Treatment Indications & Timings
Treatment indications:
*The optimal time to treat or refer ectopic incisors are between 6 to 8 years old when delayed or asymmetric eruption has been noted.
➤ Delayed eruption of incisors
- Incisors may erupt anytime between 6 to 8 years of age however there is large variability in the population (Proffit et al. 2007)
- A treatment indication is if there is asymmetric eruption of the contralateral incisor by more than 6 months (Proffit et al. 2007)
➤ Obstruction of the incisor eruption
- Clinical or radiographic signs of eruption obstruction are indications for treatment.
- Obstructions are most commonly supernumeraries such as mesiodens in the maxilla (Mittal et al. 2017).
➤ Abnormal root development of the incisors
- Incisors may possess abnormal root morphologies such as severe dilacerations.
- Dilacerations may result from previous trauma to the tooth.
- Severely dilacerated teeth have a poor prognosis for orthodontic treatment and may not fit in the alveolous appropriately if it were brought into the arch form.
- Root abnormalities that cause replacement resorption such as ankylosis will also cause failure of the incisor to erupt requiring careful treatment.
➤ Pathology or abnormalities associated with the incisors
- Although rare, cysts in the maxilla or mandible can obstruct the eruption of incisors.
- Common cysts are dentriguous cysts, eruption cysts and nasopalatine cysts.
- Other osseous or neoplastic pathologies need to be excluded as well.
- Systemic conditions or syndromes such as Cleidocranial dysplasia or cleft lip and palate are also associated with ectopic and delayed incisor eruption.
