MANAGEMENT OF IMPACTED UPPER CENTRAL INCISOR: A CLINICAL CASE REPORT

We present a clinical case of a 9.5-year-old patient with a impacted upper right central incisor. The patient seeks an orthodontic care in connection with the impaired aesthetics in the frontal segment and the lack of an incisor. After the X-ray examinations, a impaction of the incisor in a position perpendicular to the axes of the incisors and complete rotation of its whole body were established. The cutting edge of the tooth was palpated into the vestibular fold and the ligaments of the frenulum. On the CBCT examination, the retention of the impacted incisor to the root of the lateral incisor and an abrasion lesion along its cutting edge were observed. The distal support area was reduced – the premolars have not good erupted in occlusion and had not pierced the canines. A surgical-orthodontic treatment performed in two phases was used. The first phase is needed to change the tooth direction of the crown-root and requires palatal support. After surgical operation, a closed-type orthodontic traction was performed to the trans-palatal arch support. This technique preserves the level of the gingival margin in vestibular impaction teeth. In the second phase of the orthodontic treatment, the incision of the incisor and its complete introduction into the dental arch was achieved. The slow orthodontic traction and the well chosen support determined the final orthodontic result, the periodontal health and the apical development of the retained incisor were preserved. The management of a coordinated interdisciplinary approach is the basis of a favourable outcome.


Keywords: Impacted upper central incisor, Closed-type orthodontic traction

Linda Astrug-Markman

DDS, Postgraduate student, Orthodontics Department, Faculty of Dental Medicine, Medical University – Sofia, Bulgaria