Impacted Maxillary Central Incisor Research Articles

Orthodontic-surgical management of impacted maxillary central incisor

Maxillary incisors and canine, often referred to as the social six are most prominent teeth in an individual's teeth. Impaction of maxillary central incisors are less frequently than third molars and canines because of several contributing factors. Treatment of impacted teeth requires a combined orthodontic and surgical perspective. In the presented case we have used Closed-eruption technique combined with alteration in biomechanics and this had resulted in good long-term esthetic results. Keywords: Maxillary incisor; Impaction; Closed eruption technique; Modified biomechanics

Geometric morphometric analysis of the palatal morphology in children with impacted incisors: A three-dimensional evaluation.

To analyze variations in palatal morphology in subjects presenting unilaterally impacted maxillary permanent central incisors compared with a control group of subjects without eruption anomalies using a three-dimensional (3D) analysis. Twenty-six white subjects (10 girls and 16 boys; mean age 9.5 ± 1.5 years) with unilaterally impacted maxillary permanent central incisors (impacted incisor group [IIG]) were compared with a control group (CG) of 26 subjects (14 girls and 12 boys, mean age 8.7 ± 1.6 years) presenting no eruption disorders. For each subject, dental casts were taken and the upper arch was scanned using a 3D laser scanner. To study the entirety of the shape of the palate in any point of the surface, 3D geometric morphometrics was applied. Subjects with impacted maxillary incisors showed skeletal adaptations of the maxilla. In the IIG, both the superior palatal region and lateral palatal surface showed significantly different morphology when compared with CG, with a narrower and higher palatal vault. The absence of maxillary central incisors over the physiological age of eruption influenced the development of the palatal morphology compared with subjects without eruption anomalies.

The management of the dilacerated impacted maxillary central incisor

The clinical problem of how best to manage a dilacerated, impacted maxillary central incisor will only be encountered rarely. The treatment aim should be to achieve results that are indistinguishable from normal appearance in a way that is appropriate for the patient. This article discusses the incidence of dilacerations in maxillary incisors and describes the treatment approaches available − orthodontic alignment or surgical removal and management of the resulting space, considering orthodontic repositioning, autotransplantation and various prosthetic replacements. Treatment indications, advantages and disadvantages, restorative and surgical implications, as well as the evidence-base relating to the various treatment modalities will be presented, along with clinical case examples. Clinical relevance: This paper discusses a problem that, if not managed appropriately, can lead to poor results for the patient. Even for practitioners who may not undertake the treatment mentioned, it will enable them to have more in-depth discussion with their patients should the situation arise.

Evaluation of the orthodontic treatment outcome in patients with impacted maxillary central incisor in the mixed dentition

To evaluate the orthodontic treatment outcome in patients with impacted maxillary central incisor in the mixed dentition. Nine patients, aged 8 to 11 years, with impacted maxillary central incisor were treated orthodontically. The cone-beam CT(CBCT) was taken before treatment, after treatment and one year out of retention to evaluate the root length, root canal wall thickness, width of the apical foramen, and degree of root bending, alveolar bone height and thickness. The crown-to-root ratio was calculated. The periodontal and endodontic conditions were evaluated. The parameters of the treated incisors and contralateral ones served as controls were compared. Nine impacted teeth were treated successfully. Throughout the treatment, the root of impacted central incisor continued to develop and the alveolar bones also continued to develop and remodel. The condition of the alveolar bone of vertically impacted teeth was better than that of horizontally impacted ones. No periodontal pocket or pulp necrosis was found after treatment. Seven patients were examined one year after treatment. No significant difference was found in root length, palatal alveolar bone level and palatal alveolar bone thickness. The control group root length was (13.07±2.15) mm, the treatment group root length was (12.06±2.00) mm. No further alveolar bone loss, gingival recession and pulp necrosis were found. The control group labial and palatal alveolar bone levels were (0.90±0.62), (0.45±0.52) mm, labial and palatal alveolar bone thickness were (0.85±0.14), (1.21±0.41) mm. The treatment group labial and palatal alveolar bone levels were (2.18±1.59) mm, (0.57±0.71) mm, labial and palatal alveolar bone thickness were (0.48±0.29), (1.43±0.31) mm. Orthodontic therapy for impacted maxillary central incisor in the mixed dentition could promote root development and alveolar bone remodeling. Good periodontal and endodontic conditions were achieved.

Influence of impacted maxillary central incisor on craniofacial structure and its orthodontic treatment

Influence of impacted maxillary central incisor on craniofacial structure and its orthodontic treatment

The treatment timing of labial inversely impacted maxillary central incisors: A prospective study.

To determine the timing of treatment for the labial inversely impacted maxillary central incisors. Twenty-eight patients (mean age, 8.2 years) with labial inversely impacted maxillary central incisors were divided into early-treated and later-treated groups according to their dental age. All of the patients were treated with a combination of surgery and orthodontic traction using the Guide rod appliance. Cone-beam computed tomography images were taken immediately after treatment for assessing the root morphology, root length, and alveolar bone loss. Sagittal slices were evaluated at the widest labial-lingual width of the tooth in the axial view. All variables were evaluated by Simplant 13.0 software (Materialise Dental NV, Leuven, Belgium). The rank sum test indicated that the root length of two groups showed a statistically significant difference between the impacted and homonym tooth, with a shorter length in the impacted tooth (P < .05). The D-value (difference of root length between the impacted and homonym tooth) and alveolar bone loss on the labial side of the impacted incisor are significantly less in the early-treated groups when compared with the later-treated groups (P < .05). Spearman rank correlation analysis showed a statistically positive association between the treatment timing and D-value (r = .623, P < .05). The chi-square test for morphology of root apex indicated that the incidence of the root-apex-directed labial side is significantly higher in the later-treated groups when compared with the early-treated groups. The labial inversely impacted maxillary central incisors should be treated early to promote root development by achieving a better morphology of root apex, thus reducing the risk of alveolar bone loss on the labial side.

Evaluation of maxillary arch morphology in children with unilaterally impacted incisors via three-dimensional analysis of digital dental casts: a controlled study.

The purpose of this work was to analyze variations in maxillary arch dimensions in subjects presenting unilaterally impacted maxillary permanent central incisors compared with a control group of subjects without eruption anomalies. A group of 23Caucasian children [8 females and 15 males, mean age 9.7years, standard deviation (SD) 1.6years] displaying unilaterally impacted maxillary permanent central incisors (impacted incisor group: IIG) were compared with a control group (CG) of 23subjects (9 females; 14 males, mean age 8.8years, SD 1.9years) presenting no eruption disorders. Pretreatment dental casts were taken from each subject and the upper arch was scanned using a three-dimensional scanner. Linear measurements were taken on each digital model to analyze maxillary arch dimensions. Significant between-group differences were tested with the Student's t test (p<0.05). The transverse and sagittal upper-arch measurements were significantly smaller in the IIG than in the CG. In particular, the anterior arch was 1.35mm shorter in the IIG, while intercanine width was decreased by 2.51mm on the impacted side. Children revealing unilaterally impacted maxillary central incisors demonstrated a significantly constricted maxillary transverse width and shorter arch on the impacted side compared with subjects with no eruption disorders.

Impacted Central Incisor with Dilacerated Root-Treat with Ease.

A 12-year-old female patient reported to the Department of Orthodontics of Maulana Azad Institute of Dental Sciences, New Delhi with chief complaint of missing upper front tooth. On clinical examination it was found that maxillary left central incisor (21) was missing [Table/Fig-1]. No significant history of trauma or premature/delayed shedding of primary left central incisor was reported. Panoramic and maxillary occlusal view revealed impacted left central incisor with dilacerated root [Table/Fig-2,3]. Since the contralateral central incisor had erupted fully in the mouth and the root formation of the impacted central incisor was almost complete, it was decided to disimpact the tooth (21). Disimpaction was planned by surgical exposure followed by elastic traction with the help of removable appliance. Since the patient had well aligned upper and lower arches in good occlusion, it was decided to use a modified removable appliance for extrusion of 21. A removable appliance with modified labial bow was fabricated. Labial bow in the anterior region was fabricated with 22 gauge wire and helices were incorporated in the labial bow adjacent to left central incisor region. Retention was provided by the acrylic coverage in the palatal region and by well formed retentive clasps. Surgical exposure of left central incisor was performed by open exposure technique. A bondable button was placed onto the labial surface of exposed left central incisor crown [Table/Fig-4]. Patient was trained to use elastic in triangular fashion to engage button on 21, and two helices of the labial bow, which resulted in an extrusive force of 20 grams for disimpaction of 21[Table/Fig-5] [1]. Patient was advised to change the elastic daily and was reviewed every three weeks. At the end of six months, complete disimpaction of 21 was achieved with the tooth in its optimal alignment into the upper dental arch and in good relation with lower teeth [Table/Fig-6,7]. Post disimpaction panoramic view reveals tooth 21 in the optimal position with respect to maxillary occlusal plane [Table/Fig-8]. [Table/Fig-1]: Pretreatment intraoral maxillary occlusal photograph showing missing maxillary left central incisor. [Table/Fig-2,3]: Pretreatment panoramic and maxillary occlusal view showing vertically impacted maxillary left central Incisor with dilacerated root. [Table/Fig-4]: Intraoral frontal photograph after surgical exposure and with bonded attachment on labial surface of 21. [Table/Fig-5]: Intraoral frontal photograph showing mechanics for extrusion of 21 with elastic traction force. [Table/Fig-6,7]: Post treatment intraoral frontal and maxillary occlusal photographs showing 21 in alignment and good occlusion. [Table/Fig-8]: Post treatment panoramic view. In young patients, absence of maxillary anterior teeth has a major impact on esthetics, phonetics, mastication and psychosocial well being. Impaction of maxillary permanent central incisor due to dilaceration in the root is a rare condition which is associated with trauma to primary anterior tooth early in life leading to dilaceration of permanent succedaneous tooth [2]. Depending on the severity of dilacerations, decision is usually taken to either expose and align the maxillary central incisor or extract and replace it with prosthesis. Although prognosis of disimpaction of dilacerated central incisor is questionable but orthodontic alignment was preferred in this case due to two reasons. Following extraction of a tooth, the alveolar ridge becomes deficient both vertically and labiolingually which makes it unsuitable for prosthetic implant. Also, the region becomes unaesthetic for conventional prosthetic bridge placement. Any fixed prosthesis for replacement of missing central incisor cannot be given before 18 year of age to allow for completion of alveolar bone growth in growing children [3]. The removable appliance treatment chosen for this patient was a convenient treatment option with less chair side involvement with the patient. Moreover it reduces the overall treatment time required for fully bonded fixed appliance therapy since traction could be applied to the impacted tooth immediately after removable appliance insertion. Also, one of the major advantages of using this simple appliance is that it overcomes the detrimental effects encountered with fixed appliances such as demineralization and difficulty in maintenance of oral hygiene [4]. Orthodontic extrusion of an impacted tooth is usually carried out by a trained specialist by using fixed mechanics. A modified removable appliance with bonded attachment and elastic traction has been used to successfully disimpact and align maxillary central incisor in this case. Such an appliance can be fabricated and used by even a general practitioner with basic knowledge about optimal force delivery.

Prevalence of Maxillary Central Incisor Impaction and Supernumerary Teeth among Nepalese Orthodontic Patients

Introduction: Very few studies have been done on impacted maxillary central incisors and supernumerary teeth.Objective: To find the prevalence of maxillary central incisor impaction and supernumerary teeth among orthodontic patients attending Dhulikhel Hospital, Kathmandu University Teaching Hospital.Materials &amp; Method: The retrospective study consisted of 787 records of orthodontic patients of age 10-35 years. Dental model and orthopantomograph were retrieved and searched for impacted maxillary central incisors and supernumerary teeth. Incomplete records and patients with known syndromes were excluded from the study. Descriptive statistics was applied to find the prevalence rate and comparison between male and female was done by chi-square test.Result: Out of total samples, 14(1.8%) and 11(1.4%) samples were found to have impacted maxillary central incisors and supernumerary teeth respectively. There was no significant difference in prevalence of impacted maxillary central incisors between male and female samples (p=0.78), however there was significant difference in occurrence of supernumerary teeth between gender groups (p=0.025).Conclusion: The prevalence of impacted maxillary central incisor and supernumerary teeth among orthodontic patients attending Dhulikhel Hospital, Kathmandu University Teaching Hospital is 1.8% and 1.4% respectively. Male patients have higher chance of having supernumerary teeth than female patients

Evaluation of root and alveolar bone development of unilateral osseous impacted immature maxillary central incisors after the closed-eruption technique

In this study, we evaluated root and alveolar bone development in unilateral osseous impacted immature maxillary central incisors by cone-beam computed tomography before and after closed-eruption treatment, in comparison with naturally erupted contralateral immature maxillary central incisors. The study included 30 patients, 20 boys and 10 girls, with a mean age of 8.44 ± 1.20 years (range, 6.5-11.2 years). After treatment, the root lengths of both the impacted maxillary central incisors (10.66 ± 2.10 mm) and the contralateral maxillary central incisors (11.04 ± 1.76 mm) were significantly greater than their pretreatment values (6.67 ± 1.94 and 9.02 ± 2.13 mm, respectively). The root canal widths of the incisors decreased significantly after treatment. From the posttreatment cone-beam computed tomography images, the ratio of exposed root length to total root length and the thickness of the alveolar bone at 1 mm under the alveolar crest and at the apex were calculated to evaluate alveolar bone development. Impacted immature maxillary central incisors differed significantly from contralateral immature maxillary central incisors in labial exposed root length, labial ratio to total root length, and lingual alveolar crest. Clinical crown height was higher (statistically but not clinically) for the impacted incisors (9.87 mm) than for the contralateral incisors (9.37 mm). Impacted immature incisors grew to the same stage as did erupted contralateral incisors after closed-eruption treatment. Both incisor types had some alveolar bone loss, and thin alveolar bone surrounded the roots.

Multidisciplinary management of an impacted maxillary central incisor with a severe crown dilaceration

An 8-year-old girl presented with an unerupted upper right central incisor. Clinical and radiographic examination revealed a severe crown dilaceration. Her treatment involved a multidisciplinary approach, including surgical exposure, orthodontics and restorative treatment. The outcome was the accomplishment of a vital, functional and aesthetic maxillary central incisor with a good prognosis. Clinical Relevance: This case report describes how a dilacerated upper incisor, which has failed to erupt and appears to be of poor prognosis, can be aligned with a satisfactory aesthetic and functional outcome. Alignment of the affected tooth improves dental appearance in the medium term and maintains alveolar bone if restorative replacement is required in the longer term.

Maxillary central incisor impaction due to childhood trauma and orthodontic intervention

The maxillary central incisors play an important role in smile esthetics. The absence of a central incisor can affect esthetics, phonetics, and function. Permanent maxillary central incisor impaction can occur due to supernumerary teeth, cyst, abnormal tooth bud position, trauma to the deciduous incisor in childhood, etc. The purpose of this article is to discuss maxillary central incisor impaction due to childhood trauma and orthodontic intervention in its management, with an example of a case treated by two-stage surgical exposure and orthodontic traction.

Unveiling the impacted incisor

Missing and unerupted maxillary incisors can have a major impact on dental and facial esthetics and were considered to be the most unattractive deviant occlusal trait. There are very few studies reporting any functional problems associated with the missing anterior teeth although some speech difficulties have been reported, particularly with the s sound. Although impaction of 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. As missing upper incisors are regarded as unattractive, this may have an effect on self-esteem and general social interaction and it is important to detect and manage the problem as early as possible. This case report describes the treatment of a patient with a horizontally impacted maxillary central incisor. Due to a midline shift and lack of space in the upper arch, a two stage treatment plan was developed. In the first stage, space was created by using a closed coil spring. The second stage involved surgical exposure and traction of the impacted central incisor. The patient finished treatment with a normal and stable occlusion between the maxillary and mandibular arches and an adequate width of attached gingiva.

A Versatile Spring Design for Management of Impacted Teeth in Anterior Arch

A new orthodontic spring design that can be employed in the narrow labial vestibule to provide traction force for movement of impacted teeth in the anterior arch is described. The spring is fabricated at chairside in TMA wire of 0.016 × 0.022″ or 0.017 × 0.025″ size. The method for deployment of this spring design is illustrated with a case report of management of horizontally impacted maxillary central incisor in an 18-year-old patient. The spring design was able to deliver variable force vectors that are customarily required to move impacted teeth from a horizontal to vertical orientation.

Orthosurgical management of odontome-associated maxillary central incisor impaction

region. We present a case of maxillary central incisor impaction associated with a compound odontome, its radiographic features and ortho-surgical management. Abstract Odontomas are hamartomous lesions or malformations rather than true neoplasms and are frequent cause of impaction, delayed eruption of permanent teeth or retention of primary teeth. This case report describes treatment of compound odontoma in a twenty-year-old male presented to a postgraduate orthodontic clinic with chief complaint of space with respect to upper jaw on right side. Radiographically, a compound odontoma was present, which has resulted in failure of eruption of the permanent upper right central incisor. A sequential approach of surgical removal of odontome, surgical exposure and orthodontic traction of the impacted tooth with closed eruption technique resulted in proper incisor positioning. Close monitoring and interdisciplinary management during the treatment led to a successful esthetic result, with good periodontal health and functional occlusion.

Orthosurgical Management of Odontome-Associated Maxillary Central Incisor Impaction

Orthosurgical Management of Odontome-Associated Maxillary Central Incisor Impaction

Root morphology and development of labial inversely impacted maxillary central incisors in the mixed dentition: A retrospective cone-beam computed tomography study

The aim of this study was to analyze 3-dimensional data of root morphology and development in labial inversely impacted maxillary central incisors. Cone-beam computed tomography images from 41 patients with impacted incisors were divided into early and late dental age groups according to their dental age. Sagittal slices in which the labiolingual width of the tooth was the widest in the axial view were evaluated. The inverse angle, the dilaceration angle, and the length of both impacted and homonym teeth were evaluated with SimPlant Pro software (version 13.0; Materialise Dental NV, Leuven, Belgium). The Student t test indicated that the lengths of the impacted teeth were significantly shorter than those of the homonym teeth (P<0.05), and the root lengths of the early dental age group were significantly shorter than those of the late dental age group. The results from chi-square tests indicated that the incidence of dilacerations was significantly higher in the late dental age group when compared with the early dental age group. Multiple regression analyses indicated that the independent variables for root length of the impacted teeth were dental age (β=0.958; P<0.001) and length of the nondilacerated part of the root (β=0.435; P<0.001). Dilaceration was more common in the late dental age group. The roots of labial inversely impacted maxillary central incisors continue developing, but their potential is limited.

Εvaluation of a treatment protocol for unerupted maxillary central incisors: retrospective clinical study of 46 children.

To evaluate the clinical outcome of a treatment protocol performed in children with unerupted permanent maxillary central incisors, including surgical removal of any related obstruction and traction initiation in one stage, under fully repositioned flap, combined with pre- and post-operative orthodontics for space creation and final alignment. Forty-six patients aged 7.3-12.7 years (mean = 9.44 ± 1.36) having 54 impacted maxillary central incisors were reviewed. The study group included 37 patients fully treated by us and nine referrals with eruption failure of impacted incisors following previous surgical removal of various obstructions. Detailed patient's clinical and radiographic data were recorded. Aetiology of unerupted incisors included 9 patients with odontomas, 24 with supernumerary teeth, 1 with skeletal lack of space, 1 with a dentigerous cyst, 4 with dilaceration, 1 with severe incisor MIH, 5 with luxation injuries to primary predecessors and 1 with coexisting dilaceration and odontoma. The total treatment time following the standardised protocol ranged from 5 to 21 months (mean 9.88 ± 3.10), while the time needed using different approaches (no pre-operative orthodontics or obstruction removal and then to wait over an assessment period) ranged from 12 to 18 months (mean 15 ± 2.12) and 17 to 30 months (mean 23.73 ± 5.14), respectively (p < 0.05). The time needed for full alignment depended on the inclination, the height of the impacted tooth (p = 0.001) and the patient's age (p = 0.002). Additionally, the absence of pre-operative orthodontics for space creation dramatically increased treatment time (p = 0.018). In contrast, the maturity of the impacted tooth and the developmental stage of the anterior teeth did not affect treatment time. Finally, when the location of the impacted tooth and the space availability allowed waiting for spontaneous eruption, treatment time was not statistically different from that of the main treatment protocol (p = 0.545). The studied treatment protocol appears ideal for successful results and minimum treatment time. Space creation followed by surgical removal of any obstruction together with orthodontic traction initiation produces excellent results, while waiting for spontaneous eruption is indicated only in cases of favourable patient's age and tooth location. Treatment initiation with operation in the absence of the required eruption space is not recommended, whereas in unfavourable cases obstruction removal without simultaneous orthodontic traction increases dramatically the total treatment time and requires an unnecessary second operation for traction.

Bilateral Maxillary Central Incisor Impaction associated with Developing Supernumerary Premolars in the Mandibular Arch

Bilateral Maxillary Central Incisor Impaction associated with Developing Supernumerary Premolars in the Mandibular Arch

An efficient biomechanical approach for the management of an impacted maxillary central incisor

Treatment of an impacted maxillary central incisor poses a unique challenge to the orthodontist because of its position within the esthetic zone, requiring careful management of the soft tissues and an effective biomechanical setup for alignment. This article describes a novel method of extending an extrusion wire from cross tubes attached on the base archwire for forced eruption of impacted central incisors. The effectiveness and versatility of this method are demonstrated with 2 patients.