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The management of the dilacerated impacted maxillary central incisor Naomi Prado Ovais Malik David Waring Dental Update 2024 43:7, 707-709.
Authors
NaomiPrado
BSc(Hons), BDS, MFDS RCPS(Glas)
DCT1 in Oral Surgery, Paediatrics and Orthodontics, University Dental Hospital of Manchester, Higher Cambridge Street, Manchester M15 6FH, UK (n_prado@live.co.uk)
The clinical problem of how best to manage a dilacerated, impacted maxillary central incisor will only be encountered rarely. The treatment aim should be to achieve results that are indistinguishable from normal appearance in a way that is appropriate for the patient. This article discusses the incidence of dilacerations in maxillary incisors and describes the treatment approaches available – orthodontic alignment or surgical removal and management of the resulting space, considering orthodontic repositioning, autotransplantation and various prosthetic replacements. Treatment indications, advantages and disadvantages, restorative and surgical implications, as well as the evidence-base relating to the various treatment modalities will be presented, along with clinical case examples.
CPD/Clinical Relevance: This paper discusses a problem that, if not managed appropriately, can lead to poor results for the patient. Even for practitioners who may not undertake the treatment mentioned, it will enable them to have more in-depth discussion with their patients should the situation arise.
Article
A dilacerated tooth is described when a crown or root form has been altered by way of an angulation or sharp curve.1 A dilacerated, unerupted maxillary central incisor may be associated with cysts, supernumerary teeth, developmental abnormalities, or trauma to the primary predecessor – the apices of which lie close to the permanent tooth germ. The incidence of each is shown in Table 1.2
Dilacerations can occur in either the crown or the root of the developing permanent tooth. Crown dilacerations are the more uncommon presentation, occurring in only around 3% of cases3 and commonly associated with trauma to the primary dentition (especially intrusion injuries).
The severity of dilaceration caused by trauma will depend on a variety of factors. These include the stage of development of the permanent tooth when the trauma occurs, the direction and magnitude of the force of impact and the proximity of the apices of the primary predecessor to the permanent tooth germ.4
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