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Infra-occluded deciduous molars can pose a great challenge to clinicians. The management and treatment of a severely infra-occluded tooth often requires a multidisciplinary team (MDT) approach. This case report demonstrates the effective management of a 7-year-old girl who presented with a severely infra-occluded maxillary deciduous second molar. It highlights the importance of early diagnosis and appropriate intervention to help prevent further disruption to a patient's occlusal development. Following removal of the submerging deciduous molar, an upper sectional (2x4) fixed appliance was used to recreate sufficient space for the developing premolars and correct the occlusal discrepancies caused as a result of the infra-occlusion.
CPD/Clinical Relevance: A novel approach to managing an infra-occluded deciduous molar and correcting the associated space loss due to its submergence is described and the benefits of early MDT intervention are highlighted.
Article
Infra-occlusion, also known as submergence, is a term used to describe a tooth that fails to continue to erupt vertically and becomes positioned below the occlusal plane following the continued growth of the surrounding dentition.1 The most common cause of infra-occlusion is ankylosis.2 This can lead to the delayed exfoliation of primary teeth and affect the occlusal development of the permanent dentition. There are two main theories for ankylosis occurring: first, owing to local clinical factors, and secondly owing to genetic predisposition.3 Infra-occlusion is often diagnosed clinically; however, it is important to carry out appropriate radiographic investigations to rule out any abnormal pathology and to confirm the presence of the permanent successors. Congenitally missing premolars are commonly associated with infra-occluded deciduous molars.4 The incidence of an infra-occluded primary tooth with a missing permanent successor has been reported at 12.9%.5 The reported prevalence of infra-occlusion varies enormously between 1% and 35%.6,7 Kurol et al reported infra-occlusion prevalence at 9%.8
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