Small link chain, made of stainless steel or brass, is of great help in handling impacted teeth. It provides multiple points of ligation, judgment of movement and leaves the point of attachment to the tooth relatively unmolested. The chain is available at stores handling jewelry findings, and hobby craft supply stores. It comes in a variety of sizes. 22 links per inch is a suitable size.
When the entire crown can be exposed, one end of the chain is ligated to the crown using a double-loop tie (Fig. 1) of stainless steel ligature wire. Where encircling the tooth with ligature wire is not feasible, the chain can be attached to an eye pin ( Fig. 2) which in turn is threaded into the partially exposed impacted tooth as described by Prescott.1 Tension is applied to the free end by tying with elastic thread (Fig. 1) or by ligating to any type of auxiliary spring on the arch wire (Fig. 2).
The usual procedure is to have the surgery done after the basic appliances have been cemented. When the surgical procedure is completed, the surgeon loosely secures the free end to any convenient point, and the first activation is done about three weeks after surgery. The chain can be done before the appliances are cemented, in which case the free end is tied to any convenient tooth, so that there isn't a free hanging chain to annoy the patient.
The x-rays show the procedure and progress in a patient for whom the procedure was used (Fig. 3).
David A. Dragiff
