title: Impacted maxillary central incisor: surgical exposure and orthodontic treatment.
abstract: This case report describes the treatment of a patient with a horizontally impacted maxillary central incisor, a canine in the same quadrant, and an inclusion tendency. Due to severe crowing in the maxilla and the Class II molar relationship on the impaction side, a 2-stage treatment plan was developed. In the first stage, the right first premolar and deciduous canine were extracted; this allowed enough space for the eruption of the maxillary right permanent canine. The second stage included surgical exposure and traction of the impacted central incisor with a fixed orthodontic appliance. An excisional uncovering technique was needed to expose the impacted incisor. After it erupted, an apically positioned partial-thickness flap was used to add keratinized attached gingiva in the area surrounding the crown, initially located in an area of unattached gingiva. The patient finished treatment with a normal and stable occlusion between the maxillary and mandibular arches and an adequate width of attached gingiva.
authors.affiliation: Department of Orthodontics, Centro de Investigação Ciências da Saúde, Instituto Superior de Ciências da Saúde-Norte/CESPU, Gandra, Portugal. teresa.pinho@iscsn.cespu.pt
authors.forename: Teresa
authors.initials: T
authors.lastname: Pinho
authors.forename: Manuel
authors.initials: M
authors.lastname: Neves
authors.forename: Célia
authors.initials: C
authors.lastname: Alves
mesh_terms: D002508:Cephalometry; D002648:Child; D003481:Cuspid / Q000473:pathology; D005260:Female; D005893:Gingivoplasty; D006801:Humans; D007180:Incisor / Q000002:abnormalities* / Q000601:surgery; D008312:Malocclusion, Angle Class II / Q000150:complications / Q000628:therapy*; D008437:Maxilla; D019647:Oral Surgical Procedures; D050793:Orthodontic Extrusion; D013524:Surgical Flaps; D014092:Tooth Root / Q000002:abnormalities; D014095:Tooth, Impacted / Q000150:complications / Q000601:surgery / Q000628:therapy*