com
Dr. Giancotti is an Assistant Professor and Dr. Greco is a postgraduate student, Department of Orthodontics, and Dr. Germano is a Clinical
Consultant, Department of Oral Surgery, Fatebenefratelli Hospital, University of Rome “Tor Vergata”, Rome, Italy. Contact Dr. Giancotti at Viale
Gorizia 24/c, 00198 Rome, Italy; e-mail: giancott@uniroma2.it.
sistance generates an appropriate biomechanical to compensate for the lack of mandibular develop-
system. ment. Because the maxillary third molars were too
• Nickel titanium springs exert a continuous force close to the maxillary sinus for safe extraction, the
without requiring reactivation. inclined and overerupted maxillary second molars
were extracted.
The G-Molar-Up technique was attempted
Case Report
first on the left side of the lower arch. In a single
A 15-year-old male presented with a Class II surgical appointment, a miniscrew (Excalibur
malocclusion and a severe deep bite (Fig. 2). The SIA,*** 10mm long, 1.8mm in diameter) was in
panoramic radiograph showed deep impaction of serted in the retromolar area; the mandibular left
the mandibular second molars and severe impac- third molar was extracted; and the G-Molar-Up
tion of the maxillary third molars. The treatment device was connected to the miniscrew head and
plan involved resolution of the mandibular and bonded to the exposed surface of the second molar
maxillary molar impactions, followed by surgery (Fig. 3).
Two months later, the lower right third molar
was extracted. Over the following two months, the
second molar showed slight spontaneous upright-
ing, somewhat reducing the severity of impaction
(Fig. 4A). At this point, a G-Molar-Up device was
bonded to the right second molar, with traction
from a miniscrew in the retromolar region (Fig. 4B).
No reactivations of the coil springs were re
***SIA Orthodontic Manufacturer, Caserta, Italy; www.
Fig. 1 A. G-Molar-Up auxiliary. siaorthodontics.com.
Fig. 2 15-year-old male patient with Class II skeletal and dental maloc-
clusion before treatment. Upper second molars are extruded and third
molars impacted; lower second and third molars are horizontally ori-
ented, with second molars deeply impacted.
A B C
Fig. 3 A. Miniscrew placed in lower left retromolar region. B. Lower left third molar extracted. C. G-Molar-Up
auxiliary attached between miniscrew and deeply impacted lower left second molar.
A B
Fig. 4 A. Spontaneous uprighting of lower right second molar after extraction of third molar. B. G-Molar-Up
auxiliary bonded to lower right second molar and activated.
quired, although the mesh attachment was rebond- erupted into the second-molar positions, and the
ed more proximally when the mesial surface of patient was scheduled for a recall appointment to
each second molar was accessible (Fig. 5). After plan future surgical treatment.
about 10 months of traction, the crown of the lower
left second molar was accessible enough to bond
Conclusion
a fixed sectional appliance for refinement of the
molar position and torque (Fig. 6A). Three months Orthodontic treatment involving eruption
later, the same procedure was followed with the and uprighting of deeply impacted mandibular
lower right second molar (Fig. 6B). second molars requires careful timing of third-
After 18 months of active treatment, both molar extractions and space-opening forces. More
mandibular second molars had been completely over, the planned biomechanics must provide an
uprighted and moved into their proper positions, efficient force system while minimizing undesir-
with most of the tooth movement effected by the able side effects. The G-Molar-Up system, as
G-Molar-Up auxiliaries (Fig. 7). In the meantime, shown here, is a predictable treatment option in
the maxillary third molars had spontaneously such cases.
B
Fig. 5 A. Progress of lower left second-molar eruption over three months, including relocation of bonded
mesh pad to mesiobuccal cusp. B. Progress of lower right second-molar eruption over three months,
including relocation of bonded mesh pad to mesial surface.
A B B
Fig. 6 Brackets and sectional nickel titanium wires placed for right (A) and left (B) second-molar positioning
and torquing.
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