Maxillary Central Incisors Research Articles

Interdisciplinary Management of a Class II Bimaxillary Protrusion Case With a Traumatized Maxillary Central Incisor: A Case Report

Interdisciplinary Management of a Class II Bimaxillary Protrusion Case With a Traumatized Maxillary Central Incisor: A Case Report

Designing mouthwash formulations with innovative molecular components to control initial dental erosion in vivo.

This study aimed to examine and compare the efficacy of mouthwashes containing different proteins and peptide on the prevention of enamel erosion in vivo, as well as to evaluate the participants' satisfaction with the formulations. Twelve participants were selected and underwent five cross-over mouthwash phases: Water (control); 0.1mg/mL CaneCPI-5; 0.5mg/mL MaquiCPI-3; 0.1mg/mL CsinCPI-2; and 0.037mg/mL Stn15pSpS. After prophylaxis, the participants rinsed (1min), followed by the acquired enamel pellicle (AEP) formation (2h). An erosive challenge was made (biopsy, citric acid 1%, 15s) on the buccal surface of the central maxillary incisors. The Relative Surface Reflection Intensity (%SRI) was assessed and analyzed by ANOVA/Tukey's tests. The calcium release in acid was measured by the Arsenazo method and verified by Kruskal-Wallis/Dunn's tests. The Spearman's correlation was used between analyses. A questionnaire evaluated the satisfaction of participants. For both analyses, the results showed that mouthwashes containing the proteins or peptide were significantly more effective in preventing enamel erosion compared to deionized water, with no significant differences among the active ingredients (p < 0.05). Also, there was a significant negative correlation between %SRI and calcium released (r=-0.5754). The questionnaire revealed that the volunteers were satisfied with the taste of the products. In addition, the experimental procedures were well tolerable, and no side effects were reported. All mouthwashes containing proteins or peptide were acceptable and effective in protecting enamel against initial dental erosion in vivo. This study highlights the potential of these pioneer organic components for the development of mouthwashes designed for people with risk of erosive tooth wear.

Effect of Salvadora persica chewing sticks on maxillary central incisors crown-root angulation in Western-Asian population &amp; correlation with Collum angle on 3D CBCT images

The main aim of the study was to identify the Collum angle classification for maxillary central incisors among individuals use vs not-use chewing sticks which could have beneficial role for immediate implant placement in respective individuals. Additionally, to identify the root-crown positioning and angulation in the Western Asian Saudi Arabian population for chewing sticks user’s vs non-users in order to develop guideline for the prosthetic procedures using Cone beam computed tompography (CBCT). A total number of 380 CBCT scans were included in the study for both of the groups based on the inclusion criterion of the patients reporting to the Dental OPD of Riyadh Elm University. The data was analyzed using 3D planner dental imaging software. Initially the teeth were classified based on root position in relation to facial plate of alveolar bone using Jung et al. classification. Additionally, the Collum angle and the root angulation of the maxillary central incisors was evaluated. The data was analyzed using one-way Anova with post-hoc Tuckey-Kramer test for pair-wise comparison. As per the Jung et al. classification, majority of the roots were observed with buccal placement. Based on the Collum angle classification majority of the maxillary central incisors were observed with facial placement (n=170), specially subtype I (n=78). But the root angulation was observed to be independent of Collum angle. Thus, it can be concluded, unlike root angulation, Collum angle has a correlation with root positioning. The angle for the individuals using chewing sticks of Salvadora Persica was similar to the individuals not using the miswak. Collum angle is correlated in all classified position of root. But the root angulation is independent of classification varies between miswak and non-miswak users.

Quantitative Evaluation of Enamel Thickness in Maxillary Central Incisors in Different Age Groups Utilizing Cone Beam Computed Tomography a Retrospective Analysis

Background/Objectives: The presence of enamel on the tooth surface is crucial for the long-term success of minimally invasive adhesive restorations such as dental veneers. Our study aims to evaluate the enamel thickness in the incisal, middle, and cervical portions of the labial surface of the upper central incisors using cone beam computed tomography (CBCT). This imaging method provides detailed and accurate three-dimensional images with a low radiation dose, allowing an accurate assessment of enamel thickness. The analysis aims to identify variations in enamel thickness depending on the age and different levels of the labial tooth surface. Methods: 800 CBCT scans performed for diagnostic or therapeutic purposes on patients aged 18–60 years were analyzed. The data were gathered from the imaging archives of private practitioners from Targu Mures and the “George Emil Palade” University of Medicine, Pharmacy, Science, and Technology of Targu Mures. Enamel thickness measurements were conducted using the OnDemand3D Communicator CBCT evaluation program, with subsequent statistical analysis performed using GraphPad Instat Prism software. Results: Results showed significant variation in enamel thickness between the incisal, middle, and cervical segments of the labial surface of the upper central incisors. A decrease in enamel thickness with age has been observed. In patients aged 18–40, mean values of enamel thickness 1 mm and 3 mm above the cementoenamel junction (CEJ) were 0.48 ± 0.092, respectively, 0.819 ± 0.158. In patients over 40, the mean values were 0.454 ± 0.116 and 0.751 ± 0.067 at 1 mm, respectively, 3 mm above the CEJ. Statistically significant differences were found between the two age groups at 1 mm and 3 mm above the CEJ, with p &lt; 0.0001 and p = 0.0214. Conclusions: A statistically significant decrease can be observed in enamel thickness in almost the entire labial surface of the upper central incisors with aging. The varied thickness of the enamel at different tooth levels requires individualized planning for each patient to maximize the long-term aesthetic and functional results.

Endodontic and Surgical Management of Trauma-Induced Combined Internal and External Root Resorption with Periapical Cyst: A Case Report

Root resorption, involving the breakdown of hard tissues like dentin and cementum, can result from trauma and subsequent infection, potentially leading to tooth loss. This case report details the management of combined internal and external root resorption with a periapical cyst in a 32-year-old male. After trauma, the maxillary left central incisor (#21) presented with root resorption and a displaced apex. Endodontic treatment using MTA and surgical enucleation of the cyst were performed. A 12-month follow-up showed successful resolution and tissue regeneration. This case emphasizes the effectiveness of combining advanced endodontic and surgical techniques for complex resorption cases.

Marginal Discrepancy and Internal Fit of 3D-Printed Versus Milled Laminate Veneers: An In Vitro Study

The clinical success of laminate veneers depends upon their marginal discrepancy (MD) and internal gap (IG). This study aims to compare and evaluate the MD, overall discrepancy (OD), absolute marginal discrepancy (AMD), and IG of 3D-printed (Varseosmile TrinQ and Varseosmile Crown Plus) and computer-aided design and manufacturing (CAD/CAM)-milled (Brilliant Crios) laminate veneers using cone-beam computed tomography (CBCT). Thirty maxillary central incisors were prepared and divided randomly into three groups (n = 10). All teeth were scanned for veneer fabrication: Group PVT teeth with 3D-printed Varseosmile TrinQ, Group PVC teeth with 3D-printed Varseosmile Crown Plus, and Group BCM teeth with Brilliant Crios milled veneers. The specimens with respective veneers were scanned using CBCT, and the sectional images were measured for IG, MD, OD, and AMD. The mean values for MD recorded were 0.27, 0.31, and 0.40 for PVT, PVC, and BCM respectively). The mean values for IG recorded were as follows: PVT group—0.24, PVC group—0.28, and BCM group—0.39, and those for OD were as follows: PVT—0.22, PVC—0.32, and BCM—0.41. Intragroup significance was observed for IG and OD (p = 0.001). Findings revealed that milled veneers have a higher IG and MD than 3D-printed veneers, making them less clinically acceptable.

Effects of Mechanized Irrigation Protocols on Endodontic Obturation Using Calcium Silicate-Based Sealer

The aim of this study was to evaluate the effects of mechanized final irrigation protocols (XPE, XP-Endo Finisher; XPC, XP-Clean; and ECL, Easy Clean) compared to PUI (passive ultrasonic irrigation) on the debris incidence and open dentinal tubules, and their effects on the adhesion interface after 48 h and 6 months. One hundred twenty maxillary central incisors were submitted to chemical–mechanical preparation using a rotary instrument and 2.5% sodium hypochlorite. Specimens were distributed in 4 groups (n = 30) in accordance with the mechanized final irrigation protocol: XPE, XPC, ECL, or PUI. Forty specimens (n = 10/group) were submitted to SEM analysis to evaluate the residue incidence and dentin open tubules. The other specimens were obturated using Bio-C Sealer and submitted to push-out bond strength and adhesive failure mode evaluations in the cervical, middle, and apical thirds after 48 h or 6 months (n = 10/group). Only in the apical third, ECL presented the highest residue incidence and fewer open dentinal tubules when compared to the XPE, XPC, and PUI groups (p &lt; 0.05). In the cervical and middle root thirds, no significant differences were observed regardless of the group evaluated (p &gt; 0.05). After 48 h, ECL resulted in the lowest bond strength only in the apical third (p &lt; 0.05), while the XPE, XPC, and PUI groups remained similar in the cervical and middle thirds (p &gt; 0.05). At 6 months, all groups showed lower bond strength values regardless of the root third evaluated, but ECL showed the lowest bond strength in the apical and middle root thirds when compared to the other groups (p &lt; 0.05). The ECL protocol did not provide adequate residue removal on the apical radicular third and negatively affected the longevity of endodontic obturation using a calcium silicate-based sealer.

Traumatic Dental Injuries in Children and Adolescents from a Major Dental Clinic in Bosnia and Herzegovina: A 5-Year Retrospective Study

The aim of this study was to investigate the epidemiology of dental trauma in a public dental clinic in Banja Luka, Bosnia and Herzegovina, from 2019 to 2024. Methods: This research was conducted as a retrospective cross-sectional study. The data were analysed and compared between injured primary and permanent maxillary and mandibular teeth. Results: The review of the dental records revealed 73 patients (49 boys and 24 girls) with TDIs, involving 55 primary and 64 permanent teeth. Most of the patients (27 patients, 36.98%) were aged 7–9 years. The main cause of TDI was falls in both dentitions (81.81% of injured primary teeth and 73.43% of injured permanent teeth). The time of arrival after a TDI for assistance in the dental clinic for most cases was after 24 h in both dentitions, 45.45% of injured primary teeth and 48.43% of permanent teeth. For both dentitions, enamel fractures were the most common injury of hard dental tissues and the pulp, and the necrosis of the maxillary central incisor was the most common complication. Conclusions: It is very important to improve trauma management and increase public knowledge on the way parents seek proper treatment for the TDIs of their children, and in due time.

Retreatment and aesthetic restoration of maxillary incisor with calcified root canal using a dynamic navigation system: a case report

BackgroundPulp canal occlusion (PCO) increases the difficulty of root canal treatment as well as tooth preservation and restoration. This is the first case report of successful localization of a calcified root canal under the guidance of a dynamic navigation system (DNS) for complete root canal retreatment and aesthetic restoration after a failed attempt to locate the calcified root canal with a traditional dental operating microscope (DOM).Case presentationThe patient was scheduled for root canal treatment for a labially inclined maxillary central incisor and post-core crown restoration with resin veneers in another hospital, but the calcified root canal could not be located with a microscope, so the patient was referred to our department. Root canal retreatment was planned for tooth #8, and the calcified root canal of tooth #9 was planned to be located and dredged under the guidance of a DNS. We used a DNS for successful positioning and to complete the root canal retreatment operation in the following 4 steps: preoperative CBCT imaging, preoperative plan design, calibration and registration, and real-time dynamic navigation. Three months later, teeth #8 and #9 presented no clinical symptoms, after which the fiber post-cores and zirconia all-ceramic crown restorations were completed. At the 12-month follow-up visit, the patient continued to be symptom­free, and satisfied with the final aesthetic restoration.ConclusionsThis case report suggests that DNS may be a promising technique with high accuracy and effectiveness to reduce the risk of iatrogenic errors and provide maximal preservation of dentin, when the traditional treatment of calcified root canals approaches failure (lateral perforation).

Comparative evaluation of the position of incisive canal and its proximity to the maxillary central incisor roots with different incisor inclinations – A CBCT study

Objectives: The aim of this study was to evaluate and compare the incisive canal position and its proximity to maxillary central incisor roots at different incisor inclinations. Material and Methods: A 105 CBCT samples have been then divided into three groups on the basis of U1-SN and U1-NA when traced on lateral cephalogram into normal, proclined, and retroclined. Several linear measurements have been made in the axial plane at three different levels, that are palatal opening, mid-root level, and apex, in relation to the incisive canal. Angular measurements were also made in the sagittal plane. Results: A significant difference was found between the proximity of the maxillary right and left central incisor to the incisive canal in the proclined and retroclined group at the mid-root level and at the apex. There has been a major variation between the angles developed by the incisive canal to the palatal plane in all three groups. A significant correlation was also found between the angle formed by the incisive canal to the palatal plane and the tooth’s long axis to the palatal plane. Conclusion: The proclined group exhibits the shortest distance between the incisive canal and the incisors, implying the need for meticulous planning in Class II Division 1 and bimaxillary protrusion cases. This planning is crucial when aiming for extensive retraction and intrusion to prevent any contact with an incisive canal, thus reducing the root resorption risk.

Age estimation by evaluation of pulp chamber to crown volume of central incisor and first molar of maxilla, using Cone-Beam CT

ObjectivesThis study examines the relationship between chronological age and the ratio of pulp chamber volume to crown volume in maxillary central incisors and first molars. Cone-beam computed tomography (CBCT) is used to measure the pulp chamber size, which decreases following the eruption of the tooth. Study designThe study focused on age estimation using cone beam computed tomography (CBCT) images of 156 patients from Mashhad Dental School (67 maxillary central incisors and 42 maxillary first molars). We stratified the age range into three groups: 18–27 years, 28–37 years, and 38–49 years. The study used Planmeca ProMax 3D and ITK-SNAP 3.4.0 software for segmentation and volume quantification. The data was analyzed using PASW Statistics 18 software, with descriptive statistics and linear regression analysis for age estimation. ResultsThis study created a mathematical model for calculating chronological age, taking into account factors such as pulp-to-crown volume ratio, gender, and tooth type. Results showed no significant difference in mean age between male and female subjects, and the average pulp-to-crown volume ratio remained consistent across genders and tooth types. ConclusionThe study uses CBCT to estimate Iranian population age using maxillary central incisors and first molars. The pulp chamber to crown volume ratio is reliable for 28–37 years, but accuracy decreases with age. Larger sample sizes and other teeth could improve estimation.

Evaluation of polyaryletherketone materials as post-core abutments for removable partial dentures: A finite element analysis

ObjectiveThe purpose was to compare the biomechanical behavior of single-piece post-core restorations made from polyaryletherketone materials with fiber post-core restorations when serving as abutments for RPD using finite element analysis (FEA). MethodsPhantom maxillary central incisor and mandibular second premolar were trimmed 1-mm coronally to cemento-enamel junction; root canals were enlarged and the teeth were scanned. Data was transferred to a solid modeling software.Twenty four models, including six post-core restorations:glass-fiber post/composite core (GFH/GFL) and single-piece post-core groups as, PEKK(PKH/PKL);Ti02-reinforced PEEK(TH/TL);ceramic reinforced PEEK(CeH/CeL);carbon fiber reinforced PEEK(CaH/CaL);glass fiber reinforced PEEK(GFPH/GFPL) with hybrid ceramic/lithium disilicate crowns on each tooth were constructed.Loads of 100 N for central incisor, and 300 N for premolar in a 45°oblique direction were applied to simulate masticatory forces. Clasp removal force of a RPD was simulated as 5 N vertically.FEA was employed to evaluate the von Mises stresses.Strain at cement layer was also investigated. ResultsCaH/CaL groups revealed the lowest stress for both teeth at root while TH/TL groups revealed the highest stress. The lowest stress values in the post-core were in GFH/GFL groups while the highest stress occurred in the CaH/CaL groups for both teeth. SignificanceGlass-fiber post-cores exhibited the lowest stresses in the post under masticatory and clasp removal forces. It may suggest a potentially lower risk of post fracture compared to polyaryletherketone group materials. TiO2-reinforced PEEK post-cores exhibited the lowest stresses among PAEK materials, indicating a potentially high fracture resistance.

Nonsurgical root canal treatment of an Oehlers type IIIa maxillary central incisor with dens invaginatus: a case report

Dens invaginatus has a complex anatomy, making endodontic treatment challenging. We report the case of a 11-year-old girl who presented with radiolucency at the apex of the maxillary central incisor; she was diagnosed with symptomatic apical periodontitis. Cone-beam computed tomography (CBCT) revealed dens invaginatus. The invagination and root canal were observed using a dental operating microscope, and nonsurgical root canal treatment was performed. The invagination was connected to the periodontal tissue, and the tooth was classified as Oehlers type IIIa. Root canal preparations were performed using NiTi files and an ultrasonic device. A calcium hydroxide paste was used as an intracanal dressing. The root canal was filled using a single-cone hydraulic condensation technique with a highly fluid calcium silicate-based sealer. At the 2-year follow-up, no clinical symptoms were observed, and CBCT images revealed no radiographic lesions. Nonsurgical endodontic treatment using CBCT imaging, dental microscope, effective cleaning systems, and a highly fluid sealer facilitated the successful treatment of apical periodontitis attributed to dens invaginatus. The single-cone hydraulic condensation technique using a bio-ceramic sealer is considered effective even in cases with a complex morphology and open apex.

Evaluation of anterior teeth crown-root morphology and alveolar bone structure in patients with closed deep overbite using cone beam computed tomography

This retrospective study used cone-beam computed tomography to investigated the crown-root morphology and alveolar bone structure in incisors region in subjects with closed deep overbite and comparison the difference between gender and age. The CBCT images for 40 subjects (group C) with Angle II division 2 were selected from patients of the HeFei Stomatological Hospital from November 2023 to March 2024.20 individual normal occlusion subjects (group A),20 patients with Angle II division 1(group B) were included. The crown-root ratio of the maxillary and mandibular anterior teeth, crown-root angle and alveolar bone structure were measured on the CBCT images, the data were statistically analyzed. In addition to mandibular lateral incisor, the crown-root ratio of maxillary and mandibular anterior teeth in the Class II division 2 group was higher than that in the individual normal occlusion group and the Class II division 1 (P < 0. 05). The crown-root angle of maxillary anterior teeth in the Class II division 2 group was smaller than that in the individual normal occlusion group and the Class II division 1 (P < 0. 05). The alveolar bone thickness of the maxillary central incisor was comparatively smaller, while the alveolar bone height was relatively higher in the Class II division 2 group. Age and gender were associated with change in root lengths and crown-root angle for the Class II division 2 group (P < 0. 05). Patients with closed deep overbite malocclusion exhibit a significant difference compared to the controls for most measurements. The patients presenting with Class II division 2 malocclusion exhibit excessive inward positioning of the anterior teeth, resulting in evident crown-root angle, a large crown-root ratio, and minimal labial alveolar bone. In order to keep the tooth movement within the safe range of alveolar bone movement, it is necessary to strictly control the torque and use appropriate orthodontic force to reduce the risk of bone fenestration, bone dehiscence, gingival recession and root resorption.

Conservative Management of Facial Talon Cusp in a Permanent Maxillary Central Incisor: A Case Report

Conservative Management of Facial Talon Cusp in a Permanent Maxillary Central Incisor: A Case Report

Rehabilitation of a Severe Anterior Ridge Defect with a Fixed-Removable Prosthesis

Significant anterior ridge abnormalities might be difficult to restore with prosthesis. To attain good speech and aesthetics necessitate not only the restoration of the missing teeth but also the closure of the problematic region. One recommended treatment option for individuals with substantial ridge abnormalities is the Andrews bridge which is a fixed-removable prosthesis. The prosthesis correctly replaces the missing teeth and corrects the ridge defect area and restore speech and appearance. A 35-year-old female patient reported with the principal complaint of spacing in her lower front teeth and difficulty in phonetics and poor appearance. On clinical examination spacing was seen in the maxillary central incisors along with pro-clination and 31,32,33,41,42,43 teeth were missing and the edentulous defect area was coming under Seibert's Class III category. Rehabilitation of such defect with an Andrews bridge described in this case report, which used natural teeth as abutments for its permanent component and a detachable superstructure.

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.

Orthodontic-Surgical Management of Triple Impacted Mesiodens and Maxillary Incisors - A Case Report

Abstract Rationale: Mesiodens are supernumerary teeth located in the pre-maxilla between the two central incisors with a prevalence rate of 0.15–1.9%. An impacted mesiodens may cause delayed eruption of permanent incisors, ectopic eruption, pathological disturbances and malalignment of teeth. Patient Concerns: The patient complained of missing upper front teeth associated with pain in the same region for two weeks. Diagnosis: Upon clinical and radiographic examination, it was diagnosed as triple impacted mesiodens with impacted permanent maxillary central incisors. Treatment: The clinicians in the study approached the issue by surgical removal of the impacted mesiodens and orthodontic treatment for extrusion of the impacted permanent maxillary central incisors. Outcomes: The patient was relieved of the pre-operative concerns and followed up regularly for the eruption of permanent maxillary central incisors. Take-away Lessons: The authors advocate the importance of timely diagnosis and proper management of such rare pathologies.

Artificial Intelligence in Aesthetic Dentistry: Is Treatment with Aligners Clinically Realistic?

Smile aesthetics are increasingly prioritized in dental practice, with accurate orthodontic assessment and treatment planning being crucial for optimal outcomes. This study evaluates Invisalign® SmileView™ (SV), an AI-based tool that simulates post-treatment smiles, focusing on its ability to present potential orthodontic outcomes to patients. Background/Objectives: This research aims to study whether SV can simulate predictable orthodontic results and if it makes anatomical modifications to the teeth. Additionally, it will evaluate whether SV displays smiles that conform to the orthodontic criteria described in the literature. Finally, the study will analyze whether the software can align the dental with the facial midline. Methods: A total of 51 subjects were recruited in Madrid, Spain. The operator took a frontal photograph of the subjects with a social smile (T0), following the application’s instructions. Subsequently, the subjects followed the steps to modify their smile (T1), resulting in a new image of the subject with a different smile. The following variables were collected, analyzed, and compared with the standards defined in the literature: smile width, vertical exposure of the maxillary central incisor, width of the maxillary central and lateral incisors, proportion of the maxillary lateral incisor width to the central incisor, anterior gingival exposure level, position of the upper and lower dental midlines relative to the facial midline. Results: 58% of the sample showed dental expansion, with an excessive expansion (&gt;5 mm) observed in 8%. In the maxillary arch, 5.9% of incisors exceeded predictable aligner movement (&gt;1.5 mm), with 3.9% showing excessive extrusion and 2% excessive intrusion. For the lateral incisors, the mesiodistal size was reduced less than 0.5 mm in 31.4% of cases, with excessive interproximal reduction (&gt;0.5 mm) in 5.9%. Additionally, 62.7% of cases would require multidisciplinary treatment due to an increase in size. SV centered the upper midline in 77.9% of these cases. Among the sample, the upper midline was initially centered in 74.5% of subjects, and SV maintained it centered in 84.2% of these subjects. Conclusions: SV tends to generate simulations of broader smiles, which are mostly achievable through aligner treatments, from an orthodontic perspective, and showed high predictability regarding the vertical movements of the incisors that can be achieved with aligners. Moreover, it adjusted the mesiodistal size of the upper incisors in its simulations and demonstrated the ability to identify and correct deviations of the dental midlines relative to the facial midline.

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.