Orthodontic Traction of a Deeply Impacted Mandibular Second Molar With Severe Root Dilaceration in Close Proximity to the Inferior Alveolar Canal: A Case Report.

BACKGROUND

Impaction of mandibular second molars is uncommon, particularly when associated with severe root dilaceration and intimate proximity to the inferior alveolar canal. Such cases present considerable diagnostic and therapeutic challenges because surgical extraction may result in neurosensory injury. This case report describes the successful interdisciplinary management of a deeply impacted mandibular second molar using controlled orthodontic traction supported by skeletal anchorage.

CASE PRESENTATION: An 18-year-old female presented seeking orthodontic treatment because of dissatisfaction with her smile esthetics. Clinical examination demonstrated a skeletal Class I relationship with increased vertical facial proportions, mild mandibular deviation, posterior crossbite, and reduced overjet and overbite. Panoramic radiography and cone-beam computed tomography (CBCT) revealed a deeply impacted mandibular left second molar with severe root dilaceration, intimate proximity to the inferior alveolar canal, and a pericoronal radiolucency suggestive of a dentigerous cyst.Following interdisciplinary consultation with oral and maxillofacial surgeons, orthodontic traction was selected as a conservative alternative to surgical extraction. Initial treatment included maxillary expansion, alignment, and space creation, followed by surgical exposure, marsupialization of the pericoronal lesion, and attachment of a gold chain. Controlled orthodontic traction was subsequently performed using fixed orthodontic appliances, temporary anchorage devices (TADs), and a customized auxiliary levering arm.

RESULTS

After 30 months of active treatment, the impacted mandibular second molar erupted successfully into functional occlusion while maintaining pulp vitality and without clinical evidence of inferior alveolar nerve injury. A stable occlusion was maintained throughout the 6-month follow-up period.

CONCLUSION

This case demonstrates that carefully planned interdisciplinary management combined with controlled skeletal anchorage-supported orthodontic traction can provide a safe and effective alternative to surgical extraction in selected patients with deeply impacted mandibular second molars presenting with severe root dilaceration and close proximity to the inferior alveolar canal.