Abstract
Supernumerary teeth and odontomas are obstacles for spontaneous tooth eruption and may result in impaction. The aim of the study is to present a conservative treatment approach for impacted teeth following surgical obstruction removal by reviewing three treatment modalities: surgery only, which involves the surgical removal of the obstruction and the spontaneous eruption; surgery with immediate traction, which includes surgery combined with immediate active orthodontic brace cementation and traction; and surgery with delayed traction, which combines a surgical procedure of obstacle removal and orthodontic brace cementation with follow-up for the spontaneous eruption. The first two modalities require orthodontic traction either by an additional surgical procedure for orthodontic brace cementation, or combined with the surgical obstacle removal. With the third approach, clinical follow-up is performed via connected ligature wire elongation applied during the surgical procedure for the spontaneous emergence of the impacted tooth. Active orthodontic traction is only employed if the tooth fails to erupt. The visual follow-up via wire elongation serves as a reference during the emergence of the impacted teeth and reduces the need for radiographic examination. The surgical-orthodontic approach saves both further surgery and orthodontics (spontaneous eruption) or further surgery (in failure to erupt).
Highlights
One year later, when the tooth failed to erupt spontaneously (Figure 1A), an orthodontic treatment was initiated, including space opening and repeated surgical exposure combined with orthodontic brace cementation and active traction
Two different surgical procedures were required in this case: one for the surgical removal of the supernumerary tooth, and another for the orthodontic brace cementation
(2) Surgery with immediate traction—the impacted tooth successfully erupted and Surgery only—post repeated surgical exposure combined with orthodontic brace cementation, the patient demonstrated successful orthodontic traction of the impacted central incisors to the correct position in the dental arch after 15 months (Figure 1C) of active orthodontic treatment
Summary
Tooth impaction is characterised by eruption failure once the normal time of eruption has passed and adjacent and antimere teeth have properly erupted [1,2,3]. Tooth eruption is a unique biological process characterized by the movement of a tooth from the alveolar process to its functional position in the oral cavity. The dental follicle is mandatory and plays a major role in the coordinated alveolar bone resorption and formation. A finely tuned genetic approach of parathyroid hormone 1 receptor (PTH1R) and parathyroid hormonerelated peptide (PTHrP) have been shown to be important in bone remodelling during eruption [5]. Impacted permanent teeth are relatively common at the early mixed dentition age [6]. The most commonly impacted maxillary tooth is the canine, occurring in less than
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
