Impacted upper central incisors - frequency and factors complicating the treatment protocol

Eruption of central incisors occurs at a time when the mixed dentition starts to develop and their impaction is mostly a severe esthetic problem.

Our aim was to assess the frequency of impaction of an upper central incisor and to analyse the factors which affect the successful outcome and the protocols for orthodontic treatment in cases of impacted upper central incisors.

In the present study, we used all medical records of 651 patients treated in our private practice over the last 3 years and also the medical records of 18 patients we diagnosed and treated for this problem over the last 8 years.

We found the ratio of impacted upper central incisors to be 1.4% as there were more male than female patients affected. There were 2.8% male patients and 0.7% female patients. The most frequent cause of impaction of the upper central incisor was the presence of mesiodentes and supernumerary teeth (55.5%), followed by presence of follicular cysts (44.4%) and odontoma collections (22.2%) or a combination of these.Several approaches have been used in treating the different positions of impacted incisors. It is necessary first to rotate the axle of the incisor and assure its root full bone coverage. We used directly TPA for support. In other patients, we waited for the spontaneous eruption after removal of the etiological factor and in another patient, we used conventional fixed techniques.

It is important that dental doctors should monitor the formation of the dentition so that they detect the impacted tooth early in its development.