Impacted Incisor Research Articles

Stepwise traction approaches of impacted incisors in mixed dentition

Stepwise traction approaches of impacted incisors in mixed dentition

Effectiveness and side effects of orthodontic traction of impacted maxillary incisors in a labially inverted position: A systematic review

Treatment of impacted upper incisors in a labially inverted position is challenging for orthodontists, and its prognosis has not been established in the literature. Thus, this systematic review aimed to determine the effectiveness and side effects of orthodontic traction of impacted maxillary incisors in a labially inverted position. A comprehensive search was conducted in multiple databases, including MEDLINE (via PubMed), Scopus, Embase, Science Direct, and LILACS, up to June 30, 2024. Initially, 1640 articles were identified, and after applying specific selection criteria, 11 articles were selected for full-text evaluation. Following the review, only six studies were deemed relevant, comprising one before-and-after study, two longitudinal retrospective studies, and three cross-sectional studies. Newcastle-Ottawa and Risk of Bias (ROB-2) tools were used to assess the risk of bias in the selected studies. The average duration of traction for maxillary labially inverted impacted central incisors ranged from 8.60±1.26months to 18±6.0months, with all cases being successfully treated. Following traction, the clinical crown height of the incisors was significantly higher compared to the control group (P<0.01). Similarly, the root length of the impacted incisors after traction was shorter in the impaction group (approximately 2mm) compared to the control group. Likewise, the thickness of the alveolar bone varied among different studies. Some authors noted that the treatment group had a smaller thickness (about 0.5mm) compared to the control group (P<0.05), while other authors found similar thickness after treatment. Although there are few reported studies with a low risk of bias, it is clear that it is possible to successfully treat labially inverted impacted maxillary central incisors with apparently few side effects. Following traction, the clinical crown height of these incisors increased, while the root length was shorter than their normally erupted contralateral teeth.

Prevalence and characteristics of and risk factors for impacted teeth with ankylosis and replacement resorption – a retrospective, 3D-radiographic assessment

BackgroundLarge variation in the prevalence of ankylosis and replacement resorption (ARR) is reported in the literature and most studies have relatively small patient numbers. The present retrospective study aimed to provide an overview on prevalence, location of, and associated risk factors with ARR based on a large sample of computed tomography (CT) / cone beam computed tomography (CBCT) scans of impacted teeth. The results should allow clinicians to better estimate the risk of ARR at impacted teeth.MethodsThe CT/CBCT scans of 5764 patients of a single center in Central Europe were screened with predefined eligibility criteria. The following parameters were recorded for the finally included population: gender, age, tooth type/position, number of impacted teeth per patient, and presence/absence of ARR. For teeth with ARR the tooth location in reference to the dental arch, tooth angulation, and part of the tooth affected by ARR were additionally registered.ResultsAltogether, 4142 patients with 7170 impacted teeth were included. ARR was diagnosed at 187 impacted teeth (2.6%) of 157 patients (3.7%); 58% of these patients were female and the number of teeth with ARR per patient ranged from 1 to 10. Depending on the tooth type the prevalence ranged from 0 (upper first premolars, lower central and lateral incisors) to 41.2% (upper first molars). ARR was detected at the crown (57.2%), root (32.1%), or at both (10.7%). After correcting for confounders, the odds for ARR significantly increased with higher age; further, incisors and first/second molars had the highest odds for ARR, while wisdom teeth had the lowest. More specifically, for 20-year-old patients the risk for ARR at impacted incisors and first/second molars ranged from 7.7 to 10.8%, but it approximately tripled to 27.3–35.5% for 40-year-old patients. In addition, female patients had significantly less often ARR at the root, while with increasing age the root was significantly more often affected by ARR than the crown.ConclusionARR at impacted teeth is indeed a rare event, i.e., only 2.6% of 7170 impacted teeth were ankylosed with signs of replacement resorption. On the patient level, higher age significantly increased the odds for ARR and on the tooth level, incisors and first/second molars had the highest odds for ARR, while wisdom teeth had the lowest.

Periodontal management during orthodontic-surgical treatment of maxillary impacted incisors: Acase report

The treatment of impacted teeth is a multidisciplinary process requiring close collaboration between periodontics and orthodontics. Impaction can have several causes, including physical obstructions in the eruption pathway, arch length discrepancies, or dental deformity. The management of these cases lies in the diagnosis established after an appropriate clinical and radiological examination. The age, position, etiology, and amount of space in the dental arch of an unerupted tooth determine how it should be treated. In several cases, orthodontic creating space, removing physical obstructions, and exposing the patient surgically with or without traction are general guidelines for treatment. In addition, ensuring adequate access to the tooth and the possibility of attaching an orthodontic anchor, the periodontal plastic surgery procedures associated with surgical clearance must preserve the integrity of the periodontium of the impacted tooth, as well as that of adjacent teeth, and above all promote the long-term maintenance of their periodontal health.

Surgical exposure of turner’s tooth and CBCT representation of inverted tooth: A case report

Enamel defects related to it’s thickness and quality are called hypoplasia, and they arise from disturbances in the enamel matrix development process. The possible developmental disruptions, which can range from mild changes in enamel mineralization to severe sequestration of the tooth germ, dilations of the crown or root, crown or root duplication, and complete or partial arrest of root formation, are explained by the topographic relationship between the primary tooth and the developing permanent tooth germ. Enamel in Turner's hypoplastic kinds might be shiny, rough, or pitted . It is extremely uncommon for permanent central incisor impaction and inversion to result from trauma, odontomas, and neighboring supernumerary teeth. Root development is restricted when incisors are displaced or impacted in the opposite direction. Dental radiographs and CBCT are used to assess the presence or absence of enamel thickening and inversion. This information is used not only for diagnosis but also to build the best possible treatment plan. Hence a case is presented of Turner’s hypoplasia and maxillary lateral incisor inversion in a 9 yr old female. MESH- Turner’s Hypoplasia, Tooth inversion, CBCT, RVG

Design of Customized Mouthguards with Superior Protection Using Digital-Based Technologies and Impact Tests

BackgroundIn contact sports, an impact on the jaw can generate destructive stress on the tooth-bone system. Mouthguards can be beneficial in reducing the injury risk by changing the dynamics of the trauma. The material properties of mouthguards and their geometrical/structural attributes influence their protective performance. Custom-made mouthguards are the gold standard, and different configurations have been proposed to improve their protection and comfort. However, the effects of different design variables on the performance of customized mouthguards are not well understood.ResultsHerein, we developed a reliable finite element model to analyze contributing factors to the design of custom-made mouthguards. Accordingly, we evaluated the isolated and combined effect of layers’ stiffness, thickness, and space inclusion on the protective capability of customized mouthguards. Our simulations revealed that a harder frontal region could distribute load and absorb impact energy through bending if optimally combined with a space inclusion. Moreover, a softer layer could enlarge the time of impact and absorb its energy by compression. We also showed that mouthguards present similar protection with either permanently bonded or mechanically interlocked components. We 3D-printed different mouthguards with commercial resins and performed impact tests to experimentally validate our simulation findings. The impact tests on the fabricated mouthguards used in this work revealed that significantly higher dental protection could be achieved with 3D-printed configurations than conventionally fabricated customized mouthguards. In particular, the strain on the impacted incisor was attenuated around 50% more with a 3D-printed mouthguard incorporating a hard insert and space in the frontal region than a conventional Playsafe® Heavypro mouthguard.ConclusionsThe protective performance of a mouthguard could be maximized by optimizing its structural and material properties to reduce the risk of sport-related dental injuries. Combining finite element simulations, additive manufacturing, and impact tests provides an efficient workflow for developing functional mouthguards with higher protectiveness and athlete comfort. We envision the future with 3d-printed custom-mouthguards presenting distinct attributes in different regions that are personalized by the user based on the sport and associated harshness of the impact incidences.

Alveolar bone retention following treatment of dilacerated labial inversely impacted maxillary central incisors-a retrospective study.

The root of late-dental-age labial inversely impacted maxillary central incisors (LIIMCIs) typically develops to severe dilacerated morphology. Therefore, reliable posttreatment periodontal estimates of orthodontic treatment prognosis would be critical to the treatment value of impacted incisors. This study aims to analyze further changes in dimensions of the alveolar bone following the closed-eruption treatment of late-dental-age dilacerated LIIMCIs. Cone beam computed tomography (CBCT) scanning data of 16 patients with unilateral dilacerated late-dental-age LIIMCIs were collected, including the pretreatment (T1) and at the 2.23 ± 0.78 years follow-up stage (T2) respectively. Patients underwent closed-eruption treatments to bring the impacted incisor into the dental arch. Dolphin imaging software was used to measure alveolar bone height labially, palatally, and proximally to the site at T1 and T2, as well as alveolar bone thicknesses at 0, 2, 4, 6 and 8 mm below the initial measurement plane (IMP). The alveolar bone heights on the impacted and contralateral sides increased from T1 to T2 (p < 0.05). Alveolar bone growth on both sides had no significant difference. In T2, the mean values of labial and distal alveolar heights on the contralateral sides were greater than on the impacted sides (p < 0.05). The mean values of total alveolar bone thicknesses on the impacted sides in T1 were significantly smaller than those on the contralateral sides in IMP-0, 2, 4, 6, 8 (p < 0.05). The total thicknesses on the impacted sides in T2 increased and were significantly greater than on the contralateral sides (p < 0.05), except for the thickness in IMP-0. The closed-eruption treatment of dilacerated late-dental-age LIIMCIs results in no significant changes to alveolar bone height, except on the labial and distal sides, with increased alveolar bone thickness, suggesting that this approach may be viable first choice therapy for non-extraction orthodontic cases.

A cross-sectional analysis of prevalence of dental anomalies by CBCT images: An institutional-based retrospective study

Abstract Aim: To determine the prevalence of different types of dental anomalies using cone-beam computed tomography (CBCT) images among the Al-Hasa population in Saudi Arabia and compare these variables between genders and nationalities. Materials and Methods: A retrospective study involving 509 CBCT images, in which patients were grouped based on their gender and nationality. The presence of dental anomalies was determined through the evaluation of CBCT images. Version 28 of the Statistical Package for the Social Sciences (IBM Corp., Armonk, NY, USA) was utilized to analyze the data, chi-square tests and multivariate analysis of variance were used, and P value was fixed at ≤0.05. Results: Out of the 509 CBCT images reviewed, a total of 135 patients (26.5%) exhibited one or more dental anomalies. Impacted canines had the highest prevalence among all types of impacted teeth, with a rate of 9.2%. Impacted premolars and molars (excluding third molars) had a lower prevalence of 2.6% and 1.2%, respectively. Impacted incisors had the lowest prevalence of 0.8%. Among dental anomalies affecting the number, position, and shape of teeth, the prevalence rates are as follows: congenitally missing teeth (6.7%), supernumerary teeth (2.2%), dilaceration (8.1%), microdontia (3.1%), ectopic eruption (2.6%), rotation (1.8%), and transposition (0.2%). Conclusions: The prevalence of dental anomalies is relatively high, with impacted canines being the most prevalent impacted teeth excluding third molars, whereas dilaceration was the most common anomaly affecting the shape of teeth. The prevalence of anomalies did not differ significantly between genders, except for rotation. Additionally, there was no significant difference reported in nationalities.

Comparison of spontaneous eruption and modified closed eruption technique with palatal traction in alignment of impacted maxillary central incisor teeth

BackgroundCentral incisor impaction is a rare condition with potentially severe clinical and psychological implications for the patient. Treatment techniques vary according to the pretreatment situation and individual factors. The aim of this study was to compare the esthetic outcomes and treatment times between two different approaches.Materials and methodsIn this retrospective study, thirty-one consecutive patients (13 boys, 18 girls; average age 9.5 ± 2.3 years) with a total of 34 impacted permanent upper central incisors were included in the study. Patients were divided into two groups according to method of treatment. Group A comprised patients in whom spontaneous eruption occurred after space opening (n = 12), and Group B comprised patients in whom teeth showed no eruption and required treatment with a modified closed eruption method with palatally oriented traction (n = 19). Treatment time and esthetic outcomes were assessed and compared between groups.ResultsThe mean treatment time was 22.0 ± 6.7 months, and all teeth were successfully aligned. No statistically significant difference in average treatment time was found between groups in baseline characteristics (p > 0.05). The amount of attached gingiva was significantly smaller when compared to contralateral reference teeth in the closed eruption group (Group B; p = 0.03). However, no difference in amount of attached gingiva was found between both groups (p = 0.26). Additionally, no difference in the clinical crown length was found between groups (p = 0.27).ConclusionThe closed eruption method with palatal traction directed at the peak of the alveolar crest provided results comparable to the physiologic tooth eruption.

Effect of dental follicles in minimally invasive open-eruption technique of labially impacted maxillary central incisors.

To summarize the open-eruption technique of impacted anterior maxillary teeth, this study reports a technically improved operation on surgical exposure based on dental follicles and evaluates post-treatment periodontal health considering the effect of dental follicles. Patients who underwent open-eruption technique with unilateral labially impacted maxillary central incisors were selected. The impacted teeth were assigned to the experimental group, and the contralateral unimpacted maxillary central incisors were assigned to the control group. In the surgical exposure, the new technique makes use of dental follicles to manage the soft tissue, so as to preserve soft tissue for better aesthetic results and healthier periodontal tissue. Tooth length, root length, alveolar bone loss, and alveolar bone thickness were recorded after the therapy. A total of 17 patients with unilateral maxillary central incisor impaction were successfully treated. The tooth length and root length of the two groups showed a statistically significant difference between the impacted and homonym teeth, with a shorter length in the impacted tooth (P<0.05). More labial alveolar bone loss was found in the experimental group compared with that in the control group (P<0.05). The outcomes of the cementoenamel junction width, pa- latal alveolar bone loss, and alveolar bone thickness did not indicate statistical significance between the experimental and control groups (P>0.05). In the surgical exposure, the new technique uses dental follicles to manage the soft tissue and preserve it for better aesthetic results and healthier periodontal tissues.

Root Development and Morphology of Impacted Maxillary Central Incisors due to Obstruction: A CBCT Study

A developing maxillary central erupts at the age of 7 years and the apical third of its root apexifies 3 years later, at age 10 years. During this period, an impacted incisor root develops its root in a restricted area, above the alveolar bone, high up in the cortex of the floor of the nose. The aim of this study was to radiographically assess whether the root development of the unerupted incisor is affected by its lack of eruption. A cross-sectional retrospective split mouth study was designed. The sample consisted of 30 consecutive patients (20 males, 9 females) aged 8–30 years (mean 11.6 years), who attended the Orthodontic Department between 2016 and 2019 for treatment of a unilateral impacted maxillary central incisor due to obstruction. Root length, volume and morphology (presence and angle of dilaceration) were evaluated on CBCT scans by 2 calibrated observers using OnDemand3DTM application software to compare the impacted and normally erupted incisors. The effects of dental age at diagnosis, type and location of obstruction and 3D position of the impacted tooth were evaluated. The impacted central incisors had significantly shorter roots (mean 3.1 mm, p < 0.001) and significantly more dilacerations (40%), while their root volume was only slightly reduced. Advanced dental age closed apex and buccally located obstruction were each found to be associated with more root dilacerations. Closed apex was also associated with an increased angle of dilaceration. Odontomas affected root volume more than supernumerary teeth. A more angulated horizontal position of the impacted tooth in sagittal and transverse dimensions resulted in less dilacerations. Non-eruption of a maxillary central incisor due to obstruction prevents normal root development and causes malformation of the apex, due to its proximity to anatomical borders. These findings suggest that interventional procedures aimed at encouraging timely eruption should be initiated early before development of the apical third of the root.

Root Dilaceration: A Case Report and Literature Review

Abstract The clinical management of impacted incisors affected by root dilaceration is challenging. This case report presents the treatment of an adolescent female patient who presented with a deeply impacted, rotated and dilacerated maxillary central incisor and also reviews the current literature on the definition, prevalence, aetiology, diagnosis, and treatment of the anomaly. The impacted and dilacerated incisor was successfully orthodontically treated following a two-stage surgical exposure and after being rotated 100 degrees in the sagittal plane (due to the deep impaction and severe displacement). A Ballista spring and piggyback appliance technique were used to elevate the tooth. The dilacerated incisor was successfully preserved and relocated in the dental arch. The pre-operative and post-operative CBCT scans showed no significant root resorption of the repositioned tooth.

The design and clinical application of a new appliance to treat impacted maxillary central incisors.

Maxillary central incisor impaction is one of the most common types of dental anomalies in children. Treatment of impacted central incisors is complicated and challenging given the position of the impacted central incisors, root development, and the complexity of the crown eruption direction. This study aimed to describe the use of a new multifunctional appliance for the treatment of impacted maxillary central incisors. This article reports the use of a novel appliance for the treatment of impacted maxillary central incisors. We describe the cases of two young patients with labial horizontally impacted maxillary central incisors. Both patients were treated using this novel appliance. Therapeutic effects were evaluated by comparing the pretreatment results, posttreatment cone-beam computed tomography images, and posttreatment clinical examination results. At the end of the treatment period using the novel appliance, the impacted central incisors had successfully been properly aligned in the dental arch, and the tooth roots had not resorbed. Both patients exhibited good dental alignment, with restored function and acceptable aesthetics. This article demonstrates that the new appliance was comfortable, convenient, safe, and effective in the treatment of impacted maxillary central incisors and that its clinical use should be promoted in the future.

Management of an impacted maxillary central incisor with surgical exposure and a 2x4 orthodontic appliance: A case Report

Dental impaction or transposition are disorders related to ectopic eruption or failure in tooth eruption, which can affect child physical, mental, and social development. This condition compromises face aesthetics, phonation, and masticatory function. The cause of impaction may vary from physical obstruction in the path of eruption, tooth material arch length discrepancy to malformation of the tooth, but supernumerary teeth are the leading cause. Failure of eruption of maxillary incisors requires early diagnosis and proper treatment planning. General principles of management of the condition include removal of physical obstruction, creation of space, and surgical exposure with or without traction. The rationale of the 2x4 orthodontic treatment of an unerupted tooth depends upon its age, position, etiology, and amount of space in the dental arch. It under the category of interceptive orthodontic procedure to prevent malocclusion near future. The present case report elaborates on case of incisor impaction with different aetiologies and varying ranges of complexity. However, it's far frequently important to continue with a surgical–orthodontic treatment. The inclination of teeth in relation to the midline and the root maturation degree determine prognosis and therapeutic timing. Thus, we are describing a case of 10 yrs. old child with, class 1 molar relationship bilaterally with missing maxillary right central incisor.

Enhanced conservation of vital pulp and apical tissues by the application of crown rotation surgery for inversely impacted central incisors: A follow‐up analysis of two patients over 4 years

To describe a novel surgical method (crown rotation surgery) to manage inversely impacted central incisors with immature roots. Two young patients each presented with an inversely impacted maxillary central incisor. To protect the apical tissues, the two impacted incisors were rotated downwards to a relatively normal position without extraction from their bony sockets. After crown rotation surgery, spontaneous eruption, continuous root development, and periodontal healing of the rotated incisors were observed. The pulp retained vitality and blood flow was normal. Moreover, there were no obvious signs of pulp canal obliteration (PCO), as indicated by Cone Beam Computed Tomography (CBCT) imaging. • By optimising protection of the vital pulp and apical tissues, crown rotation surgery represents a minimally invasive, conservative, and practical surgical technique for treating inversely impacted incisors with developing roots. • In contrast to existing surgical methods, crown rotation surgery may avoid certain complications, including PCO and abnormal or arrested root development.

Dimensional and morphologic characteristics of unilateral impacted maxillary central incisors

This cross-sectional study aimed to investigate the crown and root characteristics of impacted central incisors compared with spontaneously erupted contralateral incisors and the influence of etiologic and local factors on their dimensions. Forty-five patients (22 boys, 23 girls) who underwent orthodontic treatment for unilateral impaction of maxillary central incisors were referred for cone-beam imaging. Dimensions of the impacted and contralateral incisors were assessed using Dolphin 3D software (Dolphin Imaging & Management Solutions, Chatsworth, Calif). Paired t test and linear regression were used to compare the characteristics of the impacted and contralateral teeth. Contralateral and impacted central incisors showed statistically significant differences for root length (95% confidence interval [CI], 2.32-3.46; P<0.001), mesiodistal crown-root angulation (95% CI, 4.09-15.95; P= 0.001), and labiolingual crown-root angulation (95% CI, -18.69 to -4.70; P= 0.002). Etiologic factors did not alter the dimensions of incisors (95% CI, -1.17 to 0.76; P= 0.672). According to the multiple linear regression the independent variables associated with root length of contralateral and impacted incisors were sex (β= -0.904; 95% CI, -1.62 to - 0.19; P= 0.014) and the presence of impaction (β= -2.87; 95% CI, -3.67 to -2.07; P<0.001). Regardless of their etiology, the impacted incisors showed roots that were 2.89 mm shorter than the contralateral incisors and had greater angulation in the mesiodistal and labiolingual directions. Girls showed a reduction of 0.904 mm (7.6%) on the lengths of roots of both impacted and contralateral central incisors. The presence of impaction led to a reduction of 25% in incisor root lengths. Approximately 30% of the impacted teeth showed crown-root angulations>20° resulting in an increased distal and labial angulation of the root apical portion.

The differences of root morphology and root length between different types of impacted maxillary central incisors: A retrospective cone-beam computed tomography study

The purpose of this trial was to use 3-dimensional data to analyze the differences of root morphology and root length between 3 different types of impacted maxillary central incisors. Cone-beam computed tomography images of 126 patients with impacted maxillary central incisors were included in this retrospective study. On the basis of the angle of the impacted incisor to the palatal plane, we categorized the tooth as labial inversely impacted, labially positioned, or palatal impacted incisor. In each category, the early and late dental age groups were classified according to the method of Nolla. The total root length of both impacted and homonym teeth, length of the nondilacerated part of the root, length of the dilacerated part of the root, the angle between the crown and root, and root direction, were measured in the sagittal-view sections using Dolphin Imaging software (version 11.9; Dolphin Imaging and Management Solutions, Chatsworth, Calif). Compared with the early dental age groups, the length of the dilacerated portion of the root and rate of dilaceration for inverse labial and labially positioned impactions increases, and crown-root angle decreases (P<0.05). The dilacerated part of the root bent labially, and the root morphology shows an obvious L-shaped curve. The length of the nondilacerated part of the root for palatal impactions is greater(P<0.05). The dilacerated part of the root bends palatally, and the root morphology shows a continuous C-shaped curve. Obstruction from the alveolar bone will cause different root morphology. Root morphology of labial impactions shows an obvious L-shaped curve; palatal impactions show a continuous C-shaped curve.

Management of Bilateral Horizontally Impacted and Dilacerated Maxillary Central Incisors at the Nasal Floor: A Multidisciplinary Specialist Approach

In cases of horizontally impacted and dilacerated maxillary central incisors where alignment is attempted, treatment is often prolonged, and achieving an optimal result can be uncertain. We present a case of bilateral horizontally impacted maxillary central incisors lying against the nasal floor, associated with supernumerary teeth, further complicated by a dilaceration, where alignment of the impacted incisors was completed efficiently. CPD/Clinical Relevance: To demonstrate an orthodontic case of how impacted dilacerated central incisors at the nasal floor were efficiently aligned.

Impacted Permanent Incisor Associated With Compound Odontoma: Case Report and Literature Review

Odontoma is defined as calcifying benign odontogenic tumor composed of various tooth tissues such as enamel, dentin, pulp, and cementum and representing the second most common odontogenic tumor of the jaw bones. These lesions are often associated with impacted permanent teeth. They are usually small, asymptomatic and diagnosed after routine radiographic examination. The aim of this work was to report a case of a compound odontoma in the anterior maxilla of a 35-year-old woman, which was causing the impaction of the maxillary left central incisor. A removal of the tumor was planned. An orthodontic approach was proposed as a surgical procedure for orthodontic traction of the impacted tooth. After 12 months, the clinical and radiographic examination revealed the eruption of the impacted incisor. The recommended treatment of compound odontoma is the complete removal of the tumour. An orthodontic approach may be indicated to correct any malocclusion or to perform the traction of the tooth, due to a possible impaction.

Suffocated Maxillary Central Incisors (Surgical and Orthodontic Management): A Report of Two Cases

Clinically, supernumerary teeth are able to cause different local disorders and the most common one is impaction of maxillary incisors. Impacted maxillary incisors substantially affect esthetics, function, and self‑esteem of patients. Impaction of maxillary permanent incisor is a rare clinical entity in dental practice. Although impaction of a permanent tooth is rarely diagnosed during the mixed dentition period, an impacted central incisor is usually diagnosed accurately when there is delay in the eruption of tooth. Multiple treatment options are available for impacted incisors. Surgical-orthodontic treatment is one of the alternative option for the correction. Early diagnosis and management of supernumer¬ary teeth is important to prevent the need for more complex surgical and orthodontic treatment. Here, we present a report of two cases of impacted maxillary incisors and its management