Surgical repositioning of impacted mandibular second molar teeth.

Impacted second molars refractory to orthodontic treatment are frequent problems. The family dentist and the orthodontist should be on the alert for them. A philosophy for their management and the authors' experience over the past 13 years are presented. The proper time for definitive treatment of these impactions is during early adolescence, generally in the 11- to 14-year range. Impaction of the second molar is usually a problem of arch length deficiency. There may be an associated problem with a third molar impaction. The alternatives for impacted second molar treatments are surgical repositioning with or without adjacent third molar removal, removal of the second molar allowing the third molar to erupt, and transplantation of the third molar to the second molar socket. In the authors' experience, surgical repositioning has provided the most promising results of the three choices. Technical aspects of surgical repositioning are discussed along with case selection criteria. Six cases are presented to demonstrate typical problems and their management. With proper timing and intervention, the prognosis is excellent for repositioning second molar impactions.