A novel aesthetic technique for alignment of an impacted anterior tooth: A case report

Impacted anterior teeth are common, with sequalae including root resorption of adjacent or nearby teeth. Management depends on patient- and tooth-specific factors; however, in cases of severe resorption, elective tooth loss may be favoured. This case discusses an aesthetic solution to disimpaction of an anterior tooth, involving multidisciplinary input.

A girl aged 13 years 10 months presented to an orthodontic department, complaining of missing teeth and poor dental aesthetics.

Class II division 1 incisor relationship on a Class I skeletal base, complicated by unerupted maxillary canines (UR3, UL3), retained URC and potential for severe crowding in the upper arch. Radiographic assessment confirmed impacted maxillary canines and an unerupted supernumerary tooth lying palatal to UR1. The impacted UR3 had caused significant root resorption to the UR1.

After a multidisciplinary discussion, the impacted UR3 was exposed and aligned into the UR1 position, with elective loss of the resorbed UR1. A novel pontic design, incorporating a traction spring, was used, enabling maintenance of a pontic in-situ while simultaneously allowing for orthodontic traction of the UR3. Restorative input after debond disguised the UR3 as the UR1.

UR3 was successfully disimpacted and aligned into the UR1 position with the use of a novel pontic design.

This case delivers a novel solution to a complex aesthetic dilemma in the anterior dentition that can be modified, and adapted, to suit other anterior impactions.