Introduction: This is a case report of the combined orthodontic/surgical and restorative management of a patient with an unerupted central incisor which was inverted, dilacerated with extremely short root. Method: A 12-year-old male patient presented with esthetic concerns due to an unerupted upper left central incisor. Examination revealed an Angle’s Class I malocclusion, which is complicated by an increased and traumatic overbite, as well as an increased overjet of 6mm, on skeletal base 1. The treatment objectives were set to correct the presenting malocclusion with the possibility of surgical extraction and auto-transplantation of the inverted tooth if adequate root length was observed. The orthodontic treatment was carried out using fixed appliance therapy with Roth 0.022 prescription appliances. Result: The orthodontic treatment lasted for 12 months. Upon surgical exposure, the tooth was found dilacerated with an extremely short fused root, thus there was a poor prognosis for auto-transplantation. Consequently, the tooth was extracted and its crown was utilized as a pontic for a long-term provisional bridge, using the fiber-reinforced composite material (Ribbond). This would provide function and esthetics while the patient was being prepared for implant therapy. Conclusion: The appearance of the finished result was esthetic and pleasing. The orthodontic treatment objectives were achieved, as the patient and parent were satisfied. Retention was achieved with the resin bridge in combination with upper Hawley’s retainer. This is an acceptable method for the treatment of an inverted and dilacerated tooth that has a short root, which was already fused prior to presentation.
Cite this paper
Ifesanya, J. U. , Nkwocha, F. G. and Gbadebo, S. O. (2023). Management of Unerupted, Inverted and Dilacerated Upper Central Incisor and Restoration with Natural Tooth Pontic and Fiber-Reinforced Resin Bridge. Open Access Library Journal, 10, e8906. doi: http://dx.doi.org/10.4236/oalib.1108906.
Helm, S., Kreiborg, S. and Solow, B. (1985) Psychosocial Implications of Malocclusion: A 15-Year Follow-up Study in 30-Year-Old Danes. American Journal of Orthodontics, 87, 110-118. https://doi.org/10.1016/0002-9416(85)90020-X
Shaw, W.C. (1981) The Influence of Children’s Dentofacial Appearance on Their Social Attractiveness as Judged by Peers and Lay Adults. American Journal of Orthodontics, 79, 399-415. https://doi.org/10.1016/0002-9416(81)90382-1
Proffit, W.R. (2007) Orthodontic Diagnosis: The development of a problem list. In: Contemporary Orthodontics. 4th Edition, Mosby Elsevier, Maryland Heights, 175.
Suri, L., Gagari, E. and Vastardis, H. (2004) Delayed Tooth Eruption: Pathogenesis, Diagnosis, and Treatment. A Literature Review. American Journal of Orthodontics and Dentofacial Orthopedics, 126, 432-445.
https://doi.org/10.1016/j.ajodo.2003.10.031
Andreasen, J.O., Sundström, B. and Ravn, J.J. (1971) The Effect of Traumatic Injuries to Primary Teeth on Their Permanent Successors. European Journal of Oral Sciences, 79, 219-283. https://doi.org/10.1111/j.1600-0722.1971.tb02013.x
von Arx, T. (1993) Developmental Disturbances of Permanent Teeth Following Trauma to the Primary Dentition. Australian Dental Journal, 38, 1-10.
https://doi.org/10.1111/j.1834-7819.1993.tb05444.x
Punde, P.A., Patil, N.M. and Pawar, R.L. (2014) Unusual Presentation of ‘U-Shaped’ Impacted Maxillary Central Incisor with Intranasal Root: Successful Surgical Management. Ethiopian Journal of Health Sciences, 24, 273-276.
https://doi.org/10.4314/ejhs.v24i3.12
Dhariwal, N.S., Gokhale, N.S., Patel, P. and Hugar, S.M. (2016) Natural Tooth as an Interim Prosthesis. Journal of Natural Science, Biology and Medicine, 7, 189-193.
Bello, S.A., Enebong, D.J. and Obi, E.V. (2017) Swinging Replantation: A Possible Protocol for the Management of Inverted Impacted Upper Central Incisor Tooth. The Journal of Contemporary Dental Practice, 18, 69-73.
https://doi.org/10.5005/jp-journals-10024-1992
Owolabi, L.F., Shehu, N.M. and Owolabi, S.D. (2014) Epilepsy and Education in Developing Countries: A Survey of School Teachers’ Knowledge about Epilepsy and Their Attitude towards Students with Epilepsy in Northwestern Nigeria. Pan African Medical Journal, 18, Article 255.
https://doi.org/10.11604/pamj.2014.18.255.3607
Ezeala-Adikaibe, B.A., Achor, J.U., Nwabueze, A.C., Agomoh, A.O., Chikani, M., Ekenze, O.S., et al. (2014) Knowledge, Attitude and Practice of Epilepsy among Community Residents in Enugu, South East Nigeria. Seizure—European Journal of Epilepsy, 23, 882-888. https://doi.org/10.1016/j.seizure.2014.08.003
Oche, O.M. and Onankpa, O.B. (2013) Using Women Advocacy Groups to Enhance Knowledge and Home Management of Febrile Convulsion amongst Mothers in a Rural Community of Sokoto State, Nigeria. Pan African Medical Journal, 14, Article 49. https://doi.org/10.11604/pamj.2013.14.49.1703
Altun, C., Cehreli, Z.C., Güven, G. and Acikel, C. (2009) Traumatic Intrusion of Primary Teeth and Its Effects on the Permanent Successors: A Clinical Follow-up Study. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, 107, 493-498.
https://doi.org/10.1016/j.tripleo.2008.10.016
Diab, M. and ElBadrawy, H.E. (2000) Intrusion Injuries of the Primary Incisors Part III: Effects on the Permanent Successors. Quintessence International, 31, 377-384.
Karatas, M.S. and Sönmez, I.S. (2013) Developmental Disturbances of a Maxillary Central Incisor due to Trauma to Its Predecessor: A Case Report. Medical Principles and Practice, 22, 590-592. https://doi.org/10.1159/000350500
Choi, S.C., Park, J.H., Kwon, Y.-D., Yoo, E.K. and Yoo, J.E. (2011) Surgical Repositioning of the Impacted Immature Maxillary Central Incisor. Quintessence International, 42, 25-28.
Spoerri, A., Signorelli, C. and van Waes, H. (2015) Surgical Repositioning of a Developing Maxillary Central Incisor. A Case Report. International Journal of Paediatric Dentistry, 25, 305-308. https://doi.org/10.1111/ipd.12129
Agrait, E.M., Levy, D., Gil, M. and Singh, G.D. (2003) Repositioning an Inverted Maxillary Central Incisor Using a Combination of Replantation and Orthodontic Movement: A Clinical Case Report. Pediatric Dentistry, 25, 157-160.
Lan, Z., Liu, R. and Dai, J. (2011) Orthodontic Management of Inverted and Impacted Bilateral Maxillary Central Incisors: A Case Report. Quintessence International, 42, 459-461.
Percinoto, C., de Mello Vieira, A.E., Megid Barbieri, C.M., Lemos Mehlado, F.L. and Moreira, K.S. (2001) Use of Dental Implants in Children: A Literature Review. Quintessence International, 32, 381-383.
Brahim, J.S. (2005) Dental Implants in Children. Oral and Maxillofacial Surgery Clinics of North America, 17, 375-381. https://doi.org/10.1016/j.coms.2005.06.003
Khetarpal, A., Talwar, S. and Verma, M. (2013) Creating a Single-Visit, Fibre-Reinforced, Composite Resin Bridge by Using a Natural Tooth Pontic: A Viable Alternative to a PFM Bridge. Journal of Clinical and Diagnostic Research, 7, 772-775. https://doi.org/10.7860/JCDR/2013/4698.2909
