A patient with impacted mandibular left lateral incisor and canine caused by complex odontoma: Relationship between differences in the direction of traction and posteruption gingiva

Abstract

• A case with impaction of adjacent teeth complicated by odontoma is reported • The impacted mandibular left lateral incisor and canine were orthodontically treated • The closed flap technique was used for traction of the impacted teeth • Resulting attached gingival width differed by traction direction and eruption site • Iodine biostaining was performed for posteruption gingiva This report presents a case of eruption disturbance of the mandibular left lateral incisor and canine complicated by complex odontoma, in which odontoma removal followed by traction of the impacted mandibular left lateral incisor and canine established good occlusion. The patient was a 12-year-old boy in good general health. Panoramic radiographs and cone-beam computed tomography (CBCT) images revealed a complex odontoma between the roots of the mandibular left central incisor and deciduous canine, and an impacted mandibular left lateral incisor and canine. After removal of the odontoma, the mandibular left lateral incisor and canine were fenestrated and tractioned using the closed flap technique. The direction of traction of the impacted teeth was determined on CBCT images, and orthodontic traction was then initiated using a lingual arch with traction loops while paying attention to the direction of traction to avoid contact between the tractioned teeth and adjacent teeth. Eruption of the mandibular left canine and lateral incisor was confirmed about 2 and 9 months after the start of traction, respectively. After traction was completed, the dentition was aligned using fixed orthodontic appliances without tooth extraction. At 27 months after the completion of treatment, the tractioned teeth were vital and remained in good occlusion. The left mandibular canine that could be erupted from the attached gingiva was found to have acquired the attached gingiva after traction, whereas the gingiva of the mandibular lateral incision that was erupted from the labial alveolar mucosa had a thin attached gingiva or alveolar mucosa after traction.