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The aberrant central incisor Tarun K Mittal Nikki E Atack Julie C Williams James S Puryer Jonathan R Sandy Tony J Ireland Orthodontic Update 2025 10:2, 46-50.
The maxillary permanent central incisor develops early in life and forms part of an aesthetic smile. Disruption of the formation or eruption of the permanent central incisor has multiple aetiological factors. Treatment options depend to some extent on the cause of failure of eruption of the central incisor. Generally, the earlier treatment is provided, the higher the likelihood of success and the less the complexity. This article gives an overview of the possible aetiology and treatment of the aberrant central incisor.
CPD/Clinical Relevance: Unerupted central incisors are a clinical complication that occurs commonly in orthodontic practice. The clinician should be aware of the aetiology and possible treatment options.
Article
The maxillary central incisor commences its development in the 30th week in utero. Calcification begins 3–4 months post-partum and the crown is usually complete by the age of 5 years. It is often the second maxillary permanent tooth to erupt, following the first permanent molars, roughly between the ages of 7–8 years. This is followed by eruption of the mandibular lateral and maxillary lateral incisors.
The follicle of the permanent central incisor forms palatal to the root apex of the deciduous predecessor and the eruptive path has a labial vector. As the mesio-distal width of the permanent tooth is greater than its predecessor, permanent maxillary central incisors, by necessity, erupt labially and therefore into a wider dental arch. This eruptive process results in resorption of the deciduous incisor root, under the influence of follicular cells.1
If there is insufficient labial migration of the permanent tooth germ, physiological resorption of the primary root will not occur and the permanent tooth will erupt palatally. This deviation of the eruptive path may also result in distortion of root form, creating a dilaceration (altered crown root angulation).
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