Impacted Maxillary Central Incisor Research Articles

Treatment of a challenging case of impacted, severely dilacerated & 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

The evaluation of lateral incisor adjacent to treated labial inversely impacted maxillary central incisor: A retrospective follow-up study

This retrospective study aimed to evaluate the further development of the lateral incisor and its associated periodontium adjacent to the treated labial inversely impacted maxillary central incisor. We enrolled 23 participants (average age, 8.24 ± 1.43 years) undergoing a mean follow-up period of 31.10 ± 13.05 months. Each participant had an unimpacted lateral incisor and a successfully treated unilateral labial inversely impacted maxillary central incisor. The contralateral lateral incisors served as controls. Cone-beam computed tomography data were available for treatment completion and follow-up stages. The variables (including root length, dental age, root canal width, root-crown angulation, and alveolar bone loss and thickness) were evaluated with Dolphin Imaging software (version 11.95; Dolphin Imaging and Management Solutions, Chatsworth, Calif). At the follow-up stage, the lateral incisors in the impacted side had significantly longer root lengths, smaller root canal widths, and thinner labial bone widths at the apex than at the posttreatment stage (P<0.001, P= 0.036, and P= 0.001, respectively). A significant lateral incisor root length reduction was noted when comparing the impacted and contralateral sides, although no variation was observed in root canal width. Similarly, crown-root angulation of the lateral incisor on the impacted side was significantly larger than that of the contralateral lateral incisor. The lateral incisor on the impacted side also had thicker labial and thinner lingual bone widths at the apex than the contralateral lateral incisor. The lateral incisor adjacent to the successfully treated labial inversely impacted maxillary central incisor showed continuous growth during follow-up stages, exhibiting a similar morphology and alveolar bone quality but shorter root length, larger root angulation, and thinner lingual bone width at the apex than those of the contralateral lateral incisors.

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.

Laser exposure and orthodontic traction of an impacted maxillary central incisor

Laser exposure and orthodontic traction of an impacted maxillary central incisor

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.

Study protocol for the management of impacted maxillary central incisors: a multicentre randomised clinical trial: the iMAC Trial

BackgroundFailure of eruption of the maxillary permanent incisor teeth usually presents in the mixed dentition between the ages of 7 and 9 years. Missing and unerupted maxillary incisors can be regarded as unattractive and have a potentially negative impact on facial and dental aesthetics. The presence of a supernumerary tooth (or odontoma) is commonly responsible for failed eruption or impaction of the permanent maxillary incisors. The primary objective of this trial is to investigate the success of eruption associated with maxillary incisor teeth that have failed to erupt because of a supernumerary tooth in the anterior maxilla.MethodsThis protocol describes an interventional multicentre two-arm randomised clinical trial. Participants meeting the eligibility criteria will be randomised (unrestricted equal participant allocation [1:1]) to either space creation with an orthodontic appliance, removal of the supernumerary tooth and application of direct orthodontic traction or space creation with an orthodontic appliance, removal of the supernumerary tooth and monitoring. The primary outcome of this trial is to determine the prevalence of successfully erupted maxillary central permanent incisors at 6 months following removal of the supernumerary tooth. Secondary outcome measures include (1) the effect of initial tooth position (assessed radiographically) on time taken for the tooth to erupt, (2) time taken to align the unerupted tooth to the correct occlusal position, (3) gingival aesthetics and (4) changes in the self-reported Oral Health Related-Quality of Life (OHRQoL) (pre-and post-treatment).DiscussionThere is a lack of high-quality robust prospective studies comparing the effectiveness of interventions to manage this condition. Furthermore, the UK national clinical guidelines have highlighted a lack of definitive treatment protocols for the management of children who present with an unerupted maxillary incisor due to the presence of a supernumerary tooth. The results of this trial will inform future treatment guidelines for the management of this condition in young children.Trial registrationISRCTN Registry ISRCTN12709966. Registered on 16 June 2022.