management of unerupted maxillary incisors

Question 1

When is maxillary incisor eruption considered late?

Answer 1

Eruption of contralateral more than 6 months earlier
Remain unerupted more than 1 year after eruption of the mandibular incisors
Significant deviation from the normal eruption sequence

Question 2

What are the causes of delayed eruption of maxillary incisors?

Answer 2

Early extraction or loss of primary
Prolonged retention of primary
Crowding in upper labial segment
Previous trauma
Localised pathology - supernumerary, odontomes and cyst formation
Less common - cleft lip and palate and cleidocranial dysplasia
Supernumerary and trauma most common

Question 3

What is the incidence of unerupted maxillary incisors?

Answer 3

3rd most commonly impacted tooth after TPM and maxillary canine

Question 4

What is the optimal age for extracting supernumeraries?

Answer 4

8-9
Generally debated if age matters

Question 5

When should retained primary teeth be extracted in cases of unerupted maxillary incisors?

Answer 5

Where incisor is close to eruption or when no obvious causative factor

Question 6

How does the position of the impacted maxillary incisor influence outcome?

Answer 6

Higher the vertical position more likely not to erupt after supernumerary removal

Question 7

How does developmental stage of unerupted maxillary incisor affect eruption?

Answer 7

If immature roots then more likely to erupt

Question 8

What are the management options for unerupted maxillary incisors?

Answer 8

Removal of physical obstruction - supernumerary, odontome
Removal of obstruction and monitor - most will erupt
Removal of obstruction and space creation
Surgical exposure and orthodontic traction
Open exposure if soft tissue impaction
Closed eruption technique with gold chain for orthodontic traction
Autotransplantation

Question 9

When should the unerupted incisor be removed and what should be done next?

Answer 9

Significant dilaceration
Ankylosis
Space maintain or space closure