Orthodontic and Surgical Management of Impacted Teeth

Vincent G. Kokich, DDS, MSD, and David P. Mathews, DDS Quintessence Publishing Co., Chicago, Illinois

Dr. Vince Kokich and his colleague, Dr. David Mathews, felt that since little had been written on the interdisciplinary manner of diagnosing and treatment of impacted teeth that it warranted a comprehensive text illustrating theirs and others’ experiences with these vexing problems. Sadly, Dr. Kokich died before finishing the last chapter, but his son, Vince Kokich Jr.; his daughter, Mary; and his wife, Marilyn; helped Dr. Mathews finish this fine text.

In this book, which contains 177 pages and 422 photographs and images, the authors have attempted to address practically every type of dental impaction with simple but complete narratives supplemented by more than 400 unusually clear photographs and illustrations. They have dedicated chapters to impacted maxillary central incisors, labially impacted maxillary canines, palatally impacted canines, impacted premolars, impacted mandibular molars, and a final chapter on complications and adverse sequelae.

Drs. Kokich and Mathews acknowledge that the most commonly impacted teeth are the mandibular third molars, which they do not speak to, followed by maxillary canines, mandibular second premolars, and maxillary central incisors. They emphasize the importance of maintaining the integrity of the dental follicle of permanent teeth while removing supernumeraries. The doctors describe four methods for uncovering impacted maxillary central incisors: gingivectomy, apically positioned flap, the closed eruption technique, and surgical replantation. They use these and variations of them in the treatment of other impactions. Once teeth are uncovered, the doctors use a variety of techniques to bring the teeth into position, which includes the useful Ballista loop.

Labially impacted maxillary canines occur only one-third of the time, while palatally impacted canines occur two-thirds of the time. Drs. Kokich and Mathews emphasize the need to properly diagnose the impaction before choosing a method to uncover the teeth. They do not neglect interceptive treatment of potential maxillary canine impactions and counsel that extractions of primary canines and primary molars can often prevent impactions if performed early enough. More than 40% of the book pages concern maxillary canine impactions, which illustrates the complications these teeth offer surgeons and orthodontists.

These superb clinicians show some truly heroic therapies, but wisely advise readers to prudently consider removing the impacted canines rather than jeopardize adjacent teeth and expose patients to unnecessary trauma.

Surprisingly, the shortest chapter deals with the uncovering and alignment of impacted mandibular second molars, which is usually as clinically troublesome as the impacted maxillary canines.

The final chapter addresses complications and adverse sequelae, while acknowledging that inappropriate treatment of impacted teeth is a principal cause of litigation in orthodontics. Drs. Kokich and Mathews analyze each unfavorable outcome and offer diagnostic and therapeutic advice that avoids the problem — e.g., do not ligate impacted teeth and use judicious bone removal during the uncovering.

This paperback publication has durable pages with appealing layouts and clear fonts. The images offer first-rate clarity. Clearly, orthodontists and surgeons need to study this book together to strategize the complicated therapy that impacted teeth require.They won’t find a better or more comprehensive guide.
Book review by Dr. Larry White.

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