Clinical Treatment Of Inversely Impacted Maxillary Central Incisor.

Inverted impaction of maxillary central incisor has been rarely observed but can pose severe problems of appearance, especially when it occurs in period of early mixed dentition of the children. With the treatment of surgical technique and orthodontic traction, the incisor can be successfully moved into its proper position. The patient was 8-year-old with impacted left maxillary central incisor. He had a Class I malocclusion with a normal overjet and lacked sufficient space for orthodontic positioning. CBCT showed that the crown rotated more than 90° in an upward direction with its incisal edge reaching the level of anterior nasal spine. A treatment including orthodontic space opening, surgical exposure and traction of the impacted central incisor was chosen. The first stage was to expose the lingual surface of the crown and attach an orthodontic button with a metal chain ligated to it. Subsequently, fixed appliance was placed to create space and optimal force was applied to pull the impacted tooth. The incisor was finally moved to its proper position with an acceptable gingival contour after active treatment of 17 months. Early therapy offers the chance for the developing root to adapt to the correct spatial relationship of the aligned crown. And the closed-eruption technique can be used to achieve the most esthetically pleasing result of gingival margin. For patients with inversely impacted maxillary central incisor, a joint of orthodontic and oral surgery can give satisfactory result in an appropriate time.