10.59987/ads/2013.2.174-183
Aim. To provide clinicians with useful information for immediate diagnosis and management of impacted maxillary incisors due to trauma.
Methods. We present a case of post-traumatic impaction of a central right maxillary incisor in a young patient. The treatment plan consisted in the interceptive management (surgical and orthodontic), the valuation of the necessary space to move the impacted tooth in the normal position and the biomechanical approach for anchorage, avoiding prosthetic/implants replacement.
Results. The therapy of an impacted maxillary incisor due to trauma requires a multidisciplinary approach: orthodontic, surgical, endodontic and periodontal considerations are essential for successful treatment.
Conclusions. Surgical exposure and orthodontic traction is the treatment most often used in case of posttraumatic impacted incisor: this technique in fact can lead to suitable results at the periodontal, occlusal and esthetics levels at an early stage and more definitively than with other treatment options.
application/pdf
1971-1441
138
2
en
P. Cozza
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Annali di stomatologia
early diagnosis
Post-traumatic impaction of maxillary incisors: diagnosis and treatment
Text.Serial.Journal
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4
Case Report
2022-08-16
2022-08-16
2013-06-01
2023-12-04
174-183
Ann Stomatol (Roma)
P. Cozza
2013
10.59987/ads/2013.2.174-183
174
1971-1441
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early diagnosis
en
183
Post-traumatic impaction of maxillary incisors: diagnosis and treatment
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2-Laganà_- 21/06/13 10:36 Pagina 174




                                                                                                                       Case report



                  Post-traumatic impaction of maxillary incisors:
                  diagnosis and treatment




                                                                                                                                     li
                                                                               na
                  Valeria Paoloni, DDS1                                   Introduction
                  Chiara Pavoni, DDS1




                                                                             io
                  Manuela Mucedero, DDS1                                  Trauma to oral and facial structures is a significant
                  Patrizio Bollero, DDS, PhD2                             problem that may have serious medical, esthetic and
                  Giuseppina Laganà, DDS1                                 psychologic consequences on both children and their
                  Paola Cozza, MD, DDS, MS1                               parents. Studies have shown that approximately 30%




                                                                          az
                                                                          of all children under the age of 7 years experience in-
                                                                          juries to ≥ 1 of their primary incisors and that most seri-
                  1 Department of Orthodontics, University of Rome “Tor   ous injuries to primary teeth occur between the ages of
                    Vergata”, Italy                                       1 and 3 years (1).




                                                                       rn
                  2 Department of Oral Pathology, University of Rome      This high incidence is related to the passage to the up-
                    “Tor Vergata”, Italy                                  right posture, the early stages of walking, a lack of mo-
                                                                          tor coordination and the unconsciousness of the child.




                                                                    te
                                                                          The majority of the trauma occurs as a result of fall ac-
                  Corresponding author:                                   cidents at home or during sporting activities (1, 2).
                  Giuseppina Laganà                                       According to gender, boys were injured more frequently
                  Department of Orthodontics,                             in all age than girls (2) and owing to their exposed posi-
                  University of Rome “Tor Vergata”
                                                                 In       tion in the dental arch, the upper central incisors are
                                                                          the teeth most commonly affected by traumatic injury in
                  Via G. Baglivi, 5/E
                  00161 Rome, Italy                                       both primary and permanent dentition (1).
                  Phone: +39 06 44232321                                  In primary dentition intrusions are the most common
                  E-mail: giuseppinalagana@libero.it                      type of trauma. These are luxation injuries which usual-
                                                       ni
                                                                          ly results from an axially directed impact, displacing the
                                                                          incisor deeper into the alveolar socket. The primary in-
                  Summary                                                 cisors is driven deeply into the alveolar bone invading
                                                                          the follicle of permanent germ which lies palatally in
                                           o


                  Aim. To provide clinicians with useful information      close proximity to its root. In fact there is a close
                  for immediate diagnosis and management of im-           anatomic relationship between the apices of the prima-
                                       izi


                                                                          ry incisors and the germs of the succeeding teeth: the
                  pacted maxillary incisors due to trauma.
                                                                          hard tissue barrier between them has a thickness of
                  Methods. We present a case of post-traumatic im-
                                                                          less than 3 mm and it might simply consist of connec-
                  paction of a central right maxillary incisor in a
                                                                          tive fibrous tissue (3).
                        Ed




                  young patient. The treatment plan consisted in the
                                                                          This close relationship explains why injuries to primary
                  interceptive management (surgical and orthodon-
                                                                          teeth are easily transmitted to the permanent dentition
                  tic), the valuation of the necessary space to move
                                                                          (4).
                  the impacted tooth in the normal position and the
                                                                          The displacement results in compression of and dam-
                  biomechanical approach for anchorage, avoiding
                                                                          age to the periodontal ligament, contusion to the socket
                  prosthetic/implants replacement.
                                                                          walls and injury to the pulp of the intruded incisor. The
               C




                  Results. The therapy of an impacted maxillary in-
                                                                          reported prevalence of intrusion injuries affecting pri-
                  cisor due to trauma requires a multidisciplinary ap-    mary incisors varies among different studies and
                  proach: orthodontic, surgical, endodontic and peri-
    CI




                                                                          ranges from 4.4% to 22% (3). This high incidence is be-
                  odontal considerations are essential for successful     cause of the pliability of the facial skeleton and of the
                  treatment.                                              periodontal ligament, the large volume of teeth in rela-
                  Conclusions. Surgical exposure and orthodontic          tion to the bone in primary and mixed dentition and fi-
                  traction is the treatment most often used in case       nally the shorter roots of primary teeth (5).
                  of posttraumatic impacted incisor: this technique       Therefore traumas to primary dentition may interfere
©




                  in fact can lead to suitable results at the peri-       with further odontogenesis of permanent teeth and ac-
                  odontal, occlusal and esthetics levels at an early      cording to site and extension of the injury, different mal-
                  stage and more definitively than with other treat-      formations may occur ranging from a slight disturbance
                  ment options.                                           in the mineralization of enamel to a sequestration of the
                                                                          entire tooth germ (4). They may lead to abnormality in
                  Key words: eruption disturbances, impacted incisor,     the path of eruption of permanent series which may re-
                  oral trauma, orthodontic traction, early diagnosis.     sult in impaction or ectopic eruption (6). The percent-

                  174                                                                       Annali di Stomatologia 2013; IV (2): 174-183
2-Laganà_- 21/06/13 10:36 Pagina 175




                  Post-traumatic impaction of maxillary incisors: diagnosis and treatment


                  age of developmental disturbances of the permanent             Diagnosis
                  incisors that could be attributed to injuries of their pre-
                  decessors ranges from 12% to 74% (3). Early diagno-            The impaction of maxillary permanent incisor is often
                  sis is very important to monitor and prevent complica-         clinically and radiologically diagnosed in early ages be-
                  tions (6).                                                     cause the non-eruption of the anterior tooth causes




                                                                                                                                          li
                                                                                 concern to parents during early mixed dentition phase
                                                                                 (8).




                                                                                    na
                  Sequelae                                                       Clinical signs of an impacted tooth include asymmetric
                                                                                 eruption of more than 6 months in relation to its homo-
                  The effects of trauma on the permanent tooth germ be-          logue, change of the sequence and chronology of nor-
                  come clinically manifest only after the normal exfoliation     mal eruption, retention of the primary tooth, midline de-




                                                                                  io
                  period is over. It is possible, however, that in an earlier    viation, space closure and elevation of the soft tissue of
                  stage a malformation may be discovered radiographi-            the palatal or labial mucosa (8, 9).
                  cally (7).                                                     Diagnosis of impacted tooth is verified and its location




                                                                               az
                  The age of the child at the time of injury (germs of the       determined through radiographic evaluation. Panoramic
                  permanent teeth are particularly sensitive in the early        radiograph is considered the standard radiographic
                  stages of their development, which occurs between the          first-step examination for treatment planning of impact-
                  ages of 4 months and 4 years), the developmental               ed teeth because (10, 11) it is unique in that it will show
                  phase of the permanent tooth germ, the direction and




                                                                            rn
                                                                                 the entire dentition as a whole (12) and it may reveal
                  severity of the trauma, the type of injury sustained and       the existence of an impacted tooth. Unfortunately, le-
                  the presence of alveolar bone fracture are important           sions of permanent teeth resulting from previous trau-
                  variable influencing the effect on the developing perma-       ma to the deciduous dentition are not always clearly




                                                                         te
                  nent germ (1, 3, 4, 7).                                        observable on panoramic radiograph because the de-
                  The consequences for permanent dentition after a trau-         ciduous teeth are projected onto the permanent teeth
                  ma to primary dentition may affect the coronal or root
                                                                                 and the direction of projection is unfavorable in regard
                  region or the whole of the permanent tooth germ (5).
                                                                                 to the root curvature (7).
                  Many sequelae can be found in the coronal region: 1)
                                                                      In
                  white or yellow-brown discoloration of enamel; 2) white
                                                                                 Due to the highly detailed three-dimension information
                                                                                 obtained, computerized tomography is the method of
                  or yellow-brown discoloration of enamel and circular
                                                                                 choice for accurately defining the position of an
                  enamel hypoplasia, that represented the borderline be-
                                                                                 unerupted tooth and identifying any root resorption of
                  tween hard tissue formed before and after injury; 3)
                                                                                 adjacent teeth not detectable by other methods (12).
                                                            ni
                  crown dilaceration, that is described as an acute devia-
                                                                                 The highly detailed information and the excellent tissue
                  tion in the long axis of the crown originating from a non-
                                                                                 contrast without blurring and overlapping of adjacent
                  axial displacement of already formed hard tissue in re-
                                                                                 structures outweighs the high radiation dose, limited
                  lation to the developing noncalcified tissue (crown di-
                                            o

                                                                                 availability, and high cost (13, 14).
                  laceration can result from an intrusion of the primary in-
                                                                                 Three-dimensional imagery enables analysis of the pre-
                  cisor when a child is around that age of 2 years, when
                                        izi


                  half the crown would be formed) (3-5).                         cise location and orientation of impacted teeth, their sit-
                  Sequelae affecting the root region include: 1) root dupli-     uation relative to obstacles to eruption, their external
                  cation; 2) root dilaceration, these lesions appeared as a      and internal anatomy, the labial and palatal bone thick-
                  marked curvature confined to the root portion and may          ness; any resorption of the adjacent teeth or pathologi-
                         Ed




                  result from intrusion of a primary incisor after comple-       cal bone loss; the presence or absence of a continuous
                  tion of permanent crown formation between the ages of          radiolucent line between the root and the bone (possi-
                  2 and 5 years; 3) partial or complete arrest of root for-      ble ankylosis) (15).
                  mation, rare sequelae resulting from injury to primary         Recently cone beam CT (CBCT) has been introduced
                  incisors between the ages of 4 and 7 years (3-5).              as a technique dedicated to the imaging of dental and
                  When the entire permanent tooth germ is affected, al-          maxillofacial structures. It has one-sixth of the radiation
               C




                  terations to the process of eruption of the permanent          of computed tomography, is more time efficient, more
                  tooth may be noted: 1) delayed eruption due to early           cost effective, is still able to provide three dimensional
    CI




                  loss of a primary incisor and formation of thick, fibrous      images, excellent bone differentiation and an unlimited
                  gingival tissue; 2) accelerated eruption, when the pri-        number of views (11, 12). Its disadvantages include
                  mary incisor is lost after the child is aged 5 years espe-     spatial resolution of subtle structures that is slightly in-
                  cially in the presence of alveolar bone resorption fol-        ferior to that of CT and limited representation of soft tis-
                  lowing an infection of the injured tooth; 3) ectopic erup-     sues (due to the lower radiation dose) (11).
                  tion or (4) impaction that can be explained by the phys-
©




                  ical displacement of the permanent germ with or with-
                  out dilaceration at the time of the injury, the lack of        Treatment
                  eruption guidance from prematurely lost primary in-
                  cisor, ankylosis or alterations of root resorption; 5) mal-    The therapy of an impacted maxillary incisor due to
                  formation of the permanent germ giving the appear-             trauma requires a multidisciplinary approach: orthodon-
                  ance of an odontoma; 6) sequestration of the perma-            tic, surgical, endodontic and periodontal considerations
                  nent tooth germ (3-5).                                         are essential for successful treatment (16). Careful

                  Annali di Stomatologia 2013; IV (2): 174-183                                                                           175
2-Laganà_- 21/06/13 10:36 Pagina 176




                  V. Paoloni et al.


                  planning is required especially because these are often      tioned flap and orthodontic traction into proper align-
                  dilacerated incisors (17).                                   ment (18).
                  If there is a retained, necrotic, ankylosed primary in-      The most commonly solution is surgical extraction of
                  cisor it must be surgically removed because it repre-        the impacted incisor (19) followed by an orthodontic
                  sents an obstacle to spontaneous eruption of the per-        treatment either to close the space or to keep it open




                                                                                                                                         li
                  manent one. Sometimes after primary tooth’s removal,         until the patient reaches an age when definitive




                                                                                   na
                  the permanent incisor erupts without any further treat-      prosthodontic treatments may be used.
                  ment. When the displacement is severe and prevents           Both methods have associated problems: orthodontic
                  the spontaneous eruption, an orthodontic treatment is        space closure substituting the lateral incisor for the
                  necessary.                                                   central one with subsequent resin restoration is seldom
                  Depending on the localization of the tooth and the de-       indicated nor aesthetically satisfactory, while removable




                                                                                 io
                  gree of dilacerations different treatment options have       prosthetic replacement during childhood and adoles-
                  been suggested in literature (8): surgical excision of the   cence may be unsatisfactory for psychological reasons
                  impacted incisor and subsequent restoration with a           (18). Moreover early loss of a maxillary incisor may re-




                                                                              az
                  bridge or implant after orthodontic space opening when       sult in loss of alveolar height in the anterior region of
                  growth had stabilized; surgical excision of the impacted     the maxilla (20). In some cases extraction of the tooth
                  incisor, orthodontic space closure and prosthodontics        is unavoidable because of the severity of the inversion
                  restoration of the left lateral incisor as the central in-   of the tooth (8).




                                                                           rn
                  cisor at a later stage; orthodontic space opening, un-       The surgical-orthodontic approach is the solution most
                  covering the impacted tooth using the apical reposi-         widely adopted to save an impacted incisor (20) and it

                                                                                               Figures 1 a-d. Pretreatment extraoral




                                                                        te
                                                                                               photographs.
                                                                     In
                                           o            ni
                                       izi
                         Ed




                                                    a                                    b
               C
    CI
©




                                                    c                                   d

                  176                                                                           Annali di Stomatologia 2013; IV (2): 174-183
2-Laganà_- 21/06/13 10:36 Pagina 177




                  Post-traumatic impaction of maxillary incisors: diagnosis and treatment


                  would yield satisfactory results with carefully planned        Aim of this report was to show the interceptive manage-
                  procedures (18).                                               ment (surgical and orthodontic) of a case with an im-
                  This technique is commonly directed to surgical expo-          pacted central maxillary incisor caused by trauma in a
                  sure of the crown and to apply an orthodontic traction.        young patient, avoiding prosthetic/implants replace-
                  The strategy adopted for the surgical exposure is mini-        ment.




                                                                                                                                       li
                  mal bone removal and closed eruption after placing an
                  attachment on the unerupted incisor. This is considered




                                                                                    na
                  a good surgical choice considering the long-term es-           Case report
                  thetic-periodontal status (9).
                  The degree and level of dilacerations, tooth’s vertical po-    A 9-year-old Caucasian girl was referred by his general
                  sition, tooth’s maturity, flap design and orthodontic trac-    dentist to the Department of Orthodontics of the Univer-




                                                                                  io
                  tion are factors determining the success rate of orthodon-     sity of Rome “Tor Vergata” for an orthodontic evalua-
                  tic-surgical management of impacted incisors (18).             tion. The chief complaint was concern about an erup-
                  The chances of failure could be due to ankylosis, exter-       tion disturbance, which had resulted in an unaesthetic




                                                                               az
                  nal root resorption, root exposure after orthodontic trac-     appearance. The child was in excellent physical health
                  tion, loss of attachment (17, 21).                             and had no history of disease, but there was a history
                  Autotransplantation with premolars or supernumerary            of anterior dental trauma at age 4 to its primary in-
                  teeth and surgical repositioning of impacted incisor has       cisors. This trauma induced the necrosis and ankylosis
                                                                                 of the maxillary primary right central incisor.




                                                                            rn
                  been reported in dental literature (20).




                                                                         te
                                                                      In
                                                            ni

                    a                                                           b
                                            o
                                        izi
                         Ed
               C




                    c                                                           d
    CI
©




                    e
                                                                                 Figures 2 a-e. Pretreatment intraoral photographs.

                  Annali di Stomatologia 2013; IV (2): 174-183                                                                        177
2-Laganà_- 21/06/13 10:36 Pagina 178




                  V. Paoloni et al.


                  Diagnosis                                                    Panoramic radiograph showed the complete set of per-
                                                                               manent teeth in different stage of formation and the im-
                  The patient had balanced facial pattern with a good          paction of the upper permanent right central incisor which
                  profile, and an asymmetric ugly smile. Intraoral clinical    showed a severe intraosseous displacement (Fig. 3).
                                                                               The vertical position of the delayed permanent incisor




                                                                                                                                         li
                  examination showed a mixed dentition, an altered se-
                  quence of eruption, the absence of the maxillary per-        in relation to the contralaterally erupted central incisor
                                                                               was in sector v3 (22) (Pict. 1), while its angulation to




                                                                                   na
                  manent right central incisor and the ankylosis and
                                                                               the mid-sagittal plane was 90° (23) (Pict. 2).
                  necrosis of the maxillary primary right central incisor
                                                                               CT-Dentascan evaluation defined exactly the place of
                  (Figs. 1a-1d).
                                                                               the impacted incisor: the tooth was positioned horizon-
                  Occlusal analysis revealed a molar Class I relationship.
                                                                               tally and its crown was close to the anterior nasal spine
                  There was not significant dental crowding in both arch-




                                                                                 io
                                                                               and across the midline, while the root was displaced
                  es. The maxillary right central incisor was absent while     palatally (6) (Figs. 4a, 4b).
                  the maxillary right lateral incisor was erupting. Overbite   Cephalometric analysis revealed a skeletal Class I mal-
                  was reduced (Figs. 2a-2e).




                                                                              az
                                                                               occlusion (ANB T1: 3°) and a normofacial pattern (FMA
                  Radiological examinations were performed to complete         T1: 26°). Lower incisor showed good inclination on
                  clinical evaluation.                                         mandibular plane (IMPA T1: 89°) (Figs. 5a, 5b).




                                                                           rn
                                                                                    Figure 3. Pretreatment panoramic radiograph.




                                                                        te
                                                                     In
                                                        ni

                                                                                    Picture 1. Smailiene et al. measurement (22).
                                           o
                                       izi
                         Ed
               C




                                                                                    Picture 2. Bryan et al. measurement (23).
    CI
©




                  178                                                                           Annali di Stomatologia 2013; IV (2): 174-183
2-Laganà_- 21/06/13 10:36 Pagina 179




                  Post-traumatic impaction of maxillary incisors: diagnosis and treatment




                                                                                                                                        li
                                                                                   na
                                                                                 io
                                                                              az
                    a                                                           b
                  Figures 4 a-b. Pretreatment CT-Dentascan.




                                                                           rn
                                                                        te
                                                                     In
                                            o               ni
                                        izi
                         Ed




                        a                                                               b
                  Figures 5 a-b. Pretreatment cephalometric radiographs.
               C




                  Treatment objectives                                           Treatment progress
    CI




                  The purpose of this treatment was to guide the im-             The multidisciplinary approach involved a combined
                  pacted incisor into proper alignment with the adja-            surgical/orthodontic treatment. After evaluating the ad-
                  cent teeth, without root damage, and to re-create a            vantages and disadvantages of the therapeutic options,
                  complete anterior dentition and a stable functional            the following treatment steps were established: 1) sur-
©




                  occlusion. The treatment aimed also to extrude the             gical removal of the ankylosed and necrotic maxillary
                  incisor with all its supporting tissues (alveolar bone         primary right central incisor which represented an ob-
                  and attached gingiva), to investigate the effects that         stacle to permanent incisor’s eruption, 2) monitoring for
                  surgical exposure, orthodontic movements and final             spontaneous eruption, 3) orthodontic traction, 4) fixed
                  tooth position would have had on them and to eval-             appliance to obtain the proper alignment.
                  uate the long-term gingival and periodontal condi-             First of all the primary incisor was surgically removed.
                  tions (19).                                                    After 6 months the maxillary right incisor erupted in an


                  Annali di Stomatologia 2013; IV (2): 174-183                                                                        179
2-Laganà_- 21/06/13 10:36 Pagina 180




                  V. Paoloni et al.


                  ectopic position parallel to the occlusal plane, near to
                  the labial fornix (Fig. 6).
                  A modified Quad Helix with a TMA arm and a terminal
                  loop was applied to the upper arch as anchorage. A
                  button was bonded on vestibular surface of tooth and




                                                                                                                                         li
                  an elastomeric module was connected from the but-
                  ton to the loop of the TMA arm. The elastic module




                                                                                  na
                  generated a constant light force of no more than 30-
                  50 g (24-26). The force was activated monthly creat-
                  ing a physiological direction of tooth eruption (27-29)
                  (Figs. 7a-7b).




                                                                                io
                  Once the impacted tooth moved close to its place in den-
                  tal arch, brackets were placed on the upper arch and it      a




                                                                             az
                                                                          rn
                                                                       te      b
                                                                    In
                                                                             Figures 8 a-b. Incisor’s derotation.

                  Figure 6. Spontaneous eruption after surgical removal of
                  the ankylosed and necrotic primary incisor.
                                                       ni
                                                                             was tied to an archwire (0.016 x 0.022-in multibraid
                                                                             stainless steel). Thanks to a lingual button and elastic
                                                                             chain the incisor was derotated. Interim radiographs
                                                                             were requested to verify the root positioning. Active treat-
                                           o

                                                                             ment with fixed appliance took 10 months (Figs. 8a-8b).
                                                                             When the impacted incisor was in its position in upper
                                       izi


                                                                             arch, brackets were debonded and the patient began
                                                                             wearing essix retainers.
                         Ed




                                                                             Treatment result

                                                                             The patient showed a good smile arch and balanced
                                                                             profile (Figs. 9a-9d).
                    a                                                        The impacted maxillary right central incisor was suc-
                                                                             cessfully brought into proper position. The final appear-
               C




                                                                             ance of the tooth was esthetically pleasing, with gingi-
                                                                             val margins at the same level with similar clinical
    CI




                                                                             crowns sizes. The tooth responded well to vitality and
                                                                             did not show abnormalities in crown shape. No pulp
                                                                             pathology or color change was found. From a periodon-
                                                                             tal point of view a band of labial keratinized gingival
                                                                             measuring 4 mm was present, and pocket depth
                                                                             ranged from 1 to 2 mm (Figs. 10a-10e).
©




                                                                             Final radiographs indicated intact roots, proper root
                                                                             alignment, and no root disease.
                                                                             A skeletal class I (ANB 3°) was mantained. An ideal
                    b                                                        overbite and overjet were established and a Class I
                                                                             molar and canine relationship was presented. Upper
                  Figures 7 a-b. Modified Quad Helix with a TMA arm and a    and lower incisors showed good inclination (IMPA 89°;
                  terminal loop.                                             U1^FH 110°) (Figs. 11a-11c).

                  180                                                                           Annali di Stomatologia 2013; IV (2): 174-183
2-Laganà_- 21/06/13 10:36 Pagina 181




                  Post-traumatic impaction of maxillary incisors: diagnosis and treatment


                                                                                            Figures 9 a-d. Post-treatment extraoral
                                                                                            photographs.




                                                                                                                                       li
                                                                                       na
                                                                                     io
                                                                                  az
                    a                                            b




                                                                               rn
                                                                            te
                                                                         In
                                            o               ni
                                        izi


                    c                                            d
                         Ed
               C
    CI




                    a                                                b                           c
©




                    d                                                e                            Figures 10 a-e. Post-treatment intrao-
                                                                                                  ral photographs.


                  Annali di Stomatologia 2013; IV (2): 174-183                                                                        181
2-Laganà_- 21/06/13 10:36 Pagina 182




                  V. Paoloni et al.


                                                                                                                          Figures 11 a-c. Radiograph-
                                                                                                                          ic records: two months be-
                                                                                                                          fore debonding.




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                                                                                           na
                                                                                         io
                                                                                      az
                    a




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                                                                                te
                                                                             In
                                             o                ni

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                                         izi



                  Conclusions                                                           2. Kargul B, Caglar E, Tanboga I. Dental trauma in Turkish chil-
                                                                                           dren, Istanbul. Dent Traumatol 2003; 19:72-75.
                                                                                        3. Diab M, elBadrawy HE. Intrusion injuries of primary incisors.
                  A traumatic injury in early age can realize a delay of erup-
                          Ed




                                                                                           Part III: Effects on the permanent successors. Quintessence
                  tion and eventually an impacted tooth. Upper incisors are                Int 2000; 31(6):377-384.
                  the most frequent impacted teeth due to trauma (6).                   4. Andreasen JO, Sundström B, Ravn JJ. The effect of trau-
                  Surgical exposure and orthodontic traction is the treat-                 matic injuries to primary teeth on their permanent succes-
                  ment most often used: this technique in fact can lead to                 sors. I. A clinical and histologic study of 117 injured permanent
                  suitable results at the periodontal, occlusal and esthet-                teeth. Scand J Dent Res 1971; 79(4):219-83.
                  ics levels at an early stage and more definitively than               5. Arenas M, Barberia E, Lucavechi T, Maroto M. Severe trau-
               C




                                                                                           ma in the primary dentition - diagnosis and treatment of se-
                  with other treatment options.
                                                                                           quelae in permanent dentition. Dent Traumat 2006; 22(4):226-
                  Sometimes the surgical removal of the retained trauma-                   230.
    CI




                  tized primary incisor alone can lead to spontaneous                   6. Cozza P, Mucedero M, Ballanti F, De Toffol L. A case of an
                  eruption of the permanent tooth.                                         unerupted maxillary central incisor for indirect trauma localized
                  However long-term monitoring of the stability and peri-                  horizontally on the anterior nasal spine. J Clin Pediatr Dent
                  odontal health of the impacted incisor is very important                 2005; 29(3):201-203.
                  after orthodontic traction (30).                                      7. von Gool AV. Injury to the permanent tooth germ after trau-
                                                                                           ma to the deciduous predecessor. Oral Surg Oral Med Oral
©




                                                                                           Pathol 1973; 35(1):2-12.
                                                                                        8. Kuvvetli SS, Seymen F, Gencay K. Management of an
                  References                                                               unerupted dilacerated maxillary central incisor: a case report.
                                                                                           Dent Traumatol 2007; 23(4):257-261.
                   1. Altun C, Cehreli ZC, Güven G, Acikel C. Traumatic intrusion       9. Valladares Neto J, de Pinho Costa S, Estrela C. Orthodon-
                      of primary teeth and its effects on the permanent successors:        tic-surgical-endodontic management of unerupted maxillary
                      a clinical follow-up study. Oral Surg Oral Med Oral Pathol Oral      central incisor with distoangular root dilaceration. J Endod
                      Radiol Endod 2009; 107(4):493-498.                                   2010; 36(4):755-759.

                  182                                                                                       Annali di Stomatologia 2013; IV (2): 174-183
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                  Post-traumatic impaction of maxillary incisors: diagnosis and treatment


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                  Annali di Stomatologia 2013; IV (2): 174-183                                                                                          183
