Management of Bilateral Horizontally Impacted and Dilacerated Maxillary Central Incisors at the Nasal Floor: A Multidisciplinary Specialist Approach

Impacted maxillary central incisors are relatively rare with a reported incidence of 0.06–0.2% in the general population.¹ Impacted maxillary central incisors have a significant effect on dental and facial aesthetics, and this can be especially concerning for young children.² A maxillary central incisor is generally considered to have delayed eruption if: there is eruption of contralateral teeth greater than 6 months previously; maxillary incisors remain unerupted more than 1 year following the eruption of mandibular incisors; or if there is a deviation of the normal eruption sequence, for example lateral incisors erupting before central incisors.³

The literature reveals multiple different causes of impacted maxillary incisors and include local causes, such as supernumerary teeth, dental malformations, dilacerations, ectopic position of the tooth bud,⁴ non-vital or ankylosed deciduous teeth,⁵ gingival fibromatosis and systemic conditions including cleidocranial dysplasia.⁶ Supernumeraries are the most common cause (56–60%) of maxillary incisor impactions, with tuberculate supernumeraries being more likely to hinder eruption than conical supernumeraries.^7,8 Odontomes have been suggested by others to cause delayed eruption or impaction of maxillary central incisors in approximately 28–60% of cases,⁵ with complex odontomes more commonly causing impactions than their compound counterparts.⁹