Orthodontic traction of an impacted incisor during the mixed dentition period: A case report

Marina Marquezi Marcatto1 image, Thaísa Maria Vellasco Queiroz Pimenta2 image, Gabriela Leite Pedroso3 image, Franciele Lucca Longo4 image, Gabby Chacon Ruiz5 image, Christian Andrew Vargas Ramos6 image, Maria Bernadete Sasso Stuani7 image

Highlights

Early diagnosis and accurate treatment planning are crucial for successful management of impacted maxillary incisors in mixed dentition.

Surgical exposure, bonding, and orthodontic traction with removable appliance showed successful incisor eruption.

The combined orthodontic-surgical approach effectively restored both esthetics and function, emphasizing the importance of individualized treatment.

Abstract

Dental impaction is a common issue in orthodontics, often arising from the prolonged retention of deciduous teeth, dentoalveolar discrepancies, or supernumerary teeth. Early diagnosis, through clinical and radiographic evaluation, are crucial for successful management of impacted maxillary incisors in mixed dentition. Regarding its position the orthodontic traction can be done by removable appliance. This case report describes the successful management of an impacted maxillary central incisor (#9) in a 7-year-and-9-month-old female patient with historical of trauma at primary anterior teeth follows by a formation of a cyst. She presented an angle Class II, good transverse relationship, positive space discrepancy in both jaws and vertical impaction of tooth 9 (Nolla’s stage 9). The treatment involved a permanent incisor surgical exposure, bonding of an orthodontic button to the crown and a ligature wire. The traction was made with a removable appliance due to its vertical bone position, by a continuous force of 50gF during 7 months. The outcome was favorable, with the impacted incisor repositioned, during mixed dentition. The patient was referred for orthodontic treatment to leveling and alignment. This combined surgical-orthodontic approach demonstrated the effectiveness of accurate diagnosis and appropriate biomechanics.

Keywords: Dentition, Mixed; Orthodontics; Orthodontic Appliances, Removable; Tooth Eruption; Tooth, Impacted

Author Affiliations

  1. DDS, Department of Orthodontics, School of Dentistry of Ribeirão Preto, University of São Paulo, Brazil (Correspondence:marinammarcatto@gmail.com)
  2. PhD Student, Department of Orthodontics, School of Dentistry of Ribeirão Preto, University of São Paulo, Brazil
  3. PhD Student, Department of Orthodontics, School of Dentistry of Ribeirão Preto, University of São Paulo, Brazil
  4. PhD Student, Department of Orthodontics, School of Dentistry of Ribeirão Preto, University of São Paulo, Brazil
  5. PhD Student, Department of Orthodontics, School of Dentistry of Ribeirão Preto, University of São Paulo, Brazil
  6. PhD Student, Department of Orthodontics, School of Dentistry of Ribeirão Preto, University of São Paulo, Brazil
  7. Assoc. Prof., Department of Orthodontics, School of Dentistry of Ribeirão Preto, University of São Paulo, Brazil
  1. Mulick JF. Dr James F Mulick on impacted canines. J Clin Orthod 1979;13:824–834
  2. Lyu J, Lin Y, Lin H, Zhu P, Xu Y. New clues for early management of maxillary impacted central incisors based on three-dimensional reconstructed models. Am J Orthod Dentofacial Orthop 2018;154:390–396
  3. Hirschhaut M, Weinstein C, Alarcon C, Flores-Mir C. Clinical guidelines for the surgical and orthodontic management of impacted maxillary central incisors based on a decision tree. Compend Contin Educ Dent 2023;44:510–515
  4. Bishara SE, Jakobsen JR, Treder J, Nowak A. Arch width changes from 6 weeks to 45 years of age. Am J Orthod Dentofacial Orthop 1997;111:401–409
  5. Pedroso GL, Puls GL, Almeida APV, Valera FCP, Romano FL, et al. Surgical exposure and orthodontic traction of impacted maxillary central incisor after alteration of eruption sequence: a case report. Contemp Pediatr Dent 2025;1:70–78
  6. Martins DR, Kawakami RY, Henriques JFC, Janson G. Impacção dentária: condutas clínicas—apresentação de casos clínicos. Rev Dent Press Ortod Ortop Maxilar 1998;3:12–22
  7. Bishara SE. Impacted maxillary canines: a review. Am J Orthod Dentofacial Orthop 1992;101:159–171
  8. Lindauer SJ, Rubenstein LK, Hang WM, Andersen WC, Isaacson RJ. Canine impaction identified early with panoramic radiographs. J Am Dent Assoc 1992;123:95–97
  9. Sant’Anna EF, Marquezan M, Sant’Anna CF. Impacted incisors associated with supernumerary teeth treated with a modified Haas appliance: case report. Dent Press J Orthod 2012;17:120–128
  10. Mattiello FDL, Rizzatto SMD, Menezes LM, Araújo EA, Kim KB, et al. Dimensional and morphologic characteristics of unilateral impacted maxillary central incisors. Am J Orthod Dentofacial Orthop 2022;162:340–347
  11. Dachi SF, Howell FV. A survey of 3,874 routine full-mouth radiographs. II. A study of impacted teeth. Oral Surg Oral Med Oral Pathol 1961;14:1165–1169
  12. Kaczor-Urbanowicz K, Zadurska M, Czochrowska E. Impacted teeth: an interdisciplinary perspective. Adv Clin Exp Med 2016;25:575–585
  13. Bishara SE, Kommer DD, McNeil MH, Montagano LN, Oesterle LJ, Youngquist HW. Management of impacted canines. Am J Orthod 1976;69:371–387
  14. Suri L, Gagari E, Vastardis H. Delayed tooth eruption: pathogenesis, diagnosis, and treatment. Am J Orthod Dentofacial Orthop 2004;126:432–445
  15. Blair GS, Hobson RS, Leggat TG. Posttreatment assessment of surgically exposed and orthodontically aligned impacted maxillary canines. Am J Orthod Dentofacial Orthop 1998;113:329–332
  16. Alberto PL. Surgical exposure of impacted teeth. Oral Maxillofac Surg Clin North Am 2020;32:561–570
  17. da Costa CT, Torriani DD, Torriani MA, da Silva RB. Central incisor impacted by an odontoma. J Contemp Dent Pract 2008;9:122–128
  18. Moyers RE. Orthodontics. 4th ed. Rio de Janeiro: Guanabara Koogan; 1991
  19. Al-Juhani A, Binshalhoub A, Showail S, Alraythi M, Alzahrani A, Almutiri NF et al. Comparative analysis of dental age estimation: a systematic review and meta-analysis assessing gender-specific accuracy of the Demirjian and Nolla methods across different age groups. Cureus 2024;16:e12345
  20. Noble PM, Butcher GW. A removable appliance for the three-dimensional movement of ectopic maxillary canines. Br J Orthod 1991;18:135–138
  21. Fournier A, Turcotte JY, Bernard C. Orthodontic considerations in the treatment of maxillary impacted canines. Am J Orthod 1982;81:236–239
  22. McDonald F, Yap WL. The surgical exposure and application of direct traction of unerupted teeth. Am J Orthod 1986;89:331–340
  23. Johnston WD. Treatment of palatally impacted canine teeth. Am J Orthod 1969;56:589–596
  24. Nemec M, Garzarolli-Thurnlackh G, Lettner S, Nemec-Neuner H, Gahleitner A, et al. Prevalence, characteristics, and risk factors for impacted teeth with ankylosis and replacement resorption: a retrospective three-dimensional radiographic assessment. Prog Orthod 2024;25:34
  25. Alberto PL. Surgical Exposure of Impacted Teeth. Oral Maxillofac Surg Clin North Am 2020;32:561–570
  26. Kokich VG. Surgical and orthodontic management of impacted maxillary canines. Am J Orthod Dentofacial Orthop 2004;126:278–283
  27. Zogakis IP, Anagnostou C, Ioannidou I, Chaushu S, Papadopoulos MA. A Comparison of Different Biomechanical Systems for the Orthodontic Treatment of Palatally Impacted Canines. Bioengineering 2025;12:267
  28. Frank CA, Long M. Periodontal concerns associated with the orthodontic treatment of impacted teeth. Am J Orthod Dentofacial Orthop 2002;121:639–649
  29. Shi X, Xie X, Quan J, Wang X, Sun X, Zhang C, et al. Evaluation of root and alveolar bone development of unilateral osseous impacted immature maxillary central incisors after the closed-eruption technique. Am J Orthod Dentofacial Orthop 2015;148:587–598

Article Info

Contemp Pediatr Dent 2025:6(3):281-290

Received: 22 September 2025

Accepted: 10 December 2025

Online First: 29 December 2025

DOI: 10.51463/cpd.2025.62

89 views

Full Text

Attachments

Attachments

File Downloads
pdf CPD_2025_62 124

How to Cite 

				
					Marina Marquezi Marcatto, Thaísa Maria Vellasco Queiroz Pimenta, Gabriela Leite Pedroso, Franciele Lucca Longo, Gabby Chacon Ruiz, Christian Andrew Vargas Ramos, Maria Bernadete Sasso Stuani. Orthodontic traction of an impacted incisor during the mixed dentition period: A case report. Contemp Pediatr Dent 2025:6(3):281-290

Related Articles

Share Article

Under a Creative Commons license
Tagged