Trattamento chirurgico-ortodontico degli incisivi in malposizione: protocollo terapeutico

Objectives: The aim of this report is to provide clinicians with useful information for immediate management of impacted maxillary incisors due to obstacles to eruption. Materials and methods: A 8-year-old boy was seen in the Operative Unit of Orthodontics of Policlinico Tor Vergata in Rome. Radiographic images showed intraosseus impaction of the maxillary left central incisor due to a compound odontoma. The treatment plan consisted of three stages: (1) removal of the odontoma and extraction of the deciduous incisors; (2) rapid maxillary expansion in order to improve the intraosseus tooth position; (3) surgical exposure and orthodontic traction of the impacted central incisor to its right position. Results: The impacted maxillary left central incisor was brought into proper alignment with the adjacent teeth and produced a nice smile. Two years after the treatment, the patient presented good occlusal stability, adequate width of attached gingiva, no periodontal bone loss, symmetric gingival margins for both maxillary central incisors. Conclusions: The improvement of the intraosseus position of the unerupted incisor, obtained by removal of the odontoma and rapid maxillary expansion, has enabled a conservative surgery and the achievement of an excellent esthetics and periodontal result.