Premolar erupting underneath the ALF body wire

You most likely have come across this situation: your patient started ALF treatment when s/he was already entering the late mixed dentition phase. With the roots of the primary molars shortened from absorption, the buds of the permanent teeth were not carried along during arch development. Now, one of the premolars is erupting with the lingual cusp underneath the body wire. How to best deal with this ...?

Here are a few options:

1. Take an impression for a new body wire. 
   Disadvantages:
   ALF appliance will be out of the patient's mouth for a while;
   Additional lab fees. 
2. Adjust the body wire to accommodate the ectopic eruption.
   This is a good option as long as the body wire is kept on plane, and the overall configuration is not changed. Having a photocopy of the appliance BEFORE making any changes is a must. As you align the ALF with the photocopy, you want to see the cribs in the same location. 
   The picture on the right shows in yellow how the body needs to be adjusted:
   
            
   
   
3. Build an angled guiding ramp.
   This is the easiest option if you catch the erupting tooth in time. I like to use a colored composite material because I am bonding to a permanent tooth. The color helps later to completely remove the composite. I use Getz Blue Core Crown Build-up Material, made by Waterpik. 
   
                 
   
   
   Here is an example of what you should expect. The pictures were taken 10 weeks apart:
   
              
        

                Ljuba Lemke

The ALF online seminar is now also available to osteopathic physicians and orofacial myofunctional therapists at a reduced price. Please inquire about the discount coupon.