Traction Of Multiple Impacted Maxillary Teeth With Root Transposition

This report presents an 8-year-old male with skeletal Class I malocclusion and multiple mesioangular-horizontal high-position impacted permanent teeth (#11, #12, #13) accompanied by 12-13 root transposition in the maxillary anterior region. The complex anatomical variations, including dental root interlocking and spatial constraints, posed significant biomechanical challenges. An 8-year-old male presented with delayed eruption of the right maxillary anterior tooth after loss of its deciduous predecessor. Clinical examination revealed a mixed dentition: erupted permanent teeth 21, 22; retained deciduous teeth 51, 53; and unerupted 11, 12, 13. Occlusion showed Class I molars. CBCT: Tooth 11 was impacted below the nasal floor with mesial inclination and near-complete root development. Teeth 12 and 13 exhibited mesially oriented horizontal impaction with transposition: 13 was positioned superiorly between 11 and 12 near the nasal floor. No trauma or significant medical history was reported. The primary challenge was achieving closed eruption within the restricted alveolar bone space while performing root-controlled movement to correct the transposed positions of #12 and #13. The treatment strategy centered on transitioning from elastic traction to rigid segment mechanics, enabling precise root displacement in a spatially limited environment.This case highlights the feasibility of combining biomechanical staging in anatomically constrained alveolar bone. This study demonstrates that non-extraction orthodontic treatment guided by three-dimensional biomechanical control with multiple impacted teeth and root transposition enhances the possibility of preserving dental arch integrity.