TECHNIQUE CLINIC Jumbo Separators for Partial Molar Impactions
VOLUME 37 : NUMBER 01 : PAGES (33-35) 2003
ROBERT CERNY, BDS, MDS
Partial impactions of erupting
permanent molars do not
occur often, but when they do,
they can cause long-term problems
such as disruption of the
occlusal plane, damage to abutment
teeth, and creation of food
traps with subsequent tooth
decay and periodontal problems.
A sequence of elastic separators
can be used to resolve many of
these impactions efficiently and
effectively, with minimal patient
ring separators come in two
sizes: green--3mm diameter,
.75mm thick; and blue--4mm
diameter, 1mm thick (Fig. 1).
These are easy to fit and effective
at moving teeth apart as
much as 1mm.
What I call "jumbo separators"
--larger and thicker, black
rubber "O" rings, 6mm diameter
and 2mm thick--can be purchased
from rubber outlets or
hydraulic supply companies. These can be sterilized in the
same way as with standard separators.
The jumbo separators
should be soaked in hot water for
two to three minutes prior to fitting.
This makes them more pliable
and less susceptible to fracture.
The standard separator pliers
tend to overstretch and partially
deactivate the separators
(Fig. 2). Although this is not a
problem in routine use, maximum
activation is required to upright
impacted molars. In such
cases, therefore, the separators
should be placed with a pair of
fine, slim-line needle holders.
Stretching the separator by no
more than one-third of its diameter
allows easy placement with
little distortion and deactivation.
When used in sequence
with the smaller orthodontic separators,
the jumbo separators can
move teeth apart as much as
2mm, which is often enough to
free partially impacted molars.
A 9-year-old female presented
with an upper left first
molar partially impacted into the
distal surface of the second deciduous
molar (Fig. 3). Because
patients this young do not fully
comprehend the need to correct
such impactions, treatment
needs to be gentle and, where possible, to involve minimum
patient cooperation. Patients are
asked to continue routine toothbrushing,
but not to floss or use
toothpicks around the separators.
In this case, a blue separator
was fitted in about one
minute, using slim-line needle
holders, and left in place for one
week. The blue separator was
then replaced with a jumbo separator,
requiring less than two
minutes of chairtime. The black
separator was left in place for
two months to allow stabilization
of the correction. Patient
discomfort was minimal during
A review six weeks later
confirmed that the impaction had
A 19-year-old male patient
had previously undergone orthodontic
treatment involving the
removal of all second permanent
molars. The lower third molars
erupted with a mesial tilt and became
partially impacted into the
distal surfaces of the first permanent
molars (Fig. 4).
Blue separators were
placed for one week, then replaced
with jumbo separators for
another two months. Total chairtime
was less than 10 minutes,
and the patient experienced little
Advantages of this serial
separation technique include:Inexpensive materials that are
easy to install and remove.Minimal chairtime.Only minor patient discomfort
from fitting and wearing of the
separators.No need for special patient cooperation.Minimal risk of harm if the
separators fall out and are swallowed.