Orthodontic Traction of the Impacted Upper Permanent Central Incisor: Report of Two Cases

Abstract

Introduction: Impaction of the permanent upper central incisor is a rare condition, affecting between 0.05% and 3-4% of patients. It most commonly appears during the mixed dentition phase. Impaction may be caused by obstructive factors such as supernumerary teeth or trauma affecting root formation. This condition can have a significant impact on a patient's aesthetics, function, and psychological well-being. Orthodontic traction is an effective therapeutic strategy for managing these cases. Objectives: To demonstrate the effectiveness of orthodontic-surgical treatment through traction and torque control in impacted teeth due to supernumerary teeth. Case Presentations: Case 1: A 9-year-old female patient with early mixed dentition and absence of the permanent upper left central incisor. A surgical exposure was performed, followed by orthodontic traction using a buccal button and a traction arm. Eruption of the permanent upper left central incisor was achieved in approximately 8 weeks, followed by the placement of fixed appliances for alignment. Case 2: An 8-year-old male patient with early mixed dentition and an impacted permanent upper right central incisor. Surgical exposure was performed; a McNamara expander was used for traction. Traction allowed the eruption of the permanent upper right central incisor in 28 weeks, followed by the application of fixed appliances for alignment. Conclusions: Orthodontic traction –complemented by surgical intervention to remove obstructions– proved effective in both cases, achieving the eruption of impacted incisors without significant sequelae. Careful planning of the direction and magnitude of applied force is crucial for successful treatment. Early intervention is key to avoiding complications and ensuring favorable aesthetic and functional outcomes.