teeth, yet it is substantially uncharted territory and rarely recognized by orthodontists.
As in the second and third editions, I acknowledge the contribution to several chapters in the book, of Prof. Stella Chaushu, Chair of the Department of Orthodontics at the Hebrew University–Hadassah School of Dental Medicine, Jerusalem, Israel. For the past 25 years, our academic collaboration has achieved much in terms of basic and clinical research, particularly in the area of eruption disturbance. Tooth impaction has also been the subject of the many invited lectures and courses that we have conducted together internationally and this book largely represents the culmination of those years of endeavour, even from as early as 1964. It reflects many of the fruits of our joint academic collaboration.
Writing a text on the subject of impacted teeth involves filtering out the relevant and appropriate conclusions of published studies from the mass of orthodontic literature in general, and specifically honing in on those evidence‐based investigations published in the leading international, peer‐reviewed orthodontic journals. The treatment decisions made in individual cases or in small case series of the treatment of rare conditions cannot, by virtue of their small numbers, be founded on evidence that is other than anecdotal. This does not necessarily negate the validity of the decision to treat the next patient with the same condition in a similar manner. However, it must be understood that the decision can be justified on an empirical basis only and is likely to be dependent on careful patient selection; and it does obligate this and any other author to report the possibility of bias. I have tried to comply with this and hope that I have been successful in my diligence in the examples of treatments elaborated in the text.
In my efforts to produce a readable and understandable narrative, I managed to persuade my brother Laurence (Shmuel) Becker to be responsible for the editing and proofreading of this work. He is a lawyer and is the first to admit that he knows absolutely nothing about orthodontics. His theory was that if he could understand what I have written in this volume and could follow the ideas and the logical sequence, then any orthodontist should be able to read, follow and understand the text and the ideas that I have tried to portray easily and painlessly. And so he has corrected, amended, shuffled words around, relocated sections and substituted my words for others that only a lawyer can produce. (He is probably the only other person who will have read the entire book at least five times over.) For all this, I am greatly in his debt.
The wondrous workings of today’s desktop computers have provided me with the means to write this text, which would never have been possible using the steam‐propelled typewriter. However, my computer has also given me a false sense of security, learned from bitter experience. Many times in the past three years I lost material that I had spent days writing, either because I had failed to save it or because I had ‘copy‐pasted’ these sections into other files, which I promptly and unintentionally deleted. I cannot count the number of times that I called my son‐in‐law, Asher Cohen (also a lawyer), setting him the task of rediscovering them and putting me back into the business of writing. He found them every time, at break‐neck speed. I salute his alacrity and his digital skills!
I closely identify with the legendary Danish pianist and comedian who, at the same advanced age as I am now, was still appearing on stage before large live audiences. At the end of one of his solo performances, Victor Borge acknowledged: ‘I wish to thank my parents for having made this possible and I wish to thank my children for having made it necessary.’
Adrian Becker
Jerusalem, Israel
June 2021
About the Companion Website
This book is accompanied by a companion website.
www.wiley.com/go/becker/orthodontic_treatment_impacted_teeth
The website includes a series of Power Point presentations mainly of CBCT interpretation work‐ups and particularly in relation to diagnosis of impacted teeth. They contain embedded video clips illustrating methods for refining accurate positional identification or analysis of the teeth in 3D and in improving the qualitative recognition of pathologic entities.
Each online resource is called out in the text by number for ease of location.
View all animations in full screen by clicking the square button under the bar at the bottom right of the animation window.
1 General Principles Related to the Diagnosis and Treatment of Impacted Teeth
Adrian Becker
Assessing dental age in the clinical setting – the Jerusalem method
When is a tooth considered to be impacted?
Impacted teeth and local space loss
The timing of the surgical intervention
Patient motivation and the orthodontic option
In order for us to understand what an impacted tooth is and whether and when it should be treated, we must first define our perception of normal development of the dentition as a whole and the time‐frame within which it operates.
The development of a child has many components. In assessing the developmental age of a child, it is necessary to consider and correlate these components and there is a hypothetical mean for each, though the overall development rate rarely falls exactly on this mean. A child’s growth and development rate may also be different for each of the developmental components.
Somatic age: A child may be tall for his or her age, so that his or her somatic age may be considered to be advanced.
Skeletal age: By studying radiographs of the progress of ossification of the epiphyseal cartilages of the bones in the hands of a young patient (the carpal index) and comparing this with average data values for children of his or her age, we are in a position to assess the child’s skeletal age.
Sexual maturation age: The sexual age of a child is related to the appearance of primary and secondary sexual features.
Mental age: This is assessed by intelligence quotient (IQ) tests.
Behavioural age: This is an assessment of a child’s behaviour and his or her self‐concept.
These are among the indices complementing the chronological
