Correcting ectopic first permanent molars with metal or elastic separators.

Introduction Ectopic eruption of a first permanent molar" is a developmental disturbance in which the mesially directed path of eruption results in resorption of the second primary molar. Pulver and Bjerklin found no specific etiologic factor for ectopic eruption, but noted that it appeared more commonly among siblings^ and was not specific to any quadrant. Different modes of treatment have been proposed in the literature, ranging from orthodontic band and springs" to Croll's bilateral band and wire appliance" and Grim's removable Hawley appliance with a kick spring to distalize the trapped molar. These appliances required the patient's cooperation, and some needed preparation of the first permanent molar. Like previous band and wire appliances, the wires also tend to impinge on the gingiva or the occlusal surface, making the appliance ineffective and difficult to use. In severe cases, when extracting the second primary molar and regaining space for the eruption of the ectopic first molar are necessary, cervical headgear and the ACCO appliance have been used to distalize the first permanent molar. Elastic separators, deimpactors, and helical springs have been used for the correction of ectopically erupting permanent molars. However, they cannot be used on moderate or severe cases and the spring does not provide sufficient force to move the permanent molar. The purpose of this article is to present a simple technique using both a metal and elastic separator to correct ectopically erupting permanent maxillary and mandibular molars. The technique does not use an impression, laboratory time, etching or involve damage to the permanent teeth and can be used in mild, moderate, and severe cases.