Impacted Maxillary Central Incisor Research Articles

Orthodontic management of severe inversely impacted maxillary central incisors: a case series.

Abnormal positioning and dislocation of the central incisor can disturb tooth eruption. Generally, inversely impacted maxillary central incisors do not erupt naturally. Performing traction and applied extrusion of an inversely impacted maxillary central incisor with a high inclination angle of the crown is challenging. This study aimed to examine the possibility of orthodontic treatment for severely inversely impacted maxillary central incisors in a series of case studies. The inclination angle of the tooth crown, curvature of the tooth root, and length of the formed tooth root were measured using radiography. The teeth were then fenestrated and traction was applied using a lingual arch appliance with elastics. The average crown axis inclination was 113°, the degree of root curvature was 97.3°, and the root formation was 36.1%. Although the crown axis inclination and root curvature were severe, all the incisors were aligned in the correct position as vital teeth through surgical and orthodontic treatments. Traction should be performed in the early period of incisor development when root formation is not progressing, regardless of the tooth angle.

Early intervention of unerupted maxillary central incisor: A case series

Early intervention of an impacted maxillary central incisor is crucial to avoid space loss with tipping of the adjacent teeth and allows normal root development. This case series demonstrates the clinical considerations of a surgical-orthodontic approach in managing this eruption anomaly and its challenges. All three cases involved young patients aged 7–9 years with an impacted upper left central incisor and a positive history of dental trauma. An upper sectional fixed appliance was bonded to facilitate the closed eruption of the impacted central incisor. The treatment duration increases when more space is required for the impacted tooth. There was a marginal gingival discrepancy of all the treated central incisors with vertical relapse seen upon review, indicating the need for a careful surgical approach with good hygiene maintenance and a bonded retainer as retention. Early referral for the management of an impacted maxillary central incisor through a surgical-orthodontic approach is often successful, but treatment risks, duration, and retention regimen should be discussed with the parents for informed consent.

Unusual odontogenic keratocyst with impacted maxillary central incisor: A diagnosis challenge

Background: Odontogenic keratocyst (OKC) is considered an odontogenic cyst, with the unique clinical characteristics of this entity being local destruction, aggressive behavior, a high recurrence rate, specific histopathologic features, and the tendency for multiple lesions when associated with syndromes. Odontogenic keratocyst accounts for 12–14% of all cysts in the jaws. Purpose: The aim of this case report is to present an unusual odontogenic keratocyst associated with impacted maxillary central incisor, case management of anterior maxilla odontogenic keratocyst involving an adjacent tooth, and its postoperative six-month follow-up. Case: A 13-year-old female patient was referred to the Universitas Airlangga Hospital with a complaint that her upper front teeth had not erupted. The parents revealed that the patient had suffered trauma from falling down the stairs at the age of four, i.e., eight years ago. Case Management: The cyst was enucleated together with the associated permanent upper right central incisor, retained deciduous upper right central incisor, the permanent upper right lateral incisor, and upper right canine. Post surgical treatment, the patient used a partial denture to increase her self-confidence. Conclusion: Enucleation of the cyst with extraction of the permanent teeth should be performed to avoid recurrence of the OKC. Periodic radiographic evaluation is required with long-term follow-up.

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.

Surgical and orthodontic management of impacted maxillary central incisor in children: A case report

Impaction of maxillary permanent central incisor is a frequently reported case in dental practice, and its treatment is challenging because maxillary central incisors are of great important for both aesthetic and functional aspects, since they provide support of the lip and facial muscles. Early detection of such teeth is most important if complications are to be avoided. In this article, we report a case of a 12-year-old girl, in the Pediatric Dentistry Specialist, Dental and Oral Hospital, Airlangga University. Combined approach with surgical exposure and the application of an orthodontic force brought the impacted left maxillary central incisor down to its proper position in the dental arch.

Treatment of a challenging case of impacted, severely dilacerated &amp; deflected maxillary central incisors: A case report with 10 years follow up

Impaction, dilaceration, and internal deflection of both maxillary permanent central incisors are not frequently reported in dental practice. The treatment approach is essential as it plays a pivotal role in contributing to the facial aesthetics and occlusion in permanent dentition of the individual. This is a case of a 10-year-old male diagnosed radio graphically with impacted, severely dilacerated, and deflected both the Maxillary central incisors. The management of the case was carried out surgically and orthodontically. By combining two stages of surgical exposure, orthodontic traction and alignment, the impacted dilacerated and deflected incisors were successfully moved into the desired position. A ten-year follow-up of the stability and periodontal health showed that the tooth placed in the occlusion maintained both esthetics and function.

Quality analysis of the clinical practice guidelines for management of impacted maxillary central incisors: a systematic review.

To assess the quality of clinical practice guidelines (CPG) for management of impacted central incisors. Search was performed in PubMed, LILACS, Web of Science, EMBASE, Scopus, and Cochrane databases, and guideline-focused databases/repositories on 15-09-2022 without any limitations and was updated on 15-07-2023. Grey literature search was also performed. Two independent reviewers were involved in the study selection and data extraction. Quality assessment of the included CPG was performed by four independent appraisers using the AGREE-II instrument. The degree of agreement among the appraisers was calculated using the intraclass correlation coefficient (ICC). Five CPG were included in the review. The Ministry of Health, Malaysia (MHM) guideline obtained the highest scores in all six domains of AGREE-II and an overall score of 73% demonstrating the "highest" quality. The remaining four guidelines obtained overall "low-quality" scores ranging from 34.57-37.52%. The ICC scores ranged from 0.530 to 0.990 for various domains of AGREE-II. MHM guidelines demonstrated high-quality scores in domains of 'scope and purpose', 'clarity of presentation', 'applicability domain', and 'editorial independence', while others were found to have moderate or low quality. This review identified areas that can be addressed by future guideline developers to avoid these discrepancies.

Surgical and orthodontic management of an impacted maxillary central incisor associated with supernumerary teeth: A case report

Surgical and orthodontic management of an impacted maxillary central incisor associated with supernumerary teeth: A case report

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.

Orthodontic-Surgical Management of Impacted Maxillary Central Incisor Related to Supernumerary Tooth: a Case Report

Anterior teeth play an important role in maintaining esthetics and phonetics in human beings. Missing anterior teeth might result in rotation, shifting, and root resorption of the adjacent teeth, loss of eruption space, underdevelopment of the anterior part of the maxilla, and crossbite. Adolescent patients are very conscious about how they look, and missing anterior teeth lowers their selfesteem. Due to the above reasons, missing anterior teeth should be managed as early as possible. The present case report highlights the orthodontic traction of the impacted maxillary central incisor caused by a supernumerary tooth. At the same time, the treatment outcome regained smile in an 11-year-old patient who had stopped smiling because his peers had started to call him by the name “toothless”.

Facilitated orthodontic tooth movement with periodontal intervention: A case report

Maxillary central incisors play a significant role in the facial aesthetics as it forms a major component of smile. We report a 27 years old male patient undergoing orthodontic treatment for the forceful traction of impacted maxillary central incisors into the occlusion who presented with a fusion of the gingiva and lips in the maxillary anterior region obliterating the maxillary labial vestibule and entrapping the orthodontic retractors earlier placed. Vestibuloplasty was carried out using scalpel and electrocautery to regain the vestibular depth followed by exposure and traction of the impacted maxillary central incisors into occlusion. The patient achieved excellent results which was realised at one-year follow-up, by which time orthodontic treatment was also completed. The case is being described because of the unusual fusion of lips and gingiva, and hence requires careful treatment planning for successful outcomes.

Treatment of impacted maxillary central incisors as a consequence of trauma

Treatment of impacted maxillary central incisors as a consequence of trauma

A Rare Case of Inverted Impaction of Maxillary Central Incisor With U-Shaped Dilaceration of Middle 1/3rd

Impaction of maxillary central incisor is not frequently reported in literature. Impacted maxillary incisors are rare and detrimental to aesthetic problems in permanent dentition stage. The term dilaceration describes an abrupt deviation of the long axis of the crown or root portion of a tooth. Dilaceration generally occurs following trauma to the apices of deciduous dentition, which lies is close proximity to the permanent tooth buds.

Periodontal outcomes associated with impacted maxillary central incisor and canine teeth following surgical exposure and orthodontic alignment: a systematic review and meta-analysis.

Maxillary incisor and canine teeth are commonly impacted and require multidisciplinary treatment to accommodate them in the dental arch. To assess the periodontal outcomes of impacted maxillary central incisor and canine teeth, which have been successfully aligned in the arch following surgical exposure and orthodontic traction with fixed appliance therapy. Systematic literature searches without restrictions were undertaken in eight databases. Studies reporting surgical interventions in combination with orthodontic traction with fixed appliance therapy to align impacted maxillary incisors or canines published up to January 2023. Duplicate independent study selection, data extraction, and risk of bias assessment. Random-effects meta-analyses of aggregate data. Twenty-three studies (21 retrospective and 2 prospective) were included in the final analysis. Three studies reported outcomes for maxillary central incisors and 20 reported outcomes for maxillary canines. For maxillary central incisors, all three studies were rated as being at moderate risk of bias. For maxillary canines, 17 studies and 1 study were rated at moderate and high risk of bias, respectively. Both prospective studies were rated at a low risk of bias. Meta-analyses comparing aligned impacted maxillary canines to their non-impacted contralateral counterparts found the former had increased Plaque Index scores (mean difference [MD] 0.19; 95% confidence interval [CI] 0.03, 0.35; P = 0.03), increased clinical attachment loss (MD 0.40 mm; 95% CI 0.17, 0.63; P = 0.01), increased pocket probing depth (MD 0.18 mm; 95% CI 0.07, 0.28; P = 0.001), increased bone loss (MD 0.51 mm; 95% CI 0.31, 0.72; P < 0.001), and reduced keratinized gingival width (MD -0.31 mm; 95% CI -0.61, -0.01; P = 0.04). Limited evidence suggests that surgical exposure and orthodontic alignment of impacted maxillary central incisor or canine teeth, results in modest adverse effects in the periodontium. These findings should be viewed with caution as our certainty for these outcomes is very low to low due to the bias and heterogeneity. Further well-conducted studies reporting patient centred outcomes are required. PROSPERO (CRD42020225639).

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.

Surgical treatment of complex odontoma in anterior maxilla – A rare case report

Odontomas are the odontogenic tumour which are benign whose origin is from epithelial and mesenchymal cells. These have a high incidence rate and are widely acknowledged as hamartomas. Odontomas are mainly made up of enamel and dentin, with differing amounts of cementum and pulp. The aetiology is not known yet, the hypothesized causes are: local trauma, infection, inheritance and genetic mutation. Most of these lesions are not symptomatic and are frequently diagnosed on routine radiographs. They are divided histologically into complex and compound odontomas.These are generally diagnosed in the posterior region of the mandible and resemble haphazardly arranged tooth‑like structure. Here, we report the case of a patient who is 21 years of age with a complex odontoma-related impaction of permanent maxillary right central incisor which was managed by surgical excision through palatal approach.

Early Multidisciplinary Approach for the Management of Dilacerated Permanent Maxillary Incisor: A Case Report

Management of dilaceration teeth poses a unique challenge to the clinician due to its position within the esthetic zone. This case report describes the management of impacted maxillary central incisor with severe root dilacerations. Surgical exploration was done and orthodontic treatment was planned. The dilacerated incisor was alighed, optimal treatment outcome with esthetic and functional was well done.

Managing two impacted maxillary central incisors using surgical orthodontic traction in an adult patient

Managing two impacted maxillary central incisors using surgical orthodontic traction in an adult patient