Impacted maxillary incisors: diagnosis and predictive measurements

Background. When the incisors do not erupt at the ex- pected time, it is crucial for the clinician to determine the etiology and formulate an appropriate treatment plan. Aim. The aim of this report is to provide useful informa- tion for immediate diagnosis and management of impacted maxillary incisors using the interceptive treat- ment: removal of obstacles and rapid maxillary expan- sion (RME). Design. An accurate diagnosis may be obtained with clinical and radiographic exam such as panoramic radi- ograph, computerized tomography (CT) and cone beam computerized tomography (CBCT). It’s important to know the predictive measurements of eruption evaluated on panoramic radiograph: distance from the occlusal plane, maturity, angulation and vertical position of the unerupted incisors. Early diagnosis is important and in- terceptive orthodontic treatment, such as removal of obstacles and orthopedic rapid maxillary expansion (RME), may correct disturbances during the eruption through recovering space for the incisors and improving the intraosseus position of delayed teeth. Results. RME treatment following the surgical removal of the obstacle to the eruption of maxillary incisors leads to an improvement of the intraosseus position of the tooth. Conclusions. The angulation and the vertical position of the delayed tooth appear to be important in trying to pre- dict eruption. The improvement of the intraosseus posi- tion of the unerupted incisor, obtained by removal of the odontoma and rapid maxillary expansion, permits a con- servative surgery and the achievement of an excellent esthetics and periodontal result.