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.