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E-ISSN: 2502-0412
Vol. 8 (2) 167-177. December 2023
DOI: Prefix 10.24815

Surgical and Orthodontic Management of Impacted

Dilacerated Maxillary Incisor in a 12-Year-Old: A Case
Study
Annisa Khairani*, Heriandi Sutadi, Eva Fauziah

Department of Pediatric Dentistry, Dentistry Faculty, Universitas Indonesia, Jakarta, Indonesia

*Corresponding Author: annisakhairani@ui.ac.id

ARTICLE INFO : Received, June 5, 2023; Revised, August 10, 2023; Accepted, September 16, 2023; Published, December 26, 2023
ORCID : Khairani A (0000-0003-1098-3859); Sutadi H (0000-0002-6718-1083); Fauziah E (0000-0002-8785-5874)
DOI : 10.24815/jds.v8i2.34025

ABSTRACT
Background: At age six, the mixed dentition phase begins, typically marked by the emergence of the lower
permanent central incisors and first molars. It initiates a sequence of tooth eruptions. If one upper permanent
central incisor remains unerupted by the age of nine while its counterpart has appeared, this may indicate an
impacted tooth. Case Reports: Diagnostic serial radiographs often reveal nearly complete root formation
without clinical emergence, leading to the diagnosis of tooth impaction. One common cause of impaction is
trauma to the baby teeth and alterations in the front segment of the mouth due to the early loss of these primary
teeth and the subsequent emergence of their permanent successors. Such trauma can influence the growth and
development of the successor permanent teeth, including causing dilaceration. Disorders in tooth eruption can
significantly affect aesthetics, speech, self-esteem, and social interactions, making treatment imperative.
Conclusion: For impacted teeth, options like extraction with prosthetic replacement, orthodontic adjustment,
or surgical exposure with traction are tailored to the patient's situation. Surgical exposure and traction were
used on a 12-year-old with missing front teeth, extended by the complexity of the dilacerated root and fibrous
tissue.
Keywords: impacted, dilaceration, exposure, orthodontic traction

ABSTRAK
Latar Belakang: Pada usia enam tahun, fase pertumbuhan gigi campuran dimulai, biasanya ditandai dengan
munculnya gigi seri tengah permanen bawah dan gigi geraham pertama. Ini memulai serangkaian erupsi gigi.
Jika salah satu gigi seri permanen atas tetap tidak erupsi pada usia sembilan tahun sementara gigi seri lainnya
telah muncul, hal ini mungkin mengindikasikan gigi impaksi. Laporan Kasus: Radiografi serial diagnostik
sering menunjukkan pembentukan akar yang hampir sempurna tanpa gambaran klinis, yang mengarah pada
diagnosis impaksi gigi. Salah satu penyebab umum impaksi adalah trauma pada gigi susu dan perubahan pada
segmen depan mulut akibat tanggalnya gigi sulung secara dini dan munculnya gigi pengganti permanennya.
Trauma tersebut dapat mempengaruhi pertumbuhan dan perkembangan gigi permanen penerusnya, termasuk
menyebabkan dilaserasi. Gangguan pada erupsi gigi secara signifikan dapat mempengaruhi estetika,
kemampuan bicara, harga diri, dan interaksi sosial, sehingga pengobatan menjadi penting. Kesimpulan:
Terdapat beberapa pilihan perawatan untuk gigi impaksi, termasuk pencabutan yang diikuti dengan
penggantian prostetik, penutupan ruang ortodontik, paparan bedah, dan traksi ortodontik untuk memperbaiki
posisi. Dalam kasus pasien berusia 12 tahun yang mengalami kehilangan gigi anterior, paparan bedah, dan
traksi ortodontik dipilih. Kasus ini memerlukan waktu perawatan yang lebih lama karena sifat kompleks akar
yang mengalami dilaserasi dan adanya jaringan fibrosa.
Kata Kunci: Impaksi, dilaserasi, paparan, traksi ortodontik

1. Introduction
Typically, the maxillary first incisors erupt between 7 and 8.1. If there is a failure of eruption
of a first incisor, especially when the opposite incisor and lateral incisors are fully erupted, it is
reasonable to suspect an eruption disorder.2 A tooth that remains unerupted after root formation is
complete is considered impacted. The local and systemic factors can lead to tooth impaction, with
trauma to the primary tooth being one of the local causes. 3 Such trauma can impact the growth and
development of the successor permanent tooth, often leading to dilaceration.
Dilaceration of the permanent tooth roots is a recognized cause of impaction in maxillary
incisors, occurring in approximately 0.006%-0.2% of cases.4 This condition of eruption disorder has

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significant aesthetic and phonetic implications, potentially diminishing a child's self-esteem and
social engagement. Therefore, addressing this condition is crucial. Surgical exposure followed by
orthodontic traction is a viable treatment option for impacted permanent incisor teeth. 5
In the presented case, a 12-year-old exhibited a non-erupted maxillary anterior tooth,
compounded by space loss due to the migration of adjacent dentition. The initial examination at the
age of 9 identified an impacted tooth 21, characterized by root dilaceration and a crown angulated
at 90 degrees towards the vestibule. The therapeutic modalities for managing impacted teeth with
such dilaceration are varied and include the extraction followed by prosthetic rehabilitation, surgical
repositioning of the affected tooth, or surgical exposure aimed at facilitating orthodontic traction.
The latter involves the placement of a button and wire ligature as part of an anchorage system
integrated with fixed orthodontic appliances. This case report delineates the utilization of surgical
exposure followed by orthodontic traction in strategically managing the dilacerated impaction of
tooth 21 in young patients. The discussion emphasizes the procedural intricacies, rationale, and
expected outcomes of the chosen treatment pathway, underscoring its viability and effectiveness in
addressing functional and aesthetic concerns associated with such complex dental impactions.

2. Case Reports

A 12-year-old female patient was brought in with the primary concern of unerupted upper
anterior teeth, first observed when the patient was nine and two months old. Anamnestic data
obtained during the subjective examination indicated a history of trauma to the primary teeth at the
age of 3 years, resulting from a fall. The specifics of the injury and the condition of the primary
dentition post-trauma were not distinctly recalled by the parents (Fig 1).

Figure 1. Initial clinical photo on May 21, 2012, before bracket placement on both jaws

Upon clinical examination, tooth 21 was unerupted with no abnormalities in the extraoral
or intraoral soft tissues. The patient exhibited a left and right Angle Class I dental occlusion without
signs of crossbite, root residues, or dental fractures (Fig 1). The patient's oral hygiene was
satisfactory, though enamel caries were observed on teeth 37 and 47. The orthodontic appliances
were also loose in both the upper and lower jaws. Occlusal radiographic examination of the region
21 indicated that tooth 21 was positioned below the cervical crown of tooth 11, aligning normally in
terms of eruption direction (Fig 2a).
However, cephalometric radiography revealed the crown of tooth 21 oriented towards the
vestibule, with the root position obscured due to superimposition by surrounding hard tissues (Fig
2b). The cephalometric analysis concluded a Class I skeletal relationship, a relatively straight facial
profile, normal interincisal relationships, and an upper and lower incisor position relative to the
protrusive cranial base. Furthermore, the upper and lower lips were well-aligned with the aesthetic
line. These findings underscore the complexity of diagnosing and planning the management of
impacted and dilacerated teeth, emphasizing the need for detailed and multidimensional imaging
to guide effective treatment strategies.

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.
Figure 2. (A) Occlusal radiographs, and (A) Cephalometric radiographs of the patient before orthodontic
treatment.

The diagnosis in this patient is good oral hygiene status, enamel caries in teeth 37 and 47,
and Angle class I dental malocclusion with tooth 21 impaction due to post-traumatic dilaceration
condition at the age of 3 years. The treatment plan for this patient is DHE - OP, GIC restorations on
teeth 37 and 47, and malocclusion treatment, which begins with finding space for tooth 21, then
proceeds with surgical exposure of tooth 21 for access to bracket placement, which will then be
followed by orthodontic traction on impacted tooth 21. The results of the cephalometric analysis are
shown in Table 1.

Table 1. Analysis of Cephalometric s

Cephalometric Bjork Mean 9-11 Patients Description
components
SKELETAL ANALYSIS
< N-S-Ar 123 ± 5 123 ± 5 1390 The saddle angle is above normal.
The relationship between the anterior and posterior
cranial base is above normal.
< S-Ar-Go 143 ± 6 143 ± 5 1310 The articular angle is below normal.
The anteroposterior growth direction between the
cranium base and the mandibular ramus is less than
normal.
< Ar- Go-Me 130 ± 7 127 ± 5 1250 The angle of the mandible is normal.
The vertical growth direction between the ramus
and mandibular corpus is normal.
Sum 396 395,5 ± 5 3950 The total posterior angle is normal, and the
direction of fascial growth is normal.
SN 71 ± 3 68 ± 3 65 Normal anterior cranium base length
Sar 32 ± 3 34 ± 4 30 Normal posterior cranium base length
< ArGoN 52-55 52 ± 4 550 Upper gonial angle: normal
Anteroposterior growth of mandibular ramus
normal
< NgoMe 70-75 76 ± 4 720 Lower gonial angle: normal
Vertical growth of the mandibular corpus is normal
ArGo 44 ± 5 42 ± 3 41 Normal mandibular ramus height
GoMe 71 ± 5 68 ± 4 69 Normal mandibular corpus length
GoMe/SN 1 1 1,07 Normal mandibular to cranial base length ratio
< SNA 80 82 ± 3 760 The maxillary position below normal to the cranial
base
< SNB 78 79 ± 3 780 Normal mandibular position against the base of the
cranium
< ANB 2 3,3 ± 1,2 20 Orthognathic mandible to maxilla relationship
< GoGnSN 33 ± 5 570 Above-normal vertical growth
Y axis 69 ± 3 770 Growth pattern in the anteroposterior direction
above normal (unbalanced) in the vertical direction
S-Go 73 ± 5 63 Posterior fascial height below normal
N-Me 115 ± 6 150 Anterior facial height above normal

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Cephalometric Bjork Mean 9-11 Patients Description

components
S-Go : N-Me 63% 51% Anterior-posterior fascial height ratio
disproportionate (less than normal)
< SNPg 79 ± 3 780 Normal craniofacial angle.
Normal craniofacial plane
< NAPg 7±3 40 The facial profile is relatively straight
DENTAL ANALYSIS
< OPMP 14 ± 3 250 Mandibular to the occlusal plane above normal
< Interinsisal 120 ± 7 1210 Relationship of upper I to lower I
Normal
< UI-SN 102 ± 2 108 ± 5 1400 Upper I inclination against protrusive cranium base
(>N)
UI-N-A 6 ± 1,6 280 Upper I position against protrusive maxillary base
(>N)
< IMPA (<LI-Go-Me) 97 ± 6 960 The inclination of the lower incisiveness concerning
the base of the cranium is normal.
LI-N-B 6±2 270 Lower I position against protrusive mandibular
base (>N)
SOFT TISSUE ANALYSIS
UL-E line 2±2 1 Upper lip position in front of the aesthetic line
LL-E line 3±3 0 Lower lip position on the aesthetic line

At the patient's first visit, GIC placement was performed on teeth 37 and 47, along with
bracket reinsertion on both jaws. At the second visit, within six months after the first visit, enough
room was found for tooth 21 to proceed with planning for surgical exposure of impacted tooth 21
(Fig 3). On the third visit, the patient underwent surgical exposure of impacted tooth 21 with a closed
eruption technique and then insertion of a button with eyelet on the palatal of tooth 21 (Fig 3 B and
C) and Fig 3D and E. The eyelet of the button was wrapped around the open coil on the NiTi wire
with minimal force.

Figure 3. (A) During the May 4, 2015 visit, there was enough room in region 21 for tooth 21 to be
exposed. (B and C) Tools and materials for surgical exposure and button placement with ligature wire on
impacted tooth 21. (D) At the time of surgical exposure and placement of the button on the palatal of tooth 21.
(E) The ligature wire attached to the button of tooth 21 exited through the mucosal flap using the closed flap
technique. (F) Postoperative control I exposure before aff hecting on June 5, 2015, showed no signs of
inflammation and no subjective complaints.

The patient returned two weeks after exposure surgery for suture opening and post-surgery
control. On subjective examination, there were no complaints. Clinical examination found that the
labial mucosa and mucobuccal fold of region 21 showed no signs of inflammation and a healing
wound after incision (Fig 3F). The actions taken during this visit were suture removal and
replacement of power O, opening the coil in region 21, and activating the eyelet to the coil until the
NiTi wire was slightly lifted to provide force to stimulate the eruption of impacted tooth 21.
The patient was instructed to perform routine monthly controls to evaluate orthodontic
traction treatment and activation of fixed orthodontic devices. The two-week post-surgery control

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showed no clinical change from the first (one-week) post-surgery control (Fig 4A), and the one-
month post-surgery control showed a slight decrease in the mucobuccal fold of region 21 with the
appearance of a button shadow approaching the mucosal surface (Fig 4B). At the two-month post-
surgery control (button-eyelet placement), there was movement of tooth 21 with a bulging
mucobuccal fold (Fig 4C). From two weeks after surgery, routine monthly controls were performed
for orthodontic appliance activation. At the eighth month of control after button-eyelet installation
for orthodontic traction, there was a patient complaint in the form of limited upper lip retraction,
clinically visible mesial incisal edge of the crown of tooth 21, some other crown surfaces were still
covered with mucosa with reddish mucosa (Fig 4D), the consistency of the mucosa covering the
crown of tooth 21 was flabby and thick. The tooth position at this visit was in the cervical third of
the crown of tooth 11 with an inverted eruption direction.

Figure 4. (A) There was no clinical change two weeks after surgery (button placement). (B) One month after
button placement, there was a slight decrease in mucobuccal fold in region 21 (teeth had not erupted). (C)
Control 2 months after button placement, there was a bulging mucobuccal fold in region 21, which was more
significant than the previous visit. (D) At six months of post-button placement control, the incisal edge of the
crown of tooth 21, mucobuccal fold, had a flabby and thick consistency. At the six-month post-button control,
the incisal edge of the crown of tooth 21 was seen, and the mucobuccal fold had a flabby and thick
consistency.

At the ten-month post-button-eyelet placement visit, the mesial and distal crowns of tooth
21 were seen with the position still at one-third of the crown of tooth 11 and the direction of eruption
to the mucco-bucal fold region 21 (Fig A and B. At the visit eleven months post-button-eyelet
placement, there was a subjective complaint of pain when the upper lip was retracted. On clinical
examination, it was seen that the mesial side of the crown of tooth 21 was partially covered with
mucosa, there was gingivitis marginalis region 11 et causa plaque, and mucositis in region 21 due to
food retention on the labial surface of tooth 21. The position of tooth 21 was in the cervical crown of
tooth 11, with the eruption direction already more horizontal towards the labial than in the previous
visit (Fig. 5C, D, and E). At this visit, an incision was planned to be performed with the undermining
of the mucosa covering the crown of tooth 21 under local anesthesia to open the eruption of tooth
21, which was covered by flabby mucosa. The incision was performed from the mucosa of the distal
cervical region of tooth 21, then traced cervically towards the mucosa covering the palatal surface of
tooth 21 and down towards the incisal surface of tooth 21. At the time of the mucosal incision, the
mucosa was strongly pulled towards the mucobuccal fold of tooth 21, so suturing was minimal.
Clinically, no bone or root was exposed during the mucosal incision.

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Figure 5. (A)The clinical photograph dated January 29, 2016, shows the partial eruption of the tooth
on the mesial side while the rest of the crown surface is still covered with mucosa. (B) Cephalometric
radiograph shows. (C). Visit on March 28, 2016, with subjective complaints (+), tooth position in the cervical
1/3 of the crown of tooth 11 with horizontal direction to the labial. (D) March 28, 2016, during mucosal
incision. (E) The final position of the incision flap after suturing.

In the final position of the incision flap after suturing, there were no subjective complaints at the
following control after the second incision. Clinical examination showed no signs of inflammation in the
post-incision mucosal region; fibrous tissue formed, and the button was still attached to the palatal of tooth 21.
At the visit on June 3, 2016, it was seen that the position of tooth 21 was already in the middle third of the crown
of tooth 11 with a horizontal to labial eruption direction (Fig 6 A and B). At the 1-year post-button-eyelet
placement visit, treatment continued with orthodontic appliance activation until the expected
inclination of tooth 21 was achieved (Fig 6 C and D).

Figure 6. (A) Occlusion photo and b. The occlusal clinical photo was taken on June 3, 2016, after bracket
cementation on tooth 21, and the Niti wire could pass through tooth 21 (occlusion photo). (B) Activation was
still done by replacing power O and ligature wire buttons. (C) No subjective complaints. Clinical examination
showed the position of tooth 21 in the middle third of the crown of tooth 11 with a horizontal to labial
eruption direction.

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Fifteen months after button-eyelet placement, the eruption of tooth 21 was seen in the
cervical third of the crown with the inclination of 21 no longer perpendicular to tooth 11 with the
incisal plane of 21 in the middle third of tooth 11 (Fig 7D). In the radiographic image of cephalometric
photos before treatment of impacted tooth 21 and cephalometry at eight months post orthodontic
traction control, there is a process of movement of tooth 21 from the crown eruption position towards
the vestibule to the occlusal plane of the upper jaw. It was also evident from the patient's clinical
appearance before treatment in the last photograph (Fig 7).

Figure 7. (A) Cephalometric radiograph of the patient before treatment. (B) Cephalometric radiograph of the
evaluation eight months after orthodontic traction treatment using a button with ligature wire placed through
surgical exposure. (C) Clinical photo of the patient before treatment. (D) 15-month post-fitting control of the
eyelet for orthodontic traction of tooth 21, showing the movement of the crown of tooth 21 almost to the
incisal third of tooth 11. Clinical evaluation photo fifteen months after orthodontic traction. Clinical evaluation
photos fifteen months after orthodontic traction

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3. Result and Discussion

A 12-year-old female patient with an unerupted tooth 21 condition and a history of primary
tooth trauma at the age of 3 years. Radiographic cephalometric examination shows the inclination of
tooth 21 towards the mucobuccal fold (inverted position), while from the occlusal photo of tooth 21,
there is no difference in crown angulation between teeth 11 and 21, the root looks shorter than the
root of tooth 11. In the picture of teeth with an inverted position, radiographically occlusal projection
will appear differences in root-crown angulation opposite to other teeth (Fig 8 A, B, and C).6
Therefore it can be concluded that there is a deviation of the root axis against the crown of tooth 21
which shows a picture of the root looking shorter than the root of tooth 11 this is due to the root-
crown angulation of tooth 21 or also known as a dilacerated condition. The condition in this case is
similar to the examination results reported in previous cases. 7 In the condition of non-eruption of
one incisive tooth, while the contralateral side and lateral incisive have finished erupting in the
occlusion position, it can be suspected that there is an eruption disorder in the form of impaction. 2

Figure 8. (A, B, and C) Occlusal projection radiograph showing impacted tooth due to inversion
position (source: Inverted impaction of supernumerary teeth, Med Oral Patol Oral Cir Bucal. 2013 July 1;18
(4):613-8). (D) Occlusal radiograph of an incisive permanent tooth impaction case due to a dilacerated
condition. (E) Radiographic photograph of the presented patient's case.

In this case, tooth 21 was diagnosed with impaction due to dilaceration, and the factor
causing the dilaceration was primary tooth trauma at the age of 3 years. This follows the theory that
one of the causes of impaction factors is root dilaceration, caused by trauma to the primary teeth,
with the prevalence of cases of tooth impaction due to dilaceration conditions around 0.006% to
0.2%.4 Trauma in the preschool group, namely 3-5 years of age, often occurs due to falls due to

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learning activities, walking, running, or unstable balance. The teeth that are often traumatized are
the upper anterior teeth.
Various treatment options that can be performed in cases of impaction due to dilaceration
of the upper permanent incisive teeth include extraction of the impacted tooth followed by space
closure through adjustment of the second incisive tooth to the position of the first incisive. The
second alternative is extracting the impacted tooth and making a prosthesis or implant. The last
alternative is malocclusion treatment, which includes finding a space for the impacted tooth,
followed by exposure surgery for access to place the button, and wire ligation that will be used for
orthodontic traction on the impacted tooth to provide tensile force for eruption.8 In this case, the
dilacerated impacted tooth was managed on the upper permanent incisor with orthodontic traction
followed by exposure surgery.
Influencing factors determine the success of impacted tooth alignment, namely the position
and direction of the impacted tooth, the degree of apical closure of the root, the degree of dilaceration
of the impacted tooth, and the availability of space for the eruption of the affected tooth. Lin reported
that the treatment success rate of impacted teeth due to dilaceration depends on the degree of
dilaceration, the root formation process, and the tooth's position. Holland recommended a
movement for the axis of the impacted tooth of no more than 90°. Some literature reports successful
treatment of impacted teeth with severe dilaceration. 9 In this case, the incisive tooth was lasered to
a root length axis of 90o, and the angle of the crown axis with the palatal plane was 220 o, with the
root inside the alveolar bone. The incisive tooth impaction, in this case, could not be classified based
on the Vemet and Kokich classification or vertical position due to the position of the impaction
crown, which was deep in the vestibule and inverted.
In this case, the treatment consideration was exposure surgery followed by orthodontic
traction, namely for access to button placement with ligature wire, because the direction of the
impacted tooth did not allow spontaneous eruption without orthodontic traction even though there
was enough room for tooth 21. In addition, the root formation process that has been fully formed
cannot utilize the eruption force from the root formation process. 10 Following the procedure
literature described by Fidan in his case report, exposure surgery provides access to the bonding
bracket on the crown of the impacted tooth. In this case, the position of the impacted tooth was high
in the vestibule, with the labial position covered by the mucobuccal fold, so the bonding bracket was
replaced with a button on the palatal surface for abutment of ligature wire or orthodontic traction
eyelets.11
In orthodontic traction treatment for impaction cases, the available space in the jaw arch
must be prepared before the surgical procedure. Bodily movement of the contralateral teeth and
lateral incisors to create space for the impacted teeth can only be achieved through fixed orthodontic
appliances. In addition, vertical force control of impacted teeth is difficult with removable
appliances. The condition of the impacted tooth is also not entirely in the direction of its eruption
path. In this case, restoring the alignment of the impacted tooth requires rotational forces in the labio-
lingual (torquing) and mesiodistal (uprighting) directions. The tool requirements needed for
impaction cases are: The appliance must be able to have a rapid and continuous leveling and
rotational effect for the movement of the impacted tooth, with a controlled force for crown-root
movement; the appliance can hold the room during and after the surgical procedure without
hampering the surgical procedure to obtain good periodontal tissue; the appliance can provide a
light and controlled extrusive force and be able to anchor, for the effective movement of the impacted
tooth to reach the occlusal level; and the final position of the impacted tooth and other teeth is
completed with the same appliance without changing the appliance for treatment effectiveness.10
The exposure surgical technique used in this case was the closed eruption technique, with
the consideration that the location of the teeth that were too high in the vestibule did not allow for
apically positioned flaps, and it was hoped that the closed eruption flap technique could resemble
the natural eruption process of teeth by penetrating the mucosa.9 The attachment of the labial
epithelium to the closed eruption flap technique can maintain an aesthetic gingival contour and
height. The second incisional surgical procedure was performed in this case with consideration of
the condition of thick and flabby fibrous tissue inhibiting the eruption process of impacted teeth
even though orthodontic traction had been given. This follows the literature, which states that thick
fibrous tissue in the alveolar mucosa is one-factor inhibiting tooth eruption.2 Various reports of
treatment of impaction cases due to dilaceration of permanent incisive teeth to reach normal position

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require a time that varies between 22 to 24 months after surgical exposure for button placement with
ligature wire or power chain. Provided that there is cooperation between the operator, patient,
patient's parents, and the oral surgery team, maximum treatment results can be obtained.9 The
patient's cooperative history while undergoing malocclusion treatment from the beginning had
difficulties with periodic control as instructed by the operator, so in this patient, it took longer for
the teeth to move. In this case, the treatment time required until before the last control was 23
months.

4. Conclusion
Management of maxillary incisor impaction with root dilaceration often involves surgical
exposure and orthodontic traction. Treatment success depends on the impacted tooth's position, root
development, dilaceration extent, and space for alignment. While many cases of impacted tooth
alignment are successful, root dilaceration cases are less frequently reported due to increased clinical
challenges and longer treatment times, necessitating patient cooperation. This patient's treatment
duration is 23 months and continues towards aligning tooth 21.

5. References
1. Proffit WR, Fields HW, Larson BE, Sarver DM. Contemporary Orthodontics 6th Edition William Proffit.;
2019.
2. Malik NA. Textbook of Oral & Maxillofacial Surgery.; 2008. doi:10.5005/jp/books/10932
3. Miloro M, Ghali GE, Larsen PE, Waite P. Peterson's Principles of Oral and Maxillofacial Surgery, Fourth
Edition.; 2022. doi:10.1007/978-3-030-91920-7
4. Do Espirito Santo Jacomo DR, Campos V. Prevalence of sequelae in the permanent anterior teeth after
trauma in their predecessors: A longitudinal study of 8 years. Dental Traumatology. 2009;25(3).
doi:10.1111/j.1600-9657.2009.00764.x
5. Küchler EC, Tannure PN, De Castro Costa M, Gleiser R. Management of an unerupted dilacerated
maxillary central incisor after trauma to the primary predecessor. J Dent Child. 2012;79(1).
6. Tuna EB, Kurklu E, Gencay K, Ak G. Clinical and radiological evaluation of inverse impaction of
supernumerary teeth. Med Oral Patol Oral Cir Bucal. 2013;18(4). doi:10.4317/medoral.18877
7. Ming TC, Ong MMA. Orthodontic-surgical management of an impacted dilacerated maxillary central
incisor: A clinical case report. Pediatr Dent. 2004;26(4).
8. Pinho T, Neves M, Alves C. Impacted maxillary central incisor: Surgical exposure and orthodontic
treatment. American Journal of Orthodontics and Dentofacial Orthopedics. 2011;140(2):256-265.
doi:10.1016/j.ajodo.2009.11.018
9. Uematsu S, Uematsu T, Furusawa K, Deguchi T, Kurihara S. Orthodontic treatment of an impacted
dilacerated maxillary central incisor combined with surgical exposure and apicoectomy. Angle
Orthodontist. 2004;74(1).
10. Becker A. Orthodontic Treatment of Impacted Teeth: Third Edition.; 2013. doi:10.1002/9781118709641
11. Sabuncuoglu FA, Ölmez H, Esenlik E. Orthodontic approach to dilacerated central incisor localized
horizontally on the anterior nasal spine: A case report. J Dent Child. 2011;78(3).

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Authors Contribution

Contribution Khairani A Sutadi H Fauziah E

Concepts or ideas √ √ √
Design √ √ √
Definition of intellectual content √
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JDS (Journal of Syiah Kuala Dentistry Society) is an Open Access Journal licensed under
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Citation Format: Khairani A, Sutadi H, Fauziah E. Surgical and orthodontic management of impacted dilacerated maxillary
incisor in a 12-year-old: a case study. J Syiah Kuala Dent Soc. 2023; 8(2): 167–177.

Publisher's Note: The authors of this article assert that all claims made herein are exclusively their own and may not
necessarily reflect the views of their respective affiliated institutions or those of the publisher, editors, and reviewers. The
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Annisa Khairani*, Heriandi Sutadi. Surgical and orthodontic management of impacted dilacerated maxillary incisor in a 12-
year-old: a case study

J Syiah Kuala Dent Soc (JDS). Vol 8 (2), December 2023|FKG USK Press Page | 177