Ramus screws: the ultimate solution for lower impacted molars

It is usually desirable to recover horizontally impacted mandibular molars. Impacted third molars may also be valuable dental units if the adjacent first or second molars are compromised or missing. Uprighting horizontally impacted third molars prior to extraction may be a wise measure to avoid damaging the second molar and its periodontium and inferior alveolar nerve during a surgical extraction procedure. However, uprighting horizontally impacted molars is complex and/or difficult for the orthodontist and oral surgeon. Lin (2011 [1]) reviewed six different methods for recovering deeply impacted molars, and concluded that the most reliable and effective approach was to surgically expose the deeply impacted molars and upright them with traction via a ramus screw (Lee et al., 2014 [2]; Lin et al., 2014 [3]). From a biomechanics perspective, the anterior ramus of the mandible is an ideal location for an anchorage screw. However, this anatomic area appears to be a high risk site because it is covered with thick, mobile soft tissue (Lin et al., 2015 [4]). This article is aimed at increasing the confidence of clinicians relative to the use of ramus screws by reviewing the treatment planning, surgical procedures, orthodontic mechanics, and reliability of the procedure.