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Management of Unerupted Maxillary Incisors Omar Yaqoob BDS MFDSRCS MSc MOrthRCS FDSRCSEd FHEA Specialist Orthodontist Specialist Practice Julian O’Neill BDS MSc FFDRCSI MOrthRCS Consultant Orthodontist Maxillofacial Unit Kettering General Hospital Northants NN16 8UZ Shruti Patel BDS FDSRCS MSc MOrthRCS FDSOrthRCS Consultant in Orthodontics King’s College Hospital NHS Trust London SE5 9RS Jadbinder Seehra BDS(Hons) MFDSRCS MSc MOrthRCS FDSOrthRCS Consultant Orthodontist and Hon Clinical Senior Lecturer, Department of Orthodontics King's College London Dental Institute London SE1 9RT, UK Catherine Bryant BDS FDSRCS MSc Consultant in Oral Surgery Department of Oral Surgery King's College Hospital Dental Institute Denmark Hill, London SE5 9RW Joe Noar MSc BDS FDSRCS(Ed) FDSRCS(Eng) DOrthRCS(Eng) MOrthRCS(Eng) FHEA Consultant/Hon. Senior Lecturer Orthodontic Unit Division of Craniofacial & Development Sciences Eastman Dental Hospital/Institute 256 Gray's Inn Road London WC1X 8LD Terry Gregg FDSRCPS, FDSRCS, FFDRCSI Consultant in Paediatric Dentistry Barts Health Dental Hospital Turner Street London E12AD

Management of Unerupted Maxillary Incisors...Management of Unerupted Maxillary Incisors 3 4.1.2 Age 4.2.4 4.1.3 Compliance 4.2 Dental factors 4.2.1 Retained primary teeth 4.2.2 Position

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Page 1: Management of Unerupted Maxillary Incisors...Management of Unerupted Maxillary Incisors 3 4.1.2 Age 4.2.4 4.1.3 Compliance 4.2 Dental factors 4.2.1 Retained primary teeth 4.2.2 Position

Management of Unerupted

Maxillary Incisors

Omar Yaqoob

BDS MFDSRCS MSc MOrthRCS

FDSRCSEd FHEA

Specialist Orthodontist

Specialist Practice

Julian O’Neill

BDS MSc FFDRCSI MOrthRCS

Consultant Orthodontist

Maxillofacial Unit

Kettering General Hospital

Northants NN16 8UZ

Shruti Patel

BDS FDSRCS MSc MOrthRCS

FDSOrthRCS

Consultant in Orthodontics

King’s College Hospital NHS Trust

London SE5 9RS

Jadbinder Seehra

BDS(Hons) MFDSRCS MSc MOrthRCS

FDSOrthRCS

Consultant Orthodontist and Hon Clinical

Senior Lecturer, Department of Orthodontics

King's College London Dental Institute

London SE1 9RT, UK

Catherine Bryant

BDS FDSRCS MSc

Consultant in Oral Surgery

Department of Oral Surgery

King's College Hospital Dental Institute

Denmark Hill, London SE5 9RW

Joe Noar

MSc BDS FDSRCS(Ed) FDSRCS(Eng)

DOrthRCS(Eng) MOrthRCS(Eng) FHEA

Consultant/Hon. Senior Lecturer

Orthodontic Unit

Division of Craniofacial & Development

Sciences

Eastman Dental Hospital/Institute

256 Gray's Inn Road

London WC1X 8LD

Terry Gregg

FDSRCPS, FDSRCS, FFDRCSI

Consultant in Paediatric Dentistry

Barts Health Dental Hospital

Turner Street

London E12AD

Page 2: Management of Unerupted Maxillary Incisors...Management of Unerupted Maxillary Incisors 3 4.1.2 Age 4.2.4 4.1.3 Compliance 4.2 Dental factors 4.2.1 Retained primary teeth 4.2.2 Position

David Morris

BDS FDSRCS FDSOrthRCPS MSc

MOrthRCS

Consultant in Orthodontics

Department of Orthodontics

Leeds Dental Institute

Leeds, LS2 9LU, UK

Martyn T.Cobourne

FDSRCS, FDSOrthRCS, PhD

Professor and Hon Consultant in

Orthodontics

Department of Orthodontics

King's College London Dental Institute

LONDON SE1 9RT

Page 3: Management of Unerupted Maxillary Incisors...Management of Unerupted Maxillary Incisors 3 4.1.2 Age 4.2.4 4.1.3 Compliance 4.2 Dental factors 4.2.1 Retained primary teeth 4.2.2 Position

Management of Unerupted Maxillary Incisors

i

Contents

Introduction .............................................................................................................................................................................. 1

1 Diagnosis and management ......................................................................................................................................... 1

1.1 Definition ............................................................................................................................................ 1

1.2 Causes of delayed eruption ............................................................................................................... 1

2 Incidence and prevalence ............................................................................................................................................. 1

3 Establishing the cause of eruption failure ................................................................................................................. 1

3.1 Medical and dental history ................................................................................................................. 1

3.2 Clinical examination ........................................................................................................................... 2

3.3 Radiographic examination ................................................................................................................. 2

4 General principles of management ............................................................................................................................ 2

4.1 Patient factors .................................................................................................................................... 2

4.2 Dental factors ..................................................................................................................................... 3

5 Management options ..................................................................................................................................................... 4

5.1 Removal of a physical obstruction ..................................................................................................... 4

5.2 Removal of the obstruction only ........................................................................................................ 4

5.3 Surgical intervention(s) ...................................................................................................................... 4

5.4 Incisor removal .................................................................................................................................. 6

5.5 Ankylosed maxillary incisors .............................................................................................................. 6

5.6 Autotransplantation ............................................................................................................................ 6

5.7 Monitoring of further dental development .......................................................................................... 6

Recommendations .................................................................................................................................................................. 6

References ................................................................................................................................................................................ 7

Page 4: Management of Unerupted Maxillary Incisors...Management of Unerupted Maxillary Incisors 3 4.1.2 Age 4.2.4 4.1.3 Compliance 4.2 Dental factors 4.2.1 Retained primary teeth 4.2.2 Position

Management of Unerupted Maxillary Incisors

1

Introduction

1 Diagnosis and management

1.1 Definition

1.2 Causes of delayed eruption

2 Incidence and prevalence

½

3 Establishing the cause of eruption failure

3.1 Medical and dental history

Page 5: Management of Unerupted Maxillary Incisors...Management of Unerupted Maxillary Incisors 3 4.1.2 Age 4.2.4 4.1.3 Compliance 4.2 Dental factors 4.2.1 Retained primary teeth 4.2.2 Position

Management of Unerupted Maxillary Incisors

2

3.2 Clinical examination

3.3 Radiographic examination

4 General principles of management

4.1 Patient factors

4.1.1 Medical history

Page 6: Management of Unerupted Maxillary Incisors...Management of Unerupted Maxillary Incisors 3 4.1.2 Age 4.2.4 4.1.3 Compliance 4.2 Dental factors 4.2.1 Retained primary teeth 4.2.2 Position

Management of Unerupted Maxillary Incisors

3

4.1.2 Age

4.1.3 Compliance

4.2 Dental factors

4.2.1 Retained primary teeth

4.2.2 Position of the impacted incisor

4.2.3 Developmental stage of the impacted

incisor

4.2.4 Nature of any physical obstruction to

eruption

4.2.5 Unfavourable root formation

Page 7: Management of Unerupted Maxillary Incisors...Management of Unerupted Maxillary Incisors 3 4.1.2 Age 4.2.4 4.1.3 Compliance 4.2 Dental factors 4.2.1 Retained primary teeth 4.2.2 Position

Management of Unerupted Maxillary Incisors

4

5 Management options

5.1 Removal of a physical obstruction

5.2 Removal of the obstruction only

5.2.1 Removal of the obstruction with creation

of space

5.3 Surgical intervention(s)

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Management of Unerupted Maxillary Incisors

5

5.3.1 Open exposure

5.3.2 Closed eruption technique

5.3.3 Open versus closed eruption techniques

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5.4 Incisor removal

5.5 Ankylosed maxillary incisors

5.6 Autotransplantation

5.7 Monitoring of further dental development

Recommendations

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Management of Unerupted Maxillary Incisors

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References

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