ORIGINAL ARTICLE

Impacted central incisors: Factors affecting

prognosis and treatment duration
Stella Chaushu,a Tal Becker,b and Adrian Beckerc
Jerusalem and Tel Aviv, Israel

Introduction: In this study, we aimed to assess the patient and treatment factors that inuence the success rate
and the duration of the orthodontic-surgical modality for impacted central incisors. Methods: The records of 60
consecutively treated patients (64 impacted incisors) were retrospectively evaluated. The success rate and the
duration of each stage of treatment were examined in relation to age, sex, etiology of impaction, location of the
impacted tooth, and type of surgical exposure performed. Logistic regression analyses were applied. Results:
The group consisted of 26 male and 34 female subjects, 7.0 to 21.9 years old; 27 patients had impactions
because of root dilaceration, 29 had impactions because of obstruction, and 4 had impactions with unknown
causes. The overall success rate was 90.0%. Five of the 6 failures were dilacerated incisors. The average duration of treatment was 21.6 6 8.7 months. The only factor that signicantly increased the duration was the height
of the impacted tooth. Dilaceration was related to a longer stage of traction and, in older patients (late mixed and
full permanent dentition), to a longer nishing stage. Conclusions: The orthodontic-surgical treatment of
impacted incisors is generally successful, but relatively long. Patients and parents should be warned of the
risk of failure and the increased treatment duration, especially for dilacerated incisors impacted high in the
alveolus. (Am J Orthod Dentofacial Orthop 2015;147:355-62)

lthough the prevalence of noneruption or

impaction of the maxillary central incisor is
low, its occurrence is disguring for a young
child and of considerable concern to the parents. The
causes of this phenomenon can be divided into 2 main
groups: obstructive and traumatic causes.
The most common obstruction in the anterior maxilla
is the presence of at least 1 midline supernumerary
tooth.1-3 The frequency with which this occurs has
been found to be between 1.5% and 3.5%4 in random
population samples, although only between 28% and
60% of these patients will have resultant eruption
disturbances of the incisors.5 Odontomes are much rarer
ndings that cause obstruction in this area, and they
may vary in size and type (complex or composite).

a
Associate professor and chair, Department of Orthodontics, Hadassah School of
Dental Medicine, Hebrew University, Jerusalem, Israel.
b
Resident, Department of Endodontology, Maurice and Gabriela Goldschleger
School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel.
c
Clinical associate professor emeritus, Department of Orthodontics, Hadassah
School of Dental Medicine, Hebrew University, Jerusalem, Israel.
All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conicts of Interest, and none were reported.
Address correspondence to: Stella Chaushu, Department of Orthodontics, Hadassah School of Dental Medicine, Hebrew University, PO Box 12272, Jerusalem
91120, Israel; e-mail, drchaushu@gmail.com.
Submitted, August 2014; revised and accepted, November 2014.
0889-5406/$36.00
Copyright 2015 by the American Association of Orthodontists.
http://dx.doi.org/10.1016/j.ajodo.2014.11.019

Trauma at an early age, before the permanent

teeth have erupted, can cause damage to the
root-forming cells of the unerupted permanent tooth
germ and an attenuated productivity rate of the root
portion, and also change the orientation of the tooth
in the alveolar process. This results in the development
of a dilacerated tooth, which will then not usually erupt
unaided.3,6
The parents of a child with an unerupted central
incisor, unilaterally or bilaterally, will usually be motivated to seek treatment much earlier than the parents
of a child with almost any other orthodontic problem.
From the clinical point of view, early treatment is important for the following reasons: (1) an unerupted
maxillary central incisor can cause unesthetic and
compromised appearance, oral function, and speech;
(2) it can cause tipping of adjacent teeth, thus reducing
the space for the unerupted incisor; and (3) it is a significant environmental inuence in delaying and altering
the eruption path of the ipsilateral maxillary canine.7
The available treatment options for this condition
include (1) extraction of the tooth followed by prosthodontic rehabilitation; (2) extraction of the tooth and
realignment of the lateral incisor into the central incisor
position, with the canine and premolar sequentially
moved mesially and anatomically modied by grinding,
crowning, and so on; or (3) the orthodontic-surgical
modality.6
355

Chaushu, Becker, and Becker

356

Most patients seeking treatment for impacted

central incisors are young children. Therefore, any
prosthodontic solution can only be temporary and
will need to be modied and updated several times
before a more permanent solution becomes possible
at age 18 years or so, at the cessation of growth.
Extraction of the impacted tooth will also lead to
severe alveolar bone loss that will undermine the future
implant site.
In contrast, the orthodontic-surgical solution aims
for complete alignment of the natural teeth and requires
no prosthodontic enhancement. The eruption of the
impacted tooth draws the surrounding alveolar bone
to produce a bony crest height and periodontium similar
to those of the adjacent teeth.
In the past, it had been assumed that space opening
and elimination of the cause would be adequate to produce spontaneous resolution of the impaction. However,
evidence-based studies have shown that autonomous
eruption occurs in only 54% to 78% of patients,8-10
with a delay of up to 3 years8,10,11 and with
spontaneous acceptable alignment occurring in only a
few patients.10,12
More recent research has examined the effect of
several variables on the eruption of impacted teeth in
children after the removal of supernumeraries or odontomes.13 This study found disappointing outcomes
regarding spontaneous eruption after extraction of the
impediment, which varied in relation to its type and
form. The authors did not investigate whether acceptable alignment occurred in the successful subjects, leaving the reader to assume that orthodontic treatment
would still be necessary in many patients and justifying
the need for a phase 1 procedure.
The treatment of impacted central incisors with
dilacerations requires a different approach and is usually
lengthy and more complicated. This explains why
many patients, dentists, and orthodontists prefer
surgical repositioning or extraction with prosthodontic
rehabilitation as viable alternatives.14 However,
attitudes seem to have changed recently, with more
case reports of orthodontic treatments appearing in
the literature.15-20
In contrast to the parallel situation in regard to
impacted canines,21-25 data concerning the success
rate and duration of the orthodontic-surgical modality
treatment of impacted central incisors are sparse.3,26,27
Most of the articles offer isolated and subjective
clinical experiences. In a recent article addressing this
subject, the authors did not specify whether the
sample comprised only successfully treated patients or
consecutively affected patients from their database,
and they reported 100% success.26

March 2015
Vol 147
Issue 3

The aims of our study were to assess success rates and

durations of the orthodontic-surgical modality of treatment of impacted maxillary central incisors in a group of
consecutively treated patients and to examine factors
that may inuence these parameters to give accurate
information to patients and parents.
MATERIAL AND METHODS

The treatment records of 60 consecutive patients

with 64 impacted incisors were gathered between 2002
to 2007 from the orthodontic department of Hebrew
University in Jerusalem and from the private practices
of the 2 senior authors (S.C. and A.B.). The project was
approved by the institutional review board.
The inclusion criteria were (1) impacted maxillary
central incisors in healthy subjects; (2) a combined
orthodontic-surgical approach by one of the 2 senior
authors using the same treatment; (3) regular attendance for orthodontic appointments, as determined
from the clinical notes; and (4) complete patient
records, including diagnostic and treatment entries,
pretreatment diagnostically essential radiographic
views (good quality panoramic, periapical, and conebeam computed tomography images that were not
available for the older patients), banding and bonding
date, debanding and debonding date, date of surgical
exposure, and date of full engagement of the impacted
incisor bracket in the rst plain stainless steel archwire.
Subjects with craniofacial syndromes, cysts, or cleft lip
or palate were excluded from the study.
The diagnosis of impaction was made on the basis of
a clinical examination and diagnostic plane radiographs.
In each patient, the diagnosis was conrmed at the time
of the surgical exposure by the orthodontist, who was
routinely present for this.
Treatment usually followed the order we have
described elsewhere.6,28 It commenced with
anchorage preparation. In most patients, an updated
version of Johnson's twin appliance was used to
avoid bonding deciduous teeth that were likely to be
shed during treatment.29,30 Anchorage was provided
by a palatal arch with or without a Nance button,
and brackets were placed only on the erupted
incisors. After orthodontic leveling, aligning, and
reopening of the incisor space, a small attachment
was bonded by the orthodontist to the exposed
tooth at the end of the surgical procedure if a closed
eruption procedure was performed, or within a
few days thereafter in case of open surgery. Traction
was applied immediately to the freshly bonded
attachment. The tooth was brought to its place in
the arch by light orthodontic extrusive traction
maintained by the ligature wire.

American Journal of Orthodontics and Dentofacial Orthopedics

Chaushu, Becker, and Becker

In patients with a classic dilaceration, 2 surgical

exposures were usually required. The rst was a closed
procedure, and the second was an apically repositioned
ap, open surgical procedure. This second surgery was
needed to prevent the incisal edge of the incisor from
breaking through the oral mucosa as it was rotated in
the buccolingual plane; this was intended to encourage
the emergence of the impacted tooth crown through the
attached gingiva.28
The main outcome variables were the success rate
and the duration of the orthodontic treatment.
Treatment was considered successful if the incisor
was brought into its place in the arch. The success rate
was determined on the basis of the posttreatment
records. The success rate was calculated as the percentage of successfully aligned incisors relative to the total
number of incisors treated.
This stage of treatment was specically aimed for
resolution of the impacted central incisor and was
completed when the incisor was properly aligned in
the arch.
When more comprehensive treatment was considered, only that part of the treatment surrounding the
resolution of the incisor was considered, but in general,
the treatment of other features of the malocclusion was
postponed until the patient was ready for a phase 2
protocol.
The length of treatment in months was determined
from each patient's records.
Total treatment time refers to the period between
bonding or banding and debonding or debanding of
the orthodontic appliances, and this was arbitrarily
divided into 3 constituent treatment periods.
1.

2.

3.

T1, from the date of bonding or banding to the date

of the surgical exposure. In this preliminary or preparatory stage, bonding or banding was performed,
anchorage was prepared, and space was opened
for the impacted tooth.
T2, from the date of the surgical exposure to the
date that the tooth was fully ligated in the main
arch with a nickel-titanium wire. This was the
traction stage.
T3, from the full ligation into the stainless steel wire
to the date of debonding or debanding. During this
nishing stage, more complex movements such as
rotations, uprighting, and torquing were performed.

Success rate and duration of treatment were classied as follows: (1) age, younger group (\11 years) or
older group ($11 years); (2) sex; (3) etiology of impaction, trauma, classic dilaceration (crown angulated labially relative to the root, with the palatal aspect facing
labially, Fig 1), obstruction of the path of eruption

357

Fig 1. Classic dilaceration: A, panoramic view; B, conebeam computed tomography view.

(supernumerary, odontoma), or unknown; (4) angulation of the impacted tooth to the midline (Fig 2, A),
measured on panoramic views as the angle between
the long axis of the impacted tooth and the midline
drawn perpendicular to the occlusal plane through the
anterior nasal spine; this parameter was omitted in the
subjects with dilaceration; the cutoff angle of 20 was
based on the median angulation value of the whole
group, except for the subjects with dilaceration: \20
or $20 ; (5) vertical crown height (Fig 2, A), assessed
in the panoramic views only for unilateral cases, at the
level of the apical third of the root of the adjacent
erupted central incisor, the middle third of the root of
the adjacent erupted central incisor, and the coronal
third of the root of the adjacent erupted central
incisor; (6) distance of the impacted tooth to the midline
(Fig 2, B), measured on panoramic views as the distance
between the most mesial part of the crown of the
impacted tooth and the midline, #0 mm (the crown
crosses the midline) or .0 mm; and (7) type of surgical
exposure: open, closed, or combined (closed at the rst
exposure, open at the second exposure).
According to previous articles, different head
positions have little inuence on angular and linear
measurements if changes in the position of the occlusal
plane are equal to or less than 10 .31

American Journal of Orthodontics and Dentofacial Orthopedics

March 2015
Vol 147
Issue 3

Chaushu, Becker, and Becker

358

Table I. Patient characteristics

Fig 2. A, Angle of the incisor to midline and height relative to the contralateral normally erupted incisor; B, distance of the incisor to midline.
Statistical analysis

The statistical methods for the associations between

each variable, the success rate, and the treatment duration included chi-square tests and logistic regression
analyses using SAS software (version 9.4; SAS Institute,
Cary, NC) to calculate odds ratios and 95% condence
intervals. A multivariate regression model including
7 categorical variables was performed to identify the
factors with a signicant impact. All unilateral sides
but only 1 side of the bilateral subjects were included
in the multivariate analysis. The inclusion of each side
as a separate case in the bilateral subjects was
discounted because they are not independent variables.
The side was chosen at random by the statistician, so
that both affected sides had an even probability to be
included in the analysis. All statistical tests were
2-sided at a 5 0.05.
RESULTS

The patients' characteristics are presented in Table I.

The mean age of the whole group was 19.3 6 2.5 years,
with an age range of 7.0 to 21.9 years. The age groups
comprised 33 patients in the young group (mean,
9.0 6 1 years) and 27 in the older group (mean,

March 2015
Vol 147
Issue 3

Characteristic
Age (y)
Younger
Older
Unilateral
Bilateral
Sex
Male
Female
Etiology
Trauma
Classic dilaceration
Obstruction
Unknown
Angulation ( )*
#20
.20
Height
Apical
Middle
Coronal
Distance to midline (mm)
#0
.0
Surgical exposure
Closed
Open
Combined

No. of patients (no. of incisors)

33 (35)
27 (29)
56 (56)
4 (8)
26 (29)
34 (35)
14 (15)
13 (13)
29 (32)
4 (4)
13 (15)
16 (17)
32 (32)
18 (18)
6 (6)
31 (31)
29 (33)
44 (48)
11 (11)
5 (5)

*This variable was examined only in patients with impacted incisors

due to obstructive causes.

12.2 6 1.6 years). Twenty-six patients were male, and

34 were female.
Most patients had unilateral impactions (56), and
only 4 were affected bilaterally.
Fourteen patients had a history of trauma; however,
most of the patients with classic dilacerations also reported trauma. Therefore, these 2 groups were combined
for statistical purposes. In the statistical analysis, this
group of 27 trauma-affected patients with or without
dilaceration was compared with the group of 29 patients
with obstructed incisors. In 4 patients, the specic
etiology could not be determined.
The 2 subgroups based on angulation to the midline
were much smaller because this parameter was examined
only in the obstruction group because of the difculty of
drawing the long axis of the tooth in the subjects with
dilaceration. The angulation range was 0 to 140 .
In the unilateral group, most of the incisors were at
the level of the apical (32) or the middle (18) third of
the adjacent erupted incisor. Only 6 were recorded as
coronal, and these were therefore combined with the
middle-third group for statistical purposes.
The mean distance of the impacted tooth to the
midline was 1.4 6 3.9 mm, with a range of 4 to 20 mm.

American Journal of Orthodontics and Dentofacial Orthopedics

Chaushu, Becker, and Becker

359

Table II. Prognosis and treatment duration in relation to the variables

Variable
Age
Younger
Older
Sex (n)
Male
Female
Etiology
Trauma and dilaceration
Classic dilaceration*
Obstruction
Unknown
Angulation ( )y
#20
.20
Distance to midline (mm)
#0
.0
Height
Apical
Middle and coronal
Surgical exposure
Closed and combined
Open

SR (%)
90.0
93.9
85.2

Tt (mo)
21.6 6 8.7
19.2 6 13.0
25.8 6 10.1

T1 (mo)
4.9 6 3.6
4.1 6 2.4
6.0 6 4.1

T2 (mo)
8.7 6 4.4
8.0 6 4.6
9.6 6 5.4

T3 (mo)
8.2 6 4.8
7.5 6 10.1
9.5 6 5.2

80.1
97.1

20.1 6 8.8
21.0 6 12.6

5.5 6 4.2
4.4 6 2.5

7.4 6 3.3
9.6 6 5.9

7.7 6 5.3
7.1 6 6.7

81.5
69.2
96.6
100

21.4 6 8.8
22.1 6 6.1
18.0 6 7.4
31.8 6 15.5

5.6 6 4.4
5.5 6 2.8
4.9 6 3.2
5.5 6 7.2

10.1 6 5.5
10.8 6 5.6
7.0 6 3.3
13.7 6 7.6

5.7 6 3.2
5.8 6 3.4
6.1 6 4.6
12.5 6 4.9

19.6 6 8.7
19.6 6 5.2

7.8 6 6.5
6.1 6 3.4

7.4 6 3.1
7.0 6 3.2

4.4 6 4.1
6.5 6 3.7

90.3
89.6

21.6 6 10.1
23.3 6 15.1

5.5 6 4.1
4.8 6 3.6

8.2 6 3.6
9.1 6 6.1

7.6 6 5.8
9.3 6 10.1

84.4
95.8

23.2 6 15
19.3 6 10.1

4.8 6 3.4
4.9 6 3.4

9.6 6 5.0
7.5 6 5.0

8.7 6 10.1
6.9 6 6.5

89.8
90.9

18.1 6 8.8
23.6 6 12.4

5.0 6 3.9
6.3 6 3.5

8.1 6 4.1
11.6 6 8.2

7.8 6 6.1
5.2 6 4.8

SR, Success rate; Tt, total treatment time; T1, preparatory stage; T2, traction stage; T3, nishing stage.
*The classic dilaceration group is part of the trauma and dilaceration group; ysuccess rate was not relevant, since most of the failed cases were
dilacerated.

Table III. Characteristics of the failed patients

Patient
1
2
3
4
5
6

Age (y)
13.2
21.9
11.1
10.0
9.9
13.5

Sex
Female
Male
Male
Male
Male
Male

Reason for failure

Ankylosis
Intractable position
Ankylosis
Ankylosis
Invasive cervical root
resorption
Ankylosis

Etiology
Classic dilaceration
Classic dilaceration
Classic dilaceration
Classic dilaceration
Ttrauma and nonclassic
dilaceration
Obstruction

Most patients (44) were treated with a closed surgical

exposure, and only 11 had an open procedure. A few
patients (5), all with dilaceration, had 2 preplanned
surgical procedures, initially closed, and then, as the
tooth approached its location in the arch, an apically
repositioned ap to invest the tooth with attached
gingiva on its labial side. This group was added to the
closed surgery group in the statistical analysis because
most of the treatment was performed according to the
closed surgery approach.
The prognosis (success rate) and the duration of the
different stages of treatment are summarized in Table II.
The success rate in the whole group was 90%: 54
patients were successfully treated, and 6 had failures.
Table III describes the 6 failed patients. Four of
them were older than 11 years (patient 2 was 21.9 years

Angle ( )
-

Distance (mm)
3
20
4
0
9

Height
Apical
Middle
Apical
Apical
Apical

Surgical exposure
Closed
Closed
Closed
Closed
Closed

111

4

Apical

Open

old); most (5) were male, with 1 female (patient 1). All
had unilateral impactions. Four were impacted with
classic dilacerations probably related to previous
trauma, and the failures were due to ankylosis. One
was severely dilacerated, but not classic, because of
previous trauma (patient 5) and was subsequently
diagnosed with invasive cervical root resorption
(Fig 3). One incisor was extremely angulated and
obstructed by the roots of neighboring teeth, in an
intractable position (patient 6). Most (5) were
impacted high in the alveolus and were treated with
closed surgical exposures.
The multivariate regression analysis of all variables
and their effects on the prognosis of treatment are
shown in Table IV. The angulation could not be introduced in the regression model because of the small

American Journal of Orthodontics and Dentofacial Orthopedics

March 2015
Vol 147
Issue 3

Chaushu, Becker, and Becker

360

Fig 3. Failure caused by invasive cervical root resorption (arrows): A, initial panoramic and periapical
views; B, cone-beam computed tomography views showing the area of invasive cervical root resorption.

Table IV. Multivariate regression analysis for the

prognosis of treatment
Effect
Age
Sex
Etiology
Height
Distance at midline
Surgical exposure

Wald chi-square
0.7015
0.3241
5.3320
0.3979
0.0009
1.2286

Pr . chi-square
0.4023
0.5692
0.0209
0.5282
0.9767
0.2677

Pr, probability.

number of subjects (only obstructed) and because of

the total absence of failures in mildly angulated teeth.
The only variable that was statistically signicant
for prognosis was the etiology. Incisors impacted

March 2015
Vol 147
Issue 3

due to dilaceration had a signicantly higher risk for

failure than those impacted due to obstruction
(P 5 0.02).
The average duration for treatment for the whole
group was 21.6 6 8.7 months, as follows: (1) the
leveling, alignment, and space-opening stage (T1) took
approximately 5 months; (2) a further 9 months of
orthodontic traction (T2) were required to bring the
tooth into the arch after the surgical exposure; and (3)
on average, 8 months were needed to nish this phase
1 treatment (T3).
The duration of the total treatment and each stage
of treatment was longer in the older group. On
average, 6 more months were needed to treat older
patients; however, the differences reached statistical

American Journal of Orthodontics and Dentofacial Orthopedics

Chaushu, Becker, and Becker

signicance only for the nishing stage, T3. Treatment

for the bilateral patients lasted longer than that for the
unilateral patients, but because there were only 4
bilateral subjects, this gure should be treated with
caution. Sex, tooth angulation, and distance to the
midline did not inuence treatment duration signicantly.
Treatment of impacted incisors due to dilaceration
was more than 3 months longer than for impactions
caused by obstruction. The differences were statistically
signicant only for T2 (P 5 0.04).
The patients with classic dilaceration required the
longest treatment (almost 2 years) because of the long
period of traction (almost 11 months), and the difference
between this group and the obstruction group was even
more signicant (P 5 0.02).
Four separate multivariate analysis models were constructed to examine the impact of the variables on the
duration of each treatment stage and on the total treatment duration.
Thus, T1 was not signicantly affected by the
different variables. The variables that signicantly inuenced T2 in this model were the initial height of the
impacted incisor and the etiology. The phases of traction
were much longer for the apically located incisors
(P 5 0.01) and for the incisors impacted because of dilaceration (P 5 0.05).
The only variable that signicantly inuenced the T3
duration was age (P 5 0.02). T3 increased with the patient's age.
The multivariate analysis for the total treatment
time showed that the only variable with a signicant
impact was the initial height; this was probably due
to the increase in the T2 component: ie, a longer
period of traction for the apical incisors, as shown
above (P 5 0.03).
DISCUSSION

There can be no question that the conservative

approach to the treatment of impacted maxillary incisors is a signicant clinical challenge insofar as it requires close collaboration between an orthodontist
and an oral surgeon and, not least, skilled management
because it mainly involves a young patient. By all accounts, it is a highly successful approach, judging by
the only 2 published studies on this subject.26,27
These investigations reported no failures in their
samples of patients of impacted incisors, although it
seems likely that they included nonconsecutive and
only successful subjects.
Our sample was taken from consecutively treated
patients with incisor impaction in the database. In

361

contrast to the study of Ho and Liao,26 our study

included many more teeth impacted because of dilaceration (28). Farronato et al27 included only 10 successful
subjects, all adults with impactions resulting from dilacerations (25-35 years old).
Our study included failed cases, with 5 of the 6 failures occurring in the dilacerated group: an almost 18%
failure rate. Although clinically signicant, we considered this to be a risk worth taking, in light of the superior
outcome that this approach offers compared with other
treatment options. These alternative modalities
engender bone loss and the need for prosthodontic rehabilitation in those methods.
The poorer prognosis for dilacerated incisors nds a
cogent explanation in the fact that most orthodontists
believe that this phenomenon is due to trauma. Other
clinical sequelae related to trauma include ankylosis
and invasive cervical root resorption, both of which are
potent factors in the nonresponse of an affected tooth
to orthodontic forces; hence the increased failure rate
with dilaceration.6,32,33 Following this line of thought
still further and as would be expected in relation to the
frequency of trauma, there was a higher incidence
among the male subjects, with 5 of the 6 failures
found in them.
Relative to most phase 1 procedures, the treatment of
impacted maxillary incisors was long and not expected
to have any alleviating effect on the comprehensive orthodontic requirements that may be necessary in phase 2
treatment. Thus, taken together, the 2 phases of treatment are likely to be expensive for the patient; this
should be considered in setting the fee.
Ho and Liao26 reported only on the duration of the
traction phase. The traction time in our study was
8.00 6 4.5 months, which was similar to the ndings
in their article.
In terms of patient management, an important
observation was that the duration of phase 1 treatment
was greater in children whose impacted incisor was
located higher in the maxilla. The traction stage (T2)
was signicantly longer in the dilaceration group
because of the degree of rotation in the buccolingual
plane that is needed to bring the crown tip down to
the occlusal level. The nishing stage (T3), involving rotations, uprighting, and torquing, was signicantly
longer in the older patients, and this raised the possibility
that phase 1 treatment would become continuous with
phase 2 treatment.
Ho and Liao26 found no difference in treatment
duration between those who had an open vs a closed
surgical procedure, whereas in our study, a nonsignicantly shorter treatment time was associated with a
closed procedure.

American Journal of Orthodontics and Dentofacial Orthopedics

March 2015
Vol 147
Issue 3

Chaushu, Becker, and Becker

362

CONCLUSIONS

1.

2.

The prognosis of orthodontic-surgical treatment for

impacted incisors is good; however, failures do
occur, particularly when the etiology for the impaction is dilaceration.
Treatment is relatively longup to 2 yearsand is
signicantly affected by the initial height of the
impacted tooth.

REFERENCES
1. Zilberman Y, Malron M, Shteyer A. Assessment of 100 children in
Jerusalem with supernumerary teeth in the premaxillary region.
ASDC J Dent Child 1992;59:44-7.
2. Brin I, Zilberman Y, Azaz B. The unerupted maxillary central
incisor: review of its etiology and treatment. ASDC J Dent Child
1982;49:352-6.
3. Betts A, Camilleri GE. A review of 47 cases of unerupted maxillary
incisors. Int J Paediatr Dent 1999;9:285-92.
4. Brook AH. Dental anomalies of number, form and size: their prevalence in British schoolchildren. J Int Assoc Dent Child 1974;5:37-53.
5. Tay F, Pang A, Yuen S. Unerupted maxillary anterior supernumerary teeth: report of 204 cases. ASDC J Dent Child 1984;51:289-94.
6. Becker A. The orthodontic treatment of impacted teeth. 3rd ed.
Oxford, United Kingdom: Wiley-Blackwell; 2012.
7. Chaushu S, Zilberman Y, Becker A. Maxillary incisor impaction and
its relationship to canine displacement. Am J Orthod Dentofacial
Orthop 2003;124:144-50.
8. Di Biase DD. The effects of variations in tooth morphology and position on eruption. Dent Pract Dent Rec 1971;22:95-108.
9. Witsenburg B, Boering G. Eruption of impacted permanent upper
incisors after removal of supernumerary teeth. Int J Oral Surg
1981;10:423-31.
10. Mitchell L, Bennett TG. Supernumerary teeth causing delayed
eruptiona retrospective study. Br J Orthod 1992;19:41-6.
11. Munns D. Unerupted incisors. Br J Orthod 1981;8:39-42.
12. Gardiner JH. Supernumerary teeth. Dent Pract 1961;12:63-73.
13. Ashkenazi M, Greenberg BP, Chodik G, Rakocz M. Postoperative
prognosis of unerupted teeth after removal of supernumerary
teeth or odontomas. Am J Orthod Dentofacial Orthop 2007;131:
614-9.
14. Tsai TP. Surgical repositioning of an impacted dilacerated incisor
in mixed dentition. J Am Dent Assoc 2002;133:61-6.
15. Kuvvetli SS, Seymen F, Gencay K. Management of an unerupted
dilacerated maxillary central incisor: a case report. Dent Traumatol
2007;23:257-61.
16. Batra P, Duggal R, Parkash H. Managing morphologically atypical
impacted teeth orthodontically. J Clin Pediatr Dent 2005;29:
105-11.

March 2015
Vol 147
Issue 3

17. Lin YT. Treatment of an impacted dilacerated maxillary central

incisor. Am J Orthod Dentofacial Orthop 1999;115:406-9.
18. Cozza P, Marino A, Condo R. Orthodontic treatment of an
impacted dilacerated maxillary incisor: a case report. J Clin Pediatr
Dent 2005;30:93-7.
19. Tanaka E, Hasegawa T, Hanaoka K, Yoneno K, Matsumoto E,
Dalla-Bona D, et al. Severe crowding and a dilacerated maxillary central incisor in an adolescent. Angle Orthod 2006;76:
510-8.
20. Chew MT, Ong MM. Orthodontic-surgical management of an
impacted dilacerated maxillary central incisor: a clinical case
report. Pediatr Dent 2004;26:341-4.
21. Fleming PS, Scott P, Heidari N, DiBiase AT. Inuence of radiographic position of ectopic canines on the duration of orthodontic
treatment. Angle Orthod 2009;79:442-6.
22. Stewart JA, Heo G, Glover KE, Williamson PC, Lam EW, Major PW.
Factors that relate to treatment duration for patients with palatally
impacted maxillary canines. Am J Orthod Dentofacial Orthop
2001;119:216-25.
23. Zuccati G, Ghobadlu J, Nieri M, Clauser C. Factors associated with
the duration of forced eruption of impacted maxillary canines: a
retrospective study. Am J Orthod Dentofacial Orthop 2006;130:
349-56.
24. Becker A, Chaushu S. Success rate and duration of orthodontic treatment for adult patients with palatally impacted maxillary canines. Am J Orthod Dentofacial Orthop 2003;124:
509-14.
25. Bazargani F, Magnuson A, Dolati A, Lennartsson B. Palatally
displaced maxillary canines: factors inuencing duration and
cost of treatment. Eur J Orthod 2013;35:310-6.
26. Ho KH, Liao YF. Predictors of surgical-orthodontic treatment
duration of unilateral impacted maxillary central incisors. Orthod
Craniofac Res 2011;14:175-80.
27. Farronato G, Giannini L, Galbiati G, Maspero CA. 5-year longitudinal study of survival rate and periodontal parameter changes at
sites of dilacerated maxillary central incisors. Prog Orthod 2014;
15:3-8.
28. Becker A. Early treatment for impacted maxillary incisors. Am J
Orthod Dentofacial Orthop 2002;121:586-7.
29. Johnson JE. Adaptability of the twin-wire appliance to modern day
orthodontics (part 2). J Clin Orthod 1976;10:610-8.
30. Johnson JE. Adaptability of the twin-wire appliance to modern day
orthodontics. J Clin Orthod 1976;10:546-55.
31. Nikneshan S, Shara M, Emadi N. Evaluation of the accuracy of
linear and angular measurements on panoramic radiographs taken
at different positions. Imaging Sci Dent 2013;43:191-6.
32. Becker A, Chaushu G, Chaushu S. Analysis of failure in the treatment of impacted maxillary canines. Am J Orthod Dentofacial Orthop 2010;137:743-54.
33. Becker A, Abramovitz I, Chaushu S. Failure of treatment of
impacted canines associated with invasive cervical root resorption.
Angle Orthod 2013;83:870-6.

American Journal of Orthodontics and Dentofacial Orthopedics