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World Journal of Pharmaceutical Research
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Sonwane et al.
World Journal of Pharmaceutical
Volume 5, Issue 11, 1200-1208.
Case Report
ISSN 2277– 7105
A COMPREHENSIVE TEAM APPROACH TO MANAGE IMPACTED
MAXILLARY CENTRAL INCISOR – A RARE CASE REPORT
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*Dr. Siddharth Sonwane, 2Dr. Shweta R.K., 3Dr. B. Sunilkumar, 4Dr. Jayaesh Rai,
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1
2
Dr. Heerala Chokotiya
*Reader Department of Orthodontics Mansarovar Dental College Bhopal.
Associate Professor Department of Oral Surgery Government Dental College Aurangabad.
3
Professor and HOD Department of Orthodontics Mansarovar Dental College Bhopal.
4
5
Senior Lecturer Department of Oral Surgery Mansarover Dental College Bhopal.
Senior Lecturer Department of Orthodontics Mansarovar Dental College Bhopal.
Article Received on
09 Sept. 2016,
ABSTRACT
The purpose of orthodontic therapy is to fulfill jackson‟s triad by
Revised on 29 Sept. 2016,
Accepted on 19 Oct. 2016
means of establishment of good occlusion, enhancing the health of the
DOI: 10.20959/wjpr201611-7304
periodontium and balancing facial esthetics. In orthodontic therapy
most challenging task is to alignment of impacted teeth. Maxillary
*Corresponding Author
central incisor impaction is rare in clinical orthodontic practice, the
Dr. Siddharth Sonwane
frequency of maxillary incisor impaction ranges from 0.06% to 0.2%.
Reader Department of
Most common cause associate with impaction are Fibrous Operculum,
Orthodontics Mansarovar
Lack of Space for eruption, and presence of Mesiodens etc. However,
Dental College Bhopal.
precise diagnosis and punctual management significantly benefits
esthetic, social, psychological and functional outcomes. Through this case paper I would like
to present the surgical exposure and orthodontic traction of impacted central incisor of
impacted maxillary central incisor teeth.
KEYWORDS: impaction, surgical exposure, orthodontic tractions, Fibrous Operculum,
eruption.
INTRODUCTION
When tooth fails to erupt into dental arch during stipulated time period know as impacted
teeth. Impaction of central incisor is rare and uncommon in orthodontic practice. The latent
rationale behind impaction may be systemic or local factors such as crowding, retained or
early loss of a deciduous tooth, dental trauma, and ankylosis are proposed as local factors for
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tooth impaction, where as syndromes like cledocranial dysplasia were consider as systemic
factors.[1-3]
Several studies and case reports have been suggested that most significant etiological factor
for impaction of central incisors is obstruction in path of eruption may be supernumerary
teeth, odontome and formation of scar tissue. However, the incidences of maxillary central
incisor impaction are uncommon, with a prevalence rate of 0.06% to 0.2%.[1-4]
Impacted maxillary incisors can affect dental arch, facial aesthetics, self-esteem,
psychological trauma and phonation. Furthermore, few studies have reported that missing
anterior can impairs word like „s‟ during speech and unattractive face affecting general social
interaction.[1-6]
Considering orthodontic treatment objective and prognosis, there are various means to treat
an impacted tooth, such as wait & watch for spontaneous eruption, Tooth extraction, surgical
reposition, surgical-orthodontic approach, and dental implants.[7-9]
The endeavor of this article was to present a case in which the collective surgical-orthodontic
therapy had successfully guided the impacted maxillary central incisor to the dental arch
without periodontal complications.[10]
This treatment venture avoids postorthodontic restorations, and improved the esthetics as well
as functions.
CASE REPORT
A 17-year-old female patient has reported todepartment of orthodontics Mansarovar dental
college Bhopal madhyapradesh India, with chief complaint of missing upper front teeth and
wanted to restore missing teeth, her past dental history and family history revealed no
significant findings.
Intra-oral findings were missing maxillary right central incisors, a Class I malocclusion,
convex profile with facial symmetry and radiographically presence of mesiodense,
obliteration in labial sulcus at the mucogingival junction.
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Pretreatment panoramic radiographs revealed the overlapped impacted 11 with presence of
mesiodense (Figure 1). Cephalometric analysis indicated a Class I skeletal pattern with a high
mandibular plane angle. The L1 to MP angle reflects proclination of the mandibular incisors.
Treatment planning: - There were several ways to retract impacted central incisor into normal
occlusion, we planned to create adequate orthodontic space opening with open coil spring in
relation with 11 and surgical exposure of impacted 11 followed by orthodontic traction.
Followed by Finishing and permanent lingual retainers were planned.
Treatment progress: Maxillary dental arch was bonded using 0.022" x 0.028" slot Roath
bracket and 0.016" round niti arch wire was placed. Later 0.016" round niti arch wire was
replaced by 016 austrelian AJ wilcock premium round wire with fabrication individual arch
with help of bonwill hauelly arch fabrication system fallowed by 0.019"×0.025" rectangular
niti arch wire and 0.019"×0.025" rectangular stainless steel arch wire.
Once the alignment and leveling was achieved case was prepared for surgical exposure of
central inscisor and removal mesiodense was done, Roath 0.022" x 0.028” bracket was
bonded on the labial surface of the exposed tooth. With the help of 0.0009 SS ligature wire
eyelets and elastic thread Orthodontic traction was done.
Treatment outcome: The impacted 11 was brought into an acceptable position with
acceptable overbite, overjet and intercuspation. Well inter-digitated Class I molar
relationships were attained.
Legendary of photographs
Fig 1. Pre- photographs and opg
Fig2. Initial and surgical stage
Fig3. Post photographs and opg
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1. pre-treatment intra-oral photographs and OPG
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2. Initial stage and surgery
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Post treated photograph
Post treated OPG
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DISCUSSION
The incidence of unerupted maxillary incisors are rare, may be associated with hereditary,
environmental, iatrogenic factors such as presence of supernumerary teeth, odontomes.
Multidisciplinary approach is the best treatments planning for the impacted teeth, hence,
close comprehend collaboration of orthodontist, oral surgeon and periodontist results in
successful treatment outcome.[1-10]
Successful treatment results Often depends up on the position of the impacted incisor (ie
distance from alveolar crest, rotation, angulation and inclination) determines the surgical
procedure used. Study on closed technique approach with the apically repositioned flap
results in more aesthetically pleasing gingiva than (Kokich VG, Crabill KE et al 2006).
However, few periodontal studies reveal that there was no significant difference between the
techniques regarding periodontal attachment (Becker A, Brin I, Ben-Bassat Y et al
1990).[11,13]
Several studies have been reported regarding timing of interventions and associated
disadvantages, (Kuftinec MM, Stom D, et al 1955) reported that delayed intervention of both
Orthodontic and surgical approach may result in difficulties in aligning the tooth in the
arch.[1-14] Hence, with several studies suggesting that the younger the age, the quicker the
tooth erupts.55 However, other studies have suggested that age of intervention has no effect
(Uematsu S, Uematsu T, et al 2004).[1-15]
There are major two technique most commonly followed during exposing surgical impacted
teeth are: (a) window approach, (b) re-suture flap after bonding bracket (Levin MP, D‟Amico
RA et al 1974). First approach has its own disadvantages, aligned teeth gives bulls like
appearance and method second is always better (Moss JP et al 1975).[12-16]
In my case, sufficient space was created with open coil spring, semi lunar flap was raised to
bring teeth in to right anatomical position in the dental arch. This approach was applied as it
has been shown that the “window” approach causes significant loss of attachment, recession
and gingival inflammation occur on maxillary canines after surgical exposure. Thus, Semi
lunar flap, preserves a part of keratinized gingival, helps in maintaining gingival attachment
throughout eruption of impacted teeth, also prevent forming bull‟s appearance.
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CONCLUSION
Impaction of maxillary anterior teeth affects facial aesthetics, speech, psychological trauma
and social loneliness. Hence, it is necessary to detect early, proper diagnosis; careful
treatment planning and Periodic follow up during orthodontic traction.
A successful result of impacted teeth always depends up on state, position and presence of
enough space in the dental arch to accommodate and appropriate surgical exposure technique.
FOOT NOTES
Source of Support: Nil.
Conflict of Interest: None declared.
REFERENCES
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