Clinical aid in placing brass wires to treat ectopically erupting permanent first molars.

E ctopic eruption of the permanent first molar is a local eruption disturbance in the developing permanent dentition. This abnormal eruption pattern is most commonly seen in the maxillary arch. The abnormal mesioangular eruption path of the maxillary first molar causes resorption of the distal root of the adjacent primary second molar. Progression of ectopic eruption may cause impacted permanent first molars, possible pulpal infection, and/or premature loss of the primary second molar. Early loss of the primary second molar may result in space loss and impaction of the second premolar as well as mesial tipping of the permanent first molar. Ectopically erupting permanent maxillary first molars occur in about 3% of the population. A higher prevalence of this anomaly has been reported in siblings (19.8% ) and in children with cleft lip and palate (25%). Sixty-six percent of these cases are reported to be reversible by age 7 (jump type).' The remaining cases are irreversible (hold type) and require treatment.' Various treatment techniques have been reported to correct ectopically erupting permanent first molars. In cases with minimal impaction, the first molars can be deimpacted with interproximal wedging methods (e.g., brass wire technique, spring-type deimpactor,' or elastic separators). When the impaction is severe, distal tipping techniques are required. These methods include removable appliance with finger spring, Humphrey appliance, unilateral or bilateral reverse band and loop with a distal spur,' sectional wire with open coil spring, and Cetlin appliance/headgear. Before elastic separators were introduced, brass wire had frequently been used to separate posterior teeth, allowing molar band seating. It is also a convenient and economic method for correcting minimally impacted ectopically erupting permanent first molars. However, its use is limited because the softness of brass wire makes it difficult to pass between the primary second molars and impacted permanent first molars. When the permanent first molars are more subgingival, brass wire may become distorted and locked by the irregular surface of the resorbing distal root of the primary molars during placement. Repeated trials to insert the distorted brass wire can cause soft tissue damage. Grossman proposed making a soft tissue incision to allow brass wire to pass apically to the contact. This article introduces a clinical aid in placing brass wires in cases of ectopically erupting maxillary permanent first molars.