I appreciate their taking the stand of devil’s advocate in these situations, forcing me to justify or to discard. Nevertheless, none of this would ever have been published had I not spent so many years teaching the students on our postgraduate orthodontics specialty course. These future orthodontic standard bearers are privileged to learn from the various individual teaching preferences of mentors who rely on years of experience in practice, particularly when it comes to this bracket or that, this treatment philosophy or that and this orthodontic guru or that. Additionally, they have learned to look for and even demand clinical ideas and treatment policies that have a proven evidence‐based, track record to commend them and to justify their use. I know of no other postgraduate orthodontic course, worldwide, in which the subject of impacted teeth is explicitly taught in a comprehensive and integrative manner, including a designated weekly clinical session. It was this more than any other factor which encouraged me to embark on this mammoth task.
The future of our profession and the long‐term superior care of the even younger generation of our patients is in the hands of these aspiring orthodontists. I am grateful to them for having, perhaps unwittingly, cajoled me into writing this text. I hope that it will be a source of information for them as they undertake the challenge of some of the more difficult, unconventional and unusual cases that they will inevitably come across in practice and for which they will be expected to find appropriate therapeutic answers.
I wish to thank the following publishers of two articles, as follows:Several of the illustrations comprising Figure 7.8 were reprinted from the World Journal of Orthodontics. Vol. 5. The Role of Digital Volume Tomography in the Imaging of Impacted Teeth, by Adrian Becker and Stella Chaushu. 2004. with permission from Quintessence Publishing Co, Inc.
Several of the illustrations comprising Figure 11.9 were reprinted from Healthy periodontium with bone and soft tissue regeneration following orthodontic‐surgical retrieval of teeth impacted within cysts, by Adrian Becker & Stella Chaushu, in Biological Mechanisms of Tooth Movement and Craniofacial Adaptation. Proceedings of the Fourth International Conference, 2004, pp. 155–162. Z Davidovitch and J Mah, editors. Sponsored by the Harvard Society for the Advancement of Orthodontics. Reproduced with permission.
Adrian Becker
Jerusalem, Israel
Preface to the Third Edition
Only 14 years have passed since the publication of the first edition of this book and much has changed in orthodontics, in general and in the context of the treatment of impacted teeth, in particular. The subject material that appeared in that small monograph has developed several fold, in the light of research and the advent of new technology. These two factors have encouraged the orthodontic specialist to be more discerning in the diagnosis of pathology and more innovative and resourceful in the application of directional traction. Mistaken positional diagnosis and surgical blunders have become less common and consequent failure to resolve the impaction less frequent. At the same time, they have permitted the orthodontist to become more adventurous and to successfully apply his/her knowledge and experience to the treatment of cases where previously the tooth would have been scheduled for extraction. If this third edition may yet contribute to the furtherance of this favorable trend in any way, I will consider that my mission will have been accomplished.
It was the aim in each of the earlier editions of this book to present reasoned principles of treatment for tooth impaction, illustrated by examples from real life. Following these principles to their logical conclusion, Chapter 15 has been added in the present edition to illustrate how some extreme examples or cases with concurrent complicating factors may be resolved, several of which involve the expertise of colleagues in our sister specialties. Oddities, such as the “banana” third molar, with its impacting influence on its immediate neighbor, are also new to this edition.
Failure has intrigued me for a long time and, while Chapter 12 was new to the second edition, it has been enlarged now in the third. The recognition and importance of invasive cervical root resorption (ICRR) as a cause of failure to resolve an affected impacted tooth seems to be hardly known within the profession. There is a section added herein which discusses the etiology of this pathological entity, its disease process, its potency as a factor for failure and speculates on accepted standard procedures that may predispose to its occurrence.
To write a textbook or to update an edition may take several years. Once it is finished, it has to go through the many months of the publishing process, with questions and corrections, proofreading and amendments. In the meantime, what was written becomes progressively obsolete – new ideas are put forward in the journals, some are disciplined studies and others just innovative clinical methods learned in the very singular one‐on‐one situation in the orthodontic operatory between orthodontist and patient. In order to provide at least a partial answer to this, I have set up an internet website at www.dr‐adrianbecker. com, in which regular updates on clinical research and technique, vignettes describing individual conditions or just a customized approach to the treatment of a specific case, are published with the aim of complementing the book. The site also features a “troubleshooting impacted teeth” page for individual clinical consultations – open to anyone, whether orthodontist, patient or concerned parent. Details of the patient and his/her condition will need to be filled in and existing radiographs, CBCT and other relevant information uploaded. A report is returned to the sender within a few days with suggestions and recommendations for treatment.
The clinical research on which this text is largely based has been the product of long‐term cooperation with Professor Stella Chaushu, PhD, DMD, MSc, Chairperson of the Orthodontic Department in Jerusalem, to whom are due my special thanks. I am grateful to my co‐authors who have advised me in my writing of several of the chapters herein and to a number of my colleagues who have sent me illustrative material which I have included, with their permission. I would also like to recognize Mr. Israel Vider, director of the Dent‐Or Imaging Center in Jerusalem, for his CT imaging expertise, his assistance in granting me access to his technical laboratory and for his work on several of the illustrations that are published in this edition.
Adrian Becker
Jerusalem, October 2011
Preface to the Fourth Edition
As the fourth edition of this book goes to print, I am happy to present a much‐enhanced text, both in terms of the verbal discussion and the illustrated figures, which is offered in a similar pattern to its predecessors. The third edition of Orthodontic Treatment of Impacted Teeth, published in 2012, had 15 chapters. This new edition comprises 21 chapters, of which several are completely new and, together with the significant additions and improvements, the overall content is now approximately 60% larger.
Video clips and other 3D illustrations cannot be published in book form, thus preventing the printed literature from matching the advances in the recording of radiographic imaging that is now commonplace in dental schools, in radiographic imaging centres and in private dental offices. This is particularly so in relation to orthodontics, in general and to accurate positional and pathological diagnosis, that are so essential in the resolution of tooth impaction, in particular. In order to overcome these serious illustrative limitations, I have included a Companion website adjacent to the text, to enhance the orthodontist’s ability to use the existing presentation modes (secondary reconstructions), to extract the maximum information that is available in a cone beam CT scan. A number of 3D video clips are presented, to illustrate how to refine the diagnostic
