Surgical and orthodontic management of an impacted dilacerated maxillary central incisor and a partially transposed impacted canine: A case report

Dilaceration of a maxillary central incisor and transposition of a maxillary canine are challenging conditions that are often accompanied by impaction, leading to both esthetic and functional concerns. Studies suggested that the closed-eruption approach of impacted incisors with root dilaceration should be initiated as early as possible. Therefore, early detection and diagnosis are crucial for the success of orthodontic traction. However, the characteristics of the dilacerated teeth, such as the angulation of the apical bend and the depth of impaction, can significantly influence treatment outcomes. In cases of central incisor impaction, eruption disturbances of the ipsilateral canine are likely to occur. For a transposed and impacted canine, careful selection of surgical exposure technique and precise control of traction mechanics are essential for achieving successful alignment and an esthetically pleasing gingival contour. This report presents a patient with three impacted teeth: A dilacerated maxillary right central incisor, a horizontally impacted left central incisor, and a partially transposed, impacted maxillary right canine. The treatment approach included surgical exposure using the closed eruption technique and the apically positioned flap, which preserved periodontal health while facilitating orthodontic traction. A segmental titanium molybdenum alloy with an L-loop was utilized to guide the canine into its proper position. This case highlights the importance of early diagnosis and the integration of effective surgical and orthodontic techniques in managing the complex challenges associated with impacted teeth. In addition, periodic follow-up was critical for monitoring post-treatment stability and ensuring long-term success.