Surgical-Orthodontic Treatment For Curved Impacted Central Incisors In Children

To evaluate the therapeutic efficacy of combined surgical-orthodontic approach for differentially curved impacted central incisors during mixed dentition. This institutional review board-approved retrospective study (NJSH-2025NL-001) analyzed tweenty-one patients with radiographically confirmed curved impaction treated between 2019-2024. Treatment protocol involved: cone-beam CT-guided surgical exposure, customized 2x4 bracket system with progressive traction forces (50-100g), and multidirectional force adjustment using nickel-titanium archwires. Outcome assessment included root development staging, crown-root angulation (α), and periodontal health metrics. The treatment changes were analyzed by Wilcoxon tests. The combined surgical-orthodontic protocol achieved a 95.24% success rate, and there was no significant difference in the added root length between the curved impacted incisor and the contralateral one (P>0.05). Younger patients (6–8 years) attained 100% success within 2–7 months, while older patients (9–11 years) required prolonged treatment for 90% success, with horizontal/vertical impactions achieving full success and inverted cases reaching 83.3% success over 7–10 months, though cases with α>90° still demonstrated favorable directional correction. Longitudinal follow-up confirmed complete root maturation in all aligned teeth, with no notable post-treatment pulp chamber abnormalities observed. This study demonstrates that early surgical exposure with orthodontic traction can effectively treat curvedly impacted central incisors, preserving root development and preventing midface complications in mixed dentition, which might provide some reference for early intervention of clinical impacted cases.