A novel aesthetic technique for alignment of an impacted anterior tooth: A case report

Abstract

Introduction:

Impacted anterior teeth are common, with sequalae including root resorption of adjacent or nearby teeth. Management depends on patient- and tooth-specific factors; however, in cases of severe resorption, elective tooth loss may be favoured. This case discusses an aesthetic solution to disimpaction of an anterior tooth, involving multidisciplinary input.

Patient concerns:

A girl aged 13 years 10 months presented to an orthodontic department, complaining of missing teeth and poor dental aesthetics.

Clinical findings:

Class II division 1 incisor relationship on a Class I skeletal base, complicated by unerupted maxillary canines (UR3, UL3), retained URC and potential for severe crowding in the upper arch. Radiographic assessment confirmed impacted maxillary canines and an unerupted supernumerary tooth lying palatal to UR1. The impacted UR3 had caused significant root resorption to the UR1.

Interventions:

After a multidisciplinary discussion, the impacted UR3 was exposed and aligned into the UR1 position, with elective loss of the resorbed UR1. A novel pontic design, incorporating a traction spring, was used, enabling maintenance of a pontic in-situ while simultaneously allowing for orthodontic traction of the UR3. Restorative input after debond disguised the UR3 as the UR1.

Outcomes:

UR3 was successfully disimpacted and aligned into the UR1 position with the use of a novel pontic design.

Conclusion:

This case delivers a novel solution to a complex aesthetic dilemma in the anterior dentition that can be modified, and adapted, to suit other anterior impactions.

Plain Language Summary

A new aesthetic technique to pull down an impacted tooth

Why was the treatment done? Many patients have impacted teeth (teeth buried under gums/bone that cannot come through themselves) and need braces combined with surgery to move them into the right position. In this case, the patient’s canine tooth was in the incorrect buried position and needed to be pulled down, in place of a incisor tooth that was damaged due to the canine. Because it was a front tooth, a new aesthetic technique was tried to pull the tooth while not leaving the patient with a gap. What did the clinicians do? They came up with a technique with support from the dental laboratory, that involved a false tooth attached to the brace, which had two roles: it gave the patient a false tooth so they did not have an obvious gap, and it simultaneously helped pull down the impacted canine tooth so that it could move into the mouth. This was complicated and involved multiple teams in different specialties for the overall planning and result. What did the clinicians achieve? The technique worked well, and allowed the canine to be pulled down into position whilst not having a gap. This was successful by working with surgical teams initially, and restorative teams afterwards, so that a good result was achieved, and this technique can be used and adapted in future cases. What did the patient think? The patient was pleased with the suggestion and that her aesthetic concerns were listened to, as it meant that she did not have an obvious gap at the front of her teeth, with good overall results.