Early Treatment Of Impacted Ectopic Anterior Tooth With Root Curvature

This case report presents the interdisciplinary management of a 9-year-old girl with an ectopically impacted maxillary central incisor (21) exhibiting 90° root curvature and mesioangular impacted canine(23). The case highlights the challenges of early intervention in mixed dentition, emphasizing the importance of controlled traction mechanics to guide root development while minimizing complications. 9-year-old girl with convex profile (nasolabial angle <90°), retrognathic mandible. Mixed dentition: erupted maxillary 12, 11, 22, mandibular 3-2; Right molar distal relationship; left molar neutral-to-distal. Radiographic findings (PAN/CBCT):21: High impaction with 90° root curvature; 23: High mesioangular impaction, cusp tip contacting 21 labial surface. Treatment Process: Alignment of erupted teeth using 2×4 fixed appliances with maxillary stainless steel archwires for anchorage.Stepwise fenestration-assisted traction for 21/23. CBCT-monitored root development showed progressive apical closure and directional changes toward alveolar center. Retention: Hawley retainer to limit labial relapse of 21 pending lateral occlusion establishment. Early intervention may optimize root development guidance.Current studies support early traction for impacted incisors but lack consensus on optimal force vectors for severe root curvature (JCO 2021;55:345-350). Our CBCT findings align with theories of guided apical remodeling under controlled loads (Angle Orthod 2019;89:231-239). Early fenestration traction can reshape root development pathways in severely curved teeth.The approach offers a template for managing similar high-risk impactions, though long-term stability requires further study.