Impacted Central Incisors in the Upper Jaw in an Adolescent Patient: Orthodontic-Surgical Treatment—A Case Report

Giuseppina Malcangi,Sabino Ceci,Antonio Mancini,Felice Lorusso,Assunta Patano,Antonio Scarano,Alberto Corriero,Vito Settanni,Francesco Inchingolo,Mariagrazia Garibaldi,Filippo Cardarelli,Vito Marino Posa,Massimo Corsalini,Angelo Michele Inchingolo,Ioana Roxana Bordea,Giovanni Coloccia,Gianna Dipalma,Ludovica Nucci,Alessio Danilo Inchingolo,Daniela Di Venere,Delia Giovanniello,Biagio Rapone,Fabio Piras

doi:10.3390/app12052657

Abstract

The inclusion of both maxillary permanent central incisors is uncommon. This condition compromises face aesthetics, phonation and masticatory function. Therefore, early diagnosis is essential to avoid complications and failures. There are various reasons for inclusion, but supernumerary teeth are the leading cause. Early causes of removal and rapid expansion of the palate determine a high probability of success with the spontaneous eruption of the impacted elements. However, it is often necessary to proceed with a surgical–orthodontic treatment. The inclination of teeth in relation to the midline and the root maturation degree determine prognosis and therapeutic timing. In this case report, the orthopantomogram (OPG) X-ray of a 9-year-old boy revealed two impacted supernumerary teeth in the anterior maxillary region, preventing the eruption of the permanent upper central incisors. The impacted supernumerary teeth were surgically removed at different times. A straight wire multibrackets technique associated with a fixed palatal appliance was used. The palatal appliance featured an osteomucous resin support at the level of the retroincisal papilla. Subsequently, surgical exposure was carried out using the closed eruption technique and elastic traction, bringing 11 and 21 back into the arch.

Highlights

Eruption anomalies are classified into position-related disorders and timing-related disorders
A study has verified that performing a rapid expansion with a Rapid Maxillary Expander (RME) immediately after the obstacle removal leads to an 82% chance of problem resolution with the eruption of the impacted element after 6–7 months from the obstacle removal, while without applying the RME, the percentages are reduced by 39% [25,29,30]
Vermette et al, recommended using the closed eruption technique when the tooth is in the center of the socket or when it is high, near the nasal spine

Summary

Introduction

Eruption anomalies are classified into position-related disorders (ectopic eruption and transpositions) and timing-related disorders (premature eruption, delayed eruption or impaction). It consists of the apical repositioning of a raised full-thickness-flap above the included tooth, leaving the element uncovered It involves lifting a full-thickness flap, fixing an orthodontic bracket on the tooth surface, and completely covering the tooth and bracket with tissue These techniques offer some advantages when pulling impacted teeth [10,31,32]. Vermette et al, recommended using the closed eruption technique when the tooth is in the center of the socket or when it is high, near the nasal spine In these cases, the periodontal state of the exposed teeth after orthodontic treatment usually revealed an acceptable gingival profile and good adherent gingiva, an increase in bone level on the mesial, vestibular and distal surfaces, requiring no further mucogingival surgery [33]. The treatment is relatively long, approximately two years, and is influenced by the initial height of the tooth included in the jaw [38]

Clinical History

Findings

Conclusions