Orthodontic Treatment of Impacted Teeth. Adrian Becker

positional diagnosis of an impacted tooth virtually foolproof, enabling the application of appropriately directed traction to resolve even the most difficult cases. Temporary orthodontic implants have provided the opportunity to resolve the impaction, in many cases without the need for an orthodontic appliance and before orthopaedic treatment per se is begun. They have opened up a whole new area to exploit for mechanotherapeutic solutions to many of the problems we face.

      The first edition was based on the findings of clinical research that was carried out over a long period of time in Jerusalem during the 1980s and 1990s. In much the same way, this second edition documents the findings of ongoing and evidence‐based studies carried out by largely the same small group of clinical investigators, since then. Most of these published articles were the product of an excellent working collaboration with Dr Stella Chaushu, a former student of mine and now Senior Lecturer in the Department of Orthodontics. Her industrious and intellectual qualities have contributed to the output of a large number of valuable published studies in just a few short years.

      Under the leadership of Professor Refael Zeltser, chairperson of the Department of Oral and Maxillo‐facial Surgery at the Hebrew University – Hadassah School of Dental Medicine in Jerusalem, a whole generation of young surgeons has grown up who exhibit the ability to appreciate and value the finer points of cooperation with the orthodontist. Dr Eran Regev and Dr Nardi Casap in Jerusalem, Dr Gavriel Chaushu, the chairperson at the parallel department of the Sourasky Hospital in Tel Aviv, and Dr Harvey Samen in private practice, have worked closely with me in the treatment of our patients. Many of these cases are illustrated in the pages of this book. I derive considerable satisfaction from seeing the surgical expertise learned from and handed down by Professors Arye Shteyer and Joshua Lustmann being practised by these highly professional colleagues, on a day‐by‐day basis. Their awareness and perception of the significance of their work in determining the long‐term outcome have helped me to aim for the highest quality results and the well‐being of the patient. They deserve my gratitude.

      In the preparation of this book, I have called upon and am grateful for the expertise of a small number of people, who have provided me with authoritative and essential information that has permitted me to make the text more comprehensive and more complete. In particular, I mention Dr James Mah and Dr David Hatcher in California, with regard to cone beam CT imaging and Dr Joe Noar in London, with regard to the use of magnets.

      I have given and continue to give courses and lectures on the subject of impacted teeth in many places all over the world which, in the past few years, have been presented in collaboration with Dr Stella Chaushu. It is at these meetings that I come across some of the most interesting and rare material. I am indebted to several individual members of these audiences who frequently approach us during a coffee break, radiograph in hand, with some truly remarkable conditions, several of which have been included in this book, together with appropriate recognition.

      My colleagues in the Orthodontic Department in Jerusalem have often become the sounding board for many of the ideas that are presented herein and I am thankful to them for the discussions that we have had. I appreciate their taking the stand of devil’s advocate in these situations, forcing me to justify or to discard. Nevertheless, none of this would ever have been published had I not spent so many years teaching the students on our postgraduate orthodontics specialty course. These future orthodontic standard bearers are privileged to learn from the various individual teaching preferences of mentors who rely on years of experience in practice, particularly when it comes to this bracket or that, this treatment philosophy or that and this orthodontic guru or that. Additionally, they have learned to look for and even demand clinical ideas and treatment policies that have a proven evidence‐based, track record to commend them and to justify their use. I know of no other postgraduate orthodontic course, worldwide, in which the subject of impacted teeth is explicitly taught in a comprehensive and integrative manner, including a designated weekly clinical session. It was this more than any other factor which encouraged me to embark on this mammoth task.

      The future of our profession and the long‐term superior care of the even younger generation of our patients is in the hands of these aspiring orthodontists. I am grateful to them for having, perhaps unwittingly, cajoled me into writing this text. I hope that it will be a source of information for them as they undertake the challenge of some of the more difficult, unconventional and unusual cases that they will inevitably come across in practice and for which they will be expected to find appropriate therapeutic answers.

      I wish to thank the following publishers of two articles, as follows:Several of the illustrations comprising Figure 7.8 were reprinted from the World Journal of Orthodontics. Vol. 5. The Role of Digital Volume Tomography in the Imaging of Impacted Teeth, by Adrian Becker and Stella Chaushu. 2004. with permission from Quintessence Publishing Co, Inc.

      Several of the illustrations comprising Figure 11.9 were reprinted from Healthy periodontium with bone and soft tissue regeneration following orthodontic‐surgical retrieval of teeth impacted within cysts, by Adrian Becker & Stella Chaushu, in Biological Mechanisms of Tooth Movement and Craniofacial Adaptation. Proceedings of the Fourth International Conference, 2004, pp. 155–162. Z Davidovitch and J Mah, editors. Sponsored by the Harvard Society for the Advancement of Orthodontics. Reproduced with permission.

      Adrian Becker

      Jerusalem, Israel

      Preface to the Third Edition

      Only 14 years have passed since the publication of the first edition of this book and much has changed in orthodontics, in general and in the context of the treatment of impacted teeth, in particular. The subject material that appeared in that small monograph has developed several fold, in the light of research and the advent of new technology. These two factors have encouraged the orthodontic specialist to be more discerning in the diagnosis of pathology and more innovative and resourceful in the application of directional traction. Mistaken positional diagnosis and surgical blunders have become less common and consequent failure to resolve the impaction less frequent. At the same time, they have permitted the orthodontist to become more adventurous and to successfully apply his/her knowledge and experience to the treatment of cases where previously the tooth would have been scheduled for extraction. If this third edition may yet contribute to the furtherance of this favorable trend in any way, I will consider that my mission will have been accomplished.

      It was the aim in each of the earlier editions of this book to present reasoned principles of treatment for tooth impaction, illustrated by examples from real life. Following these principles to their logical conclusion, Chapter 15 has been added in the present edition to illustrate how some extreme examples or cases with concurrent complicating factors may be resolved, several of which involve the expertise of colleagues in our sister specialties. Oddities, such as the “banana” third molar, with its impacting influence on its immediate neighbor, are also new to this edition.

      Failure has intrigued me for a long time and, while Chapter 12 was new to the second edition, it has been enlarged now in the third. The recognition and importance of invasive cervical root resorption (ICRR) as a cause of failure to resolve an affected impacted tooth seems to be hardly known within the profession. There is a section added herein which discusses the etiology of this pathological entity, its disease process, its potency as a factor for failure and speculates on accepted standard procedures that may predispose to its occurrence.

      To write a textbook or to update an edition may take several years. Once it is finished, it has to go through the many months of the publishing process, with questions and corrections, proofreading and amendments. In the meantime, what was written becomes progressively obsolete – new ideas are put forward in the journals, some are disciplined studies and others just innovative clinical methods learned in the very singular one‐on‐one situation in the orthodontic operatory between orthodontist and patient. In order to provide at least a partial answer to this, I have set up an internet website at www.dr‐adrianbecker.