Diagnosis & Considerations
Developmental causes
- Presence of supernumeraries including odontomes
- Generalised retarded eruption
(Fleming et al. 2008, Mittal et al. 2017)
Genetic/hereditary causes
- Cleidocranial dysplasia
- Cleft lip and palate
- Bone disease
- Endocrine disorders
- Soft tissue disorders
(Fleming et al. 2008, Mittal et al. 2017)
Environmental causes
- Trauma causing dilacerations
- Early loss of primary incisor causing space loss
- Retained deciduous tooth
- Impaction of the permanent tooth
- Pathology including cysts
(Fleming et al. 2008, Mittal et al. 2017)
Clinical Considerations
Spontaneous eruption/alignment or active traction of the incisor after removal of the obstruction?
- If the cause is a retained primary incisor, the removal of the incisor will tend to result in 82% of spontaneous eruption and alignment of the tooth.
- If the ectopic incisor is caused by a supernumerary obstruction, the removal of the supernumerary will result in approximately 49-91% (Foley 2004)
- 30-54% of impacted incisors will require active traction following obstruction removal (Yaqoob et al. 2016). Yaqoob et al. hence recommends bonding and active traction for patients undergoing surgery for supernumerary removal as reduces the potential risks for further surgery and sedation.
Accommodation of a dilacerated incisor root?
- Consideration of position of root apex when the tooth is brought into arch form.
- If the root penetrates out of the buccal or palatal cortex as it is brought into the arch form, the long term prognosis is not ideal. If treatment is sought to use this tooth, elective root canal therapy and apicetomy are warranted to manage the root morphology.
- Extraction of the tooth and orthodontic space closure or space opening with temporary prosthetics during the growth years followed by a definitive prosthetic later are treatment options (Crawford et al. 2008, Kokich and Crabill 2006).
