From Impaction To Eruption: Multidisciplinary Management of A Maxillary Central Incisor Associated With A Mesiodens

Abstract

The impaction of the permanent maxillary central incisor along with the presence of mesiodens can affect the process of eruption, appearance of teeth, and occlusion. This case report describes the step-by-step management of the impacted permanent maxillary left central incisor 21 with the mesiodens in the palatal region in an 8 -year-old child. On clinical examination, it was seen that there was retention of the primary maxillary left central incisor 61 and lack of eruption of tooth 21, which was further confirmed on panoramic and cone beam computed tomography scan. Retained tooth 61 was extracted, and the mesiodens was surgically removed, with the observation for spontaneous eruption. Since spontaneous eruption did not occur, orthodontic space was created with the help of Hawley’s appliance with active finger spring. Subsequent surgical exposure of tooth 21 was done, and a lingual button along with an elastomeric elastic chain was utilized to apply orthodontic traction through a closed-eruption technique. Once enough eruption was achieved, a 2x4 fixed orthodontic appliance was inserted into the mouth. The teeth alignment was started using a 0.012-inch nickel–titanium archwire, then 0.014-inch NiTi was used after 4 weeks, and finally 0.016-inch NiTi was applied after 8 weeks. A 0.016-inch stainless steel archwire was inserted around 12 weeks for stabilization and used for 4-6 weeks prior to appliance removal. The treatment led to eruption and alignment of tooth 21 in the dental arch with acceptable esthetics, occlusal contact, and intact periodontal structures. No pulp or periodontal issues were noticed on follow-up examination. In summary, it was concluded that early diagnosis, 3D radiographic evaluation, stepwise management, and coordination between pediatric dentistry, oral surgery, and orthodontics proved to be an efficient strategy for mesiodens-related maxillary incisors impaction.