|Year : 2007 | Volume
| Issue : 1 | Page : 36-38
Treatment of space loss caused by submerged maxillary second primary molar
S Karacay1, G Guven2, F Basak2
1 Department of Orthodontics, Gulhane M. Medical Academy Center of Dental Sciences, Ankara, Turkey
2 Department of Pedodontics, Gulhane M. Medical Academy Center of Dental Sciences, Ankara, Turkey
GATA Dis Hekimligi Bilimleri Merkezi, Pedodonti AD. 06018, Etlik / Ankara
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Submersion is a clinical term describing a tooth depressed below the occlusal plane. In this case report, we present the treatment of a patient who had totally submerged primary maxillary second molar, which caused impaction of the second premolar and space loss in the maxillary arch due to tipping of adjacent teeth. A 12-year-old girl was referred to the pediatric dentistry clinic. The intra-oral examination revealed that right maxillary second primary molar was localized buccal side of posterior maxillary alveolar process, being almost completely covered by gingiva and adjacent teeth inclined closing the space of the related teeth completely. Periapical radiograph demonstrated that maxillary second premolar was impacted. Based on clinical and radiographic findings, maxillary primary second molar was extracted. Headgear was used for the distalization of maxillary right first molar in order to create space for the impacted second premolar. Eruption begun spontaneously 6 months later.
Keywords: Impacted permanent teeth, submerged primary teeth, treatment
|How to cite this article:|
Karacay S, Guven G, Basak F. Treatment of space loss caused by submerged maxillary second primary molar. J Indian Soc Pedod Prev Dent 2007;25:36-8
|How to cite this URL:|
Karacay S, Guven G, Basak F. Treatment of space loss caused by submerged maxillary second primary molar. J Indian Soc Pedod Prev Dent [serial online] 2007 [cited 2020 Dec 5];25:36-8. Available from: https://www.jisppd.com/text.asp?2007/25/1/36/31988
| Introduction|| |
Submergence is a term defining a tooth that remains below the occlusal plane.  Dental ankylosis is thought to be major etiological mechanism of submergence. ,[2,,, Studies report prevalence rates of submerged primary teeth to be from 1.3 to 8.9% of the population with a significantly higher incidence between siblings. ,,,, Generally, primary mandibular molars are affected more than 10 times as often as primary maxillary molars. 
Submerged primary molars may cause several problems in dental arch such as space loss, tipping of adjacent teeth, supra-eruption of the antagonists and dislocations of permanent teeth lying under the primary tooth. 
In this case report, we present the treatment of a patient who had totally submerged maxillary second primary molar, which caused impaction of the second premolar and space loss in the maxillary arch due to tipping of adjacent teeth.
| Case Report|| |
A 12-year-old girl was referred to the pediatric dentistry clinic when she noticed the submerged primary maxillary right second molar tooth that erupted at the level of permanent maxillary right first molar and maxillary right second premolar roots. Medical history was non-contributory. The dental history obtained by anamnesis did not reveal dental infection or trauma. Extra- and intra-oral clinical examination showed normal development of dentition except the abnormal eruption of primary maxillary right second molar and absence of maxillary right second premolar. Primary maxillary right second molar could barely be detected at first examination. It was localized at the buccal side of posterior maxillary alveolar process, near the vestibular sulcus and almost completely covered by gingiva. Although the contralateral side revealed a Class I molar relationship, there was malocclusion because; the adjacent teeth inclined closing the space of the related teeth completely [Figure - 1].
The panoramic and periapical radiographs were taken to determine the presence and position of maxillary right second premolar tooth. Radiographs showed that the primary maxillary right second molar submerged in alveolar bone. There was also an unerupted maxillary second premolar. Fully developed and distally inclined premolar was located beside the submerged primary tooth [Figure - 2]a, b.
Based on clinical and radiographic findings, the submerged primary molar was extracted surgically [Figure - 3] and a cervical headgear was used to distalize and upright the tipped permanent maxillary right first molar. The tooth was distalized and cusp tip of the impacted second premolar was seen within 6 months. When Class I molar relationship was attained, pre-adjusted appliances (0.0180.022 inch) were placed in the maxillary arch and an open coil spring was inserted between permanent maxillary right first molar and first premolar so as to protect the space until the eruption of the impacted second premolar was completed. After a few months, the second premolar erupted without applying any force onto it [Figure - 4].
| Discussion|| |
Up to now various reasons were reported for submerged teeth. ,, The most frequently stated cause of this phenomenon is ankylosis, that is, the fusion of the tooth with the surrounding bone. , A genetic input has also been suggested, based on observations in several members of the same family. , The dental, medical and familial history of our patient did not contribute to explain the reasons of submergence.
It is established in dental literature that the treatment plan of a submerged primary tooth depends on degree of abnormality, the presence of its successor permanent teeth and time of onset. ,, The simplest classification of this abnormality can be described as slight, moderate and severe, seems to be the most useful to the clinician which is 'Slight' defined as between occlusal surface and the proximal contact, 'moderate' being within the occlusal-gingival dimensions of the inter-proximal contact point and severe being anywhere below the inter-proximal contact point.  The related tooth of our patient remained under the cervical regions of the adjacent teeth. It was a severe submersion case according to author's classification and the treatment was planned based on this finding.
Most submerged primary molars with a permanent successor have been shown to exfoliate normally by the erupting successor resorbing the area of fusion.  However extensive bony ankylosis may prevent normal exfoliation, causing future alignment problems. , Studies note a 6 months delay as an acceptable exfoliation schedule for ankylosed primary molars and that degree of infra-occlusion is not related to time of delay. ,, In case of severe submersion, clinical disturbances may include incomplete alveolar process development, lack of normal mesial drift, non-response to orthodontic forces, retained primary teeth with or without a successor and impaction of the successor, a depressed tooth with tipping adjacent teeth, supra-eruption of opposing teeth, lateral open bite and higher frequency of crossbites. , According to Kurol and Thilander,  these disturbances have no long-term effects on occlusion. On the contrary, Backer and Shochat  and Karnei-Reem  notify that they have detected a significant deviation of the dental inter-incisor midline toward the affected side. In this case, submerged maxillary second primary molar impacted its permanent successor and because of space loss, the adjacent teeth inclined closing the space of related tooth completely. In the present case, there was no deviation of the dental inter-incisor midline, but severe malocclusion occurred at the affected side.
The main purpose of submerged primary molars with successors is to allow the normal eruption of the successor.  The first decision is to determine the time of onset. Late onset cases usually are in slight infra-occlusion; hence, treatment objectives are focused on exfoliation of the ankylosed tooth. Early onset cases are divided into those diagnosed early and those diagnosed late. Late diagnoses of early onset conditions are likely to present with tipped adjacent teeth, supra-eruption of the antagonist and therefore indicate orthodontic intervention followed by extraction. 
The present case was a rare early onset-late diagnosed case. Treatment was planned based on findings; after extraction of submerged tooth orthodontic procedures were applied to regain space for the successor premolar tooth. After regainment of lost space, the maxillary second premolar erupted spontaneously.
| References|| |
|1.||Altay N, Cengiz SB. Space-regaining treatment for a submerged primary molar: A case report. Int J Paediatr Dent 2002;12:286-9. [PUBMED] [FULLTEXT]|
|2.||Ekim SL, Hatibovic-Kofman S. A treatment decision-making model for infraoccluded primary molars. Int J Paediatr Dent 2001;11:340-6. [PUBMED] [FULLTEXT]|
|3.||Suprabha BS, Pai SM. Ankylosis of primary molar along with congenitally missing first permanent molar. J Indian Soc Pedod Prev Dent 2006;24:35-7. |
|4.||Kurol J. Infraocclusion of primary molars and epidemiologic and familial study. Commun Dent Oral Epidemiol 1981;9:94-102. [PUBMED] |
|5.||Douglass J, Tinanoff N. The etiology, prevalence and sequelae of infraocclusion of primary molars. J Dent Child 1991;58:481-3. [PUBMED] |
|6.||Dewhurst SN, Harris JC, Bedi R. Infraocclusion of primary molars in monozygotic twins: Report of two cases. Int J Paediatr Dent 1997;7:25-30. [PUBMED] |
|7.||McDonald RE, Avery DR. Dentistry for the child and adolescent, 6 th ed. CV Mosby: St. Louis; 1997. p. 198-205. |
|8.||Mueller CT, Gellin ME, Kaplan AL, Bohannan HM. Prevalence of ankylosis of primary molars in different regions of the United States. J Dent Child 1983;50:213-8. [PUBMED] |
|9.||Rasmussen P, Kotsaki A. Inherited primary failure of eruption in the primary dentititon: Report of five cases. J Dent Child 1997;64:43-7. [PUBMED] |
|10.||Kurol J, Thilander B. Infraocclussion of primary molars and the effect on occlusal development: A longitudinal study. Eur J Orthod 1984;6:277-93. [PUBMED] [FULLTEXT]|
|11.||Becker A, Shochat S. Submergence of a deciduous tooth: Its ramifications on the dentition and treatment of the resulting malocclusion. Am J Orthod 1982;81:240-4. [PUBMED] |
|12.||Karnei-Reem R. Infraocclusion and its effect on the dental arch. DMD Thesis, Hebrw University: Jerusalem, Israel; 1990. |
|13.||Nazif MM, Zullo T, Paulette S. The effects of primary molar ankylosis on root resorption and the development of permanent successors. J Dent Child 1986;53:115-8. [PUBMED] |
[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4]