In situ rotation surgery for correction of growing, inversely impacted maxillary central incisors

•In situ rotation surgery was performed for 2 inversely impacted maxillary incisors.•Incisor with dilacerated root spontaneously erupted after surgery.•For the in surgery, unfavorable positions were changed immediately.•Treatment durations greatly shortened.•The developing grew and maintained normal pulp vitality. Treatment of an incisor a is challenging clinicians because position incisor, abnormality root, prognosis, and, especially, long treatment duration. We report on young patients who had central incisors labially roots. Both treated by novel surgical approach, rotation, which crowns carefully rotated to relatively position, whereas apical location remained unchanged. About weeks spontaneous eruption observed. Three months later, postoperative further aligned into arch fixed orthodontic appliance. Follow-up visits or 3 years indicated that stability good gingival esthetics, pulpal vitality favorable. The roots direction incisor's longitudinal axis, different from initial curvature angle. Moreover, time reduced resulted favorable prognosis compared conventional treatment. prevalence reported be between 0.06%1Andreasen J.O. incisor.in: Andreasen Petersen J.K. Laskin D.M. Textbook Color Atlas Tooth Impactions: Diagnosis, Prevention. Munksgaard, Copenhagen, Denmark1997: 114-116Google Scholar 1.4%.2Tan C. Ekambaram M. Yiu C.K.Y. Prevalence, characteristic features, complications associated occurrence unerupted permanent incisors.PLoS One. 2018; 13: e0199501Crossref PubMed Scopus (8) Google Although exact causes tooth impaction are not fully clear, studies have some systemic and/or local factors might related it. Systemic (general) refer Cleidocranial Dysplasia, Gorlin syndrome, endocrine disorders, so on. Local include supernumerary teeth, odontoma, cysts, ankylosis, trauma deciduous predecessors.3Cangialosi T.J. Management tooth.J Am Dent Assoc. 1982; 105: 812-814Abstract Full Text PDF (10) Scholar,4Shapira Y. Mischler W.A. Kuftinec M.M. displaced mandibular canine.ASDC J Child. 49: 362-364PubMed only influences patient's appearance, speech, chewing function but also tends affect adjacent teeth,5Tsai T.P. Surgical repositioning mixed dentition.J 2002; 133: 61-66Abstract (39) Scholar,6Chang N.Y. Park J.H. Kim S.C. Kang K.H. Cho J.W. et al.Forced severely roots.Am Orthod Dentofacial Orthop. 2016; 150: 692-702Abstract (12) resulting occlusion interproximal caries. Interestingly, most crown dilacerations,1Andreasen dilaceration considered as common cause leading incisors.2Tan directs upward curving labiolingual direction.7Singh G.P. Sharma V.P. Eruption unusual dilaceration.J Clin Orthod. 2006; 40 (quiz 357): 353-356PubMed still unclear, suggested potential causes. For example, development changes primary predecessor. However, Hertwig's epithelial sheath (HERS) remains original guides dentin it would before trauma. As result, continues previous direction, affected shifted crown. This creates angle parts tooth, preformed calcified tissue uncalcified tissue, results axis dilaceration.8Topouzelis N. Tsaousoglou P. Pisoka V. Zouloumis L. Dilaceration incisor: literature review.Dent Traumatol. 2010; 26: 427-433Crossref (45) Scholar,9Becker A. Maxillary incisors.in: Becker Orthodontic Impacted Teeth. Taylor & Francis, Colchester, United Kingdom2007: 61-91Crossref clinical challenge easy handle, abnormal morphology duration.6Chang 2-stage therapy. First, surgically exposed, then followed traction.10Kocadereli I. Turgut M.D. case report.Dent 2005; 21: 234-239Crossref (11) kind generally successful, has shortcomings. whole process time-consuming, method technically complicated.11Hu H. Hu R. Jiang Cao Z. Sun Jin al.Survival labial incisors: retrospective cone-beam computed tomography 2-year follow-up.Am 2017; 151: 860-868Abstract (6) complications, such can occur during traction.8Topouzelis Scholar,12Sun Wang Ye Q. Dai W. X. al.Root dentition: study.Am 2014; 146: 709-716Abstract (17) these kinds sometimes need extracted autotransplanted. extraction adolescents always leads alveolar bone resorption, may influence future prosthodontic rehabilitation implantation.13Chaushu S. T. affecting duration.Am 2015; 147: 355-362Abstract (24) Autotransplantation deformation calcification narrower canal.14Plakwicz Kapuścińska Kukuła K. Czochrowska E.M. Pulp revascularization detached apex.J Endod. 41: 974-979Abstract (5) In this report, authors describe option mixed-dentition patients. After exposure crowns, incisal edge gently apex almost With immediate reposition did erupt spontaneously, continued develop, growth pattern path. Patient 1 8-year-old girl complaint right incisor. intraoral examination showed (Fig 1, A B). panoramic radiograph spiral tomographic (CT) images D-F). tilted over 90°. toward cervical third. An formed, F). Based her mother's statement, patient healthy without any disease. diagnosed inverse root. parents informed several options. first extract install implant prosthetic when mature. second align dentition, redistribute space using appliances. Then, lateral canine managed restoration replace third traction, time-consuming. fourth alignment. wished bring out save time, they chose option. under anesthesia. midcrestal incision made within keratinized gingiva at edentulous ridge corresponding extended vestibular groove left full-thickness flap raised gain access very thin cortical removed avoid damage palatal surface exposed clearly 2, A), gently, slowly, downward osteotome elevator It critical maintain area pivot point, much unchanged possible, entire surgery. C) labial-palatal mesial-distal mobility. repositioned sutured resorbable sutures D E). weeks, operated inside oral cavity 3, A). further, there no special mobility accomplished appliance C). moved 4 D). total about 7 half months. On completion treatment, radiographic continuous elongation present, again F G). CT image, observed growing, along curved H). accordance No resorption around dilacerations. presence lamina dura surrounding socket identified image. wore clear retainer year. routinely examined clinically status, mobility, electric testing, radiographically period. completed overjet overbite obtained, well arch. presented stable condition responded testing (Electric Tester; Denjoy Dental Co, Ltd, Hunan, China) well. revealed periodontal state teeth (probing depths <3 mm) adequate width attached gingiva. loss attachment detected, contour normal. Radiographic examinations follow-up monitor During observation, closure gradually 4, E A-C), evaluate volume anterior region maxilla. Results confirmed continuity process. located alveolus completely covered plate. immediately chief There nothing medical dental history. 5, occupied midline deviated mm insufficient. Some caries, including molars, canine, molar, molars. early molars B developed one-third its length options mentioned above. They spent dentition Then 6, A-F). postsurgical image inverted Two 7, months, By examination, periapical improved longer, 8, B), year.Fig 7Spontaneous operation, (A). (B); x-ray shows (C). (D). 5 grown continuously (E), recurved (F). better (G).View Large Image Figure ViewerDownload Hi-res Download (PPT)Fig 8Treatment (A-D). At follow-up, differently (E). addition, grew, (E, plate (F).View (PPT) period visit. situated esthetics. examination. axis. therapeutic described. found time. grow correct orientation Periodontal height, loss, bleeding probing healthy. gained esthetics traction widely used treat incisors. Extraction, repositioning,5Tsai reimplantation15Agrait Levy D. Gil Singh G.D. Repositioning combination replantation movement: report.Pediatr Dent. 2003; 25: 157-160PubMed strategies condition. Nevertheless, each drawbacks. difficult isolate contamination saliva hemorrhage procedure study, surgical-orthodontic average 9 21 complete alignment.13Chaushu complicated location, more than risk failure intractable external traction. contrast, dilacerations longer stage traction.13Chaushu Therefore, important reduce change deformity. current patients, we established method. method, step long-term largely avoided. Not does shorten reduces serious induced dilaceration. reimplantation offers simplified esthetic improvement, similar pulp, HERS, ligament could lead necrosis, inflammation, replacement resorption.16Andreasen transplantation teeth. Saunders, Philadelphia1992: 257-276Google Scholar,17Kim J. Song J.S. Choi H.J. B.J. S.O. Continued human germ.Oral Surg Oral Med Pathol Radiol. 2013; 115: e11-e15Abstract To promote minimize preserve intact ligament, stem cells papilla present kept point minimum momentum. Simultaneously, position. minimal force exerted tissues, papilla, protected. visit, radiographically, grow, indicating strategy apex. should possible injury. That importance development. Up till now, 30 surgeries been carried out. all received technique develop resorption. phenomenon occasionally (central incisors) ipsilateral canines side incisors, complication needs dealt point. conclusion, quickly repositions root's originally makes rate work, study larger sample size needed clarify success technique. like express their gratitude EditSprings (https://www.editsprings.com/) expert linguistic services provided.