Comprehensive and sequential management of an impacted maxillary central incisor with severe crown-root dilacerations

Digital-assisted diagnosis and orthodontic management of an impacted mandibular lateral incisor: a case report

BACKGROUND

The impaction of mandibular lateral incisors presents significant aesthetic and functional challenges in orthodontics, including Bolton ratio discrepancies and anterior occlusal anomalies. The increasing preference for nonextraction treatment further complicates space management within the dental arch. However, the advent of digital-assisted orthodontic technologies, particularly advanced digital simulations, has revolutionized the precision and effectiveness of diagnosis and treatment planning. These technologies enable clinicians to strategically leverage natural jaw development and create the necessary space for the alignment of impacted teeth without resorting to extraction.

CASE PRESENTATION

This case report details the treatment of a 12-year-old male with an impacted mandibular lateral incisor, which resulted in both aesthetic concerns and functional impairments, alongside Class II malocclusion. By employing a digital-assisted diagnostic approach, including comprehensive digital simulations, we meticulously evaluated the feasibility of a nonextraction treatment plan. The strategy centred on harnessing the patient's mandibular growth potential to expand the available space naturally. The treatment involved surgical exposure of the impacted tooth, followed by precise orthodontic traction guided by continuous digital monitoring. The integration of digital tools throughout the treatment process was crucial in achieving successful eruption and alignment of the impacted tooth, thus restoring optimal aesthetics and function without the need for extraction.

CONCLUSION

This case highlights the transformative impact of digital-assisted technologies in the management of complex orthodontic cases, such as impacted mandibular lateral incisors. The successful integration of these advanced tools with a nonextraction treatment approach underscores their potential to significantly enhance clinical outcomes. Digital technologies not only improve the accuracy and effectiveness of treatment but also facilitate a multidisciplinary approach that elevates the standard of patient care in addressing complex orthodontic challenges.

Dimensional and morphologic characteristics of unilateral impacted maxillary central incisors

INTRODUCTION

This cross-sectional study aimed to investigate the crown and root characteristics of impacted central incisors compared with spontaneously erupted contralateral incisors and the influence of etiologic and local factors on their dimensions.

METHODS

Forty-five patients (22 boys, 23 girls) who underwent orthodontic treatment for unilateral impaction of maxillary central incisors were referred for cone-beam imaging. Dimensions of the impacted and contralateral incisors were assessed using Dolphin 3D software (Dolphin Imaging & Management Solutions, Chatsworth, Calif). Paired t test and linear regression were used to compare the characteristics of the impacted and contralateral teeth.

RESULTS

Contralateral and impacted central incisors showed statistically significant differences for root length (95% confidence interval [CI], 2.32-3.46; P <0.001), mesiodistal crown-root angulation (95% CI, 4.09-15.95; P = 0.001), and labiolingual crown-root angulation (95% CI, -18.69 to -4.70; P = 0.002). Etiologic factors did not alter the dimensions of incisors (95% CI, -1.17 to 0.76; P = 0.672). According to the multiple linear regression the independent variables associated with root length of contralateral and impacted incisors were sex (β = -0.904; 95% CI, -1.62 to - 0.19; P = 0.014) and the presence of impaction (β = -2.87; 95% CI, -3.67 to -2.07; P <0.001).

CONCLUSIONS

Regardless of their etiology, the impacted incisors showed roots that were 2.89 mm shorter than the contralateral incisors and had greater angulation in the mesiodistal and labiolingual directions. Girls showed a reduction of 0.904 mm (7.6%) on the lengths of roots of both impacted and contralateral central incisors. The presence of impaction led to a reduction of 25% in incisor root lengths. Approximately 30% of the impacted teeth showed crown-root angulations >20° resulting in an increased distal and labial angulation of the root apical portion.