Mesially erupting mandibular second molars continued.  When we diagnose a mesially tipping mandibular second molar as it erupts we must look at the crowding present in the arch.  Many times crowding is present and that contributes to the molar’s deviation.  Premolar removal treatment must be considered as this will allow the lower first molars to drift mesially thus giving the second molar a better eruption path.  Lower second premolar removal facilitates this the best.  If the case is a borderline extraction case, mesially tipped mandibular second molars being present may swing the pendulum toward extraction of lower second premolars.

Mesially erupting mandibular second molars.  We have recently covered mesially erupting (ectopic) maxillary first molars.  It is not uncommon to see the lower second molars erupting with a mesial cant that can sometimes find them caught under the distal aspect of the first molar.  Diagnosing these early is important since once they are caught these second molars may continue to tip until they are almost horizontal and become unsalvageable.  If braces are in place and there is adequate room in the arch we can attach a second molar bracket and upright the tipped tooth.  It may be necessary to remove some of the buccal tissue with a laser in order place the bracket.  Next week more on this topic when there is lower crowding.