Extreme Tooth Impaction and Its Resolution

Operative decisions in relation to the resolution of impacted teeth with extreme ectopia frequently result in extraction of the tooth and orthodontic treatment planning that aims to achieve an optimum alignment and occlusion in its absence. As the result, many compromises are made in function, appearance, and longevity of the outcome. The decision to abandon the tooth is sometimes justified by rules promulgated by scientific studies of large samples of similar cases, but it often is because of the difficulty in accurately defining its 3-dimensional location, sometimes because its orthodontic resolution may require an unorthodox approach, and occasionally because the operator may have never before seen a similar case. The present article discusses these issues and offers 3 widely differing case reports to show how, with proper planning, excellent outcomes may be achieved in the face of what may initially appear to be an intractable situation.