Interventions to facilitate the successful eruption of impacted maxillary incisor teeth due to the presence of a supernumerary: A systematic review and meta-analysis

Combined use of molar distalization and leeway space for class II division 1 malocclusion with odontoma-induced impacted maxillary right lateral incisor in the mixed dentition: a case report

BACKGROUND

Treatment for Angle's Class II division 1 involves both extraction and non-extraction orthodontic therapy. Managing Class II division 1 malocclusion accompanied by maxillary anterior tooth impaction and anterior crowding in mixed dentition poses a therapeutic dilemma. Premolar extraction may face traction failure in the impacted tooth, resulting in excessive tooth loss, while extracting impacted teeth may compromise occlusion and anterior aesthetics, necessitating future restoration. Molar distalization as a non-extraction approach often face challenges in providing sufficient space for aligning impacted teeth and simultaneously retracting proclined anterior teeth and improving the facial profile. This study describes a non-extraction orthodontic treatment plan for Class II division 1 malocclusion accompanied by maxillary anterior tooth impaction and anterior crowding in mixed dentition.

CASE PRESENTATION

An 11-year-old girl was diagnosed with Class II division 1 malocclusion and impaction of the maxillary right lateral incisor caused by an odontoma. A non-extraction treatment plan was implemented, involving first the distalization of the maxillary molars and utilization of the leeway space to create an eruption space, followed by surgical exposure and orthodontic traction, and finally, anterior teeth retraction and mandibular advancement guided by Class II elastics. After 39 months, the impacted maxillary right lateral incisor was successfully aligned, achieving Class I molar and canine relationship with a normal overbite and overjet and an improved facial profile.

CONCLUSIONS

Molar distalization and use of the leeway space can avoid the need for tooth extraction during orthodontic treatment. Molar distalization and use of the leeway space can provide sufficient space to correct Class II molar relationship, align impacted teeth, and retract the maxillary anterior teeth. Retraction of the maxillary anterior tooth and guidance for mandibular advancement can improve the lateral facial profile.

Late-forming supernumerary teeth: A case series

The aim of this case series was to illustrate the development of late-forming supernumerary teeth (LFST) and highlight the implications for orthodontic treatment. There are limited studies relating to the aetiology, prevalence and treatment of LFST and the cases presented here demonstrate the management of LFST within a tertiary care centre. Five cases are presented, which show various presentations and chronological ages in the development of LFST. This case series emphasises the significance of maintaining a low threshold for suspecting LFST in patients where supernumerary teeth have previously been identified. It also highlights the importance of regular clinical and radiographic reviews. Timely identification can help prevent complications and optimise treatment outcomes.

Radiographic localization of supernumerary teeth: a narrative review

Objectives

To conduct a narrative review of the published literature on the localization techniques to identify the best technique for the localization of supernumerary teeth.

Methods

An extensive search of literature published in English between January 1966 and May 2024 was conducted using the "Medline via PubMed" and "Cochrane database" databases. The keywords included in the search were "localization" "radiographs", and "impacted teeth", or "un-erupted teeth", or "supernumerary teeth" or "supernumerary tooth". The citation lists from the included articles were examined to identify additional reports and a hand search was also conducted. Kappa statistics were used for intra-examiner reliability.

Results

The initial search yielded 4,864 citations, subsequently examined and supplemented by a hand search to find additional studies. Commonly used techniques for the localization of supernumerary teeth are the horizontal tube shift technique, vertical tube shift technique, vertex occlusal technique, and cone-beam computerized tomography.

Conclusion

The most commonly used localization techniques for supernumerary teeth are horizontal tube shift, vertex occlusal, vertical tube shift, and cone-beam computerized tomography. Conventional radiographs only provide two-dimensional views of 3-dimensional structures. Three-dimensional imaging alone can provide accurate data on impacted supernumerary teeth but, the need for this film has to be justified because of the higher radiation exposure.

Effectiveness and side effects of orthodontic traction of impacted maxillary incisors in a labially inverted position: A systematic review

INTRODUCTION

Treatment of impacted upper incisors in a labially inverted position is challenging for orthodontists, and its prognosis has not been established in the literature. Thus, this systematic review aimed to determine the effectiveness and side effects of orthodontic traction of impacted maxillary incisors in a labially inverted position.

METHODS

A comprehensive search was conducted in multiple databases, including MEDLINE (via PubMed), Scopus, Embase, Science Direct, and LILACS, up to June 30, 2024. Initially, 1640 articles were identified, and after applying specific selection criteria, 11 articles were selected for full-text evaluation. Following the review, only six studies were deemed relevant, comprising one before-and-after study, two longitudinal retrospective studies, and three cross-sectional studies. Newcastle-Ottawa and Risk of Bias (ROB-2) tools were used to assess the risk of bias in the selected studies.

RESULTS

The average duration of traction for maxillary labially inverted impacted central incisors ranged from 8.60±1.26months to 18±6.0months, with all cases being successfully treated. Following traction, the clinical crown height of the incisors was significantly higher compared to the control group (P<0.01). Similarly, the root length of the impacted incisors after traction was shorter in the impaction group (approximately 2mm) compared to the control group. Likewise, the thickness of the alveolar bone varied among different studies. Some authors noted that the treatment group had a smaller thickness (about 0.5mm) compared to the control group (P<0.05), while other authors found similar thickness after treatment.

CONCLUSIONS

Although there are few reported studies with a low risk of bias, it is clear that it is possible to successfully treat labially inverted impacted maxillary central incisors with apparently few side effects. Following traction, the clinical crown height of these incisors increased, while the root length was shorter than their normally erupted contralateral teeth.

Third molar agenesis in individuals with supernumerary teeth

OBJECTIVES

To explore the association between third molar agenesis and supernumerary tooth formation in a white-European population.

MATERIALS AND METHODS

A record review in various orthodontic clinics identified 380 eligible white-European individuals, half of whom had non-syndromic permanent supernumerary teeth (122 males and 68 females, totalling 244 supernumerary teeth; median age: 13.1, iqr: 1.5 years), and the other half were age- and sex-matched controls with full dentition, excluding the third molars. Tooth sequences were identified in panoramic radiographs.

RESULTS

In the supernumerary group, approximately 80% of the individuals had a single supernumerary tooth, followed by those having two additional teeth. In both groups, there was no sexual dimorphism in third molar agenesis severity. The prevalence of third molar agenesis in the supernumerary group was similar to that of the control group (28/190 = 14.7% in both groups; p = 1.0). In total, 53 third molars were missing in the supernumerary group (n = 190) compared to 67 in the control group (n = 190; p = .862). The ratio of bilateral to unilateral third molar agenesis was significantly lower in the supernumerary group than in the control group (1.0 vs. 3.7, respectively; p = .026).

CONCLUSION

The presence of supernumerary teeth did not significantly alter the likelihood of third molar agenesis or its severity. Bilateral third molar agenesis was considerably less prevalent in individuals with supernumerary teeth compared to controls. The present novel findings have important clinical and developmental implications.

Comprehensive Management of an Impacted Maxillary Central Incisor: A Case Report

The impaction of a maxillary central incisor in young patients is rare but can significantly affect aesthetics, speech, and self-esteem. This case report details the diagnosis and treatment of an 11-year-old male patient with an impacted maxillary right central incisor, along with the presence of an impacted supernumerary tooth (mesiodens). The case was managed through a combination of surgical exposure of the impacted tooth and orthodontic traction to guide the impacted tooth into its correct position. Advances in diagnostic imaging and minimally invasive surgical techniques facilitated the successful resolution of the case. Early intervention in such cases is essential for preventing long-term functional and aesthetic complications.

Treatment and genetic analysis of multiple supernumerary and impacted teeth in an adolescent patient

BACKGROUND

Multiple supernumerary teeth, combined with numerous impacted teeth, can lead to various malocclusions, posing significant treatment challenges. While certain genes associated with syndromic cases of multiple supernumerary and impacted teeth have been identified, the etiologies of non-syndromic cases still largely remain elusive.

CASE PRESENTATION

Here, we report a treatment of a 12-year-old boy who presented with 10 supernumerary teeth and 6 impacted teeth, accompanied by a genetic analysis to explore the underlying etiology. During the treatment, fifteen teeth were extracted, and various skilled techniques, including the closed-eruption technique and the application of by-pass arches, were utilized. Post-treatment, traction was successful for all the impacted teeth, without any tooth mobility or reduction in gingival height. Space closure, well-aligned teeth, and excellent functional occlusion were achieved. Furthermore, comprehensive genetic analysis was conducted through whole-exome sequencing on the patient and his parents, which revealed a potential link between the patient's numerous supernumerary teeth and abnormal mineralization. Notably, the p.Ser496Pro variant in the TCF7L2 gene was identified as a potential candidate variant in this patient.

CONCLUSIONS

Overall, our findings not only report the treatment of a rare case involving multiple supernumerary and impacted teeth but also offer valuable insights into the molecular basis of supernumerary teeth.

A retrospective analysis of the patient journey for children with an unerupted maxillary central incisor

BACKGROUND

Maxillary central incisors (MCI) are the third most impacted teeth. Timely multidisciplinary management is indicated as unerupted incisors can cause functional- and appearance-related distress.

AIM

To assess the patient journey for children with unerupted MCI, including referral, clinical assessment, surgical management and follow-up treatment, and highlight areas for improvement, as well as identify factors impacting orthodontic treatment burden (OTB).

DESIGN

A retrospective service evaluation of children aged 6-16 years who had surgical management of unerupted MCI under general anaesthetic (GA) between 2018 and 2021.

RESULTS

Fifty-two children with 62 unerupted MCI were identified. Mean age at referral was 8.8 years. Most children (82.7%) had supernumerary teeth in the anterior maxilla. Mean time between listing for GA and surgery increased from 4.3 to 15.2 months following the COVID-19 lockdown. Mean age at surgery was 10.4 years. Supernumerary removal and incisor exposure and bond was the most common treatment (56.6%). Most patients required hospital orthodontic treatment post-surgery (65.4%).

CONCLUSION

Most children referred were below 9 years (60.1%); these children had reduced OTB compared to those who had been referred at an older age. Stage of root development was also a significant predictor in OTB. An unexpected finding was that conical supernumeraries were found to prevent MCI eruption.

Surgical orthodontic intervention for impacted maxillary permanent central incisors: A case series

Key Clinical Message

Impacted maxillary central incisors represent a relatively infrequent occurrence. This condition significantly impacts the patient's self-esteem and aesthetic concerns. Effective resolution is achievable through a combined strategy involving surgical exposure, bracket attachment, and subsequent orthodontic extrusion. The Surgical orthodontic approach is the optimal strategy for addressing impacted maxillary central incisors.

Abstract

Central incisor is rarely impacted teeth often associated with supernumerary teeth. This case series includes three cases of central incisor impaction presented with complaints of missing teeth, unesthetic appearance, and unclear speech. All the cases were managed with surgical exposure followed by traction by orthodontic force, restoring smile aesthetics.