Uncovering labially impacted teeth: apically positioned flap and closed-eruption techniques

The purpose of this study was to examine the esthetic and periodontal differences between two methods of uncovering labially impacted maxillary anterior teeth: the apically positioned flap and closed-eruption techniques. The sample consisted of 30 patients who were recalled a minimum of three months after orthodontic treatment of a unilateral labially impacted maxillary anterior tooth. Eighteen of the patients had undergone an apically positioned flap (APF) procedure, and the remaining twelve had undergone the closed-eruption (CE) technique. In the CE group, clinical examination showed less width of attached gingiva on the distal surface and increased probing bone level on the facial surface of the uncovered teeth relative to their contralateral controls. Uncovered teeth in the APF group showed more apical gingival margins on the mesial and facial surfaces; greater crown length on the midfacial surface; increased probing attachment level on the facial surface; increased width of attached gingiva on the facial surface; increased probing bone level on mesial, facial, and distal surfaces; and gingival scarring. Radiographic examination showed shorter roots on the uncovered teeth in both groups. Photographic examination revealed vertical relapse of the uncovered teeth in the APF group. We conclude that labially impacted maxillary anterior teeth uncovered with an apically positioned flap technique have more unesthetic sequalae than those uncovered with a closed-eruption technique.