandibular second molar roots caused by several uprighting mechanics. Am J Orthod Dentofacial Orthop. 2018;153:415-21.

Sbricoli L, Ricci S, Cattozzo A, Favero R, Bressan E, Sivolella S. Mandibular molar uprighting using skeletal anchorage: a novel approach. J Clin Med. 2022;11:3565.

Downloads

Published

2022-12-20

How to Cite

1.
Azua PJ, Brusca MI, Garzón ML, Vela Ferreira A. Challenges and Solutions in Molar Verticalisation: A Comprehensive Perspective. Health Leadership and Quality of Life [Internet]. 2022 Dec. 20 [cited 2025 Jul. 30];1:155. Available from: https://hl.ageditor.ar/index.php/hl/article/view/155