This report presents a multidisciplinary approach to the treatment of a rare case of a distally impacted mandibular second premolar indicating a 90-degree tilt of the long axis in a healthy, 15-year-old girl. It also describes the clinical and radiologic findings after a 10-year longitudinal follow-up period. The horizontally impacted mandibular second premolar was positioned behind the roots of the first molar and in close proximity to the root of the second molar, toward the lingual cortex of the mandibular body. Treatment methods required 2 years of cooperation among an orthodontist, an oral and maxillofacial surgeon, a periodontist, and an endodontist to achieve a leveled and aligned position in a properly healed condition. Finally, the horizontally impacted mandibular second premolar was correctly positioned in the arch surrounded by healed periodontal ligament tissue. Root resorption of the adjacent orthodontic anchorage units was recorded. The 10-year postoperative follow-up presented a stable, functional, and symptom-free permanent mandibular second premolar. The multidisciplinary dental team’s considerations and cooperation account for the successful repositioning of the compromised mandibular second premolar with minimal damage to the surrounding hard and soft tissue following 10 years of longitudinal follow-up. Orthodontics 2011;12:48–59.
Key words: bone regeneration, combined lesion, endodontic treatment, impacted premolar, orthodontic traction, periodontal surgery