|Year : 2008 | Volume
| Issue : 1 | Page : 26-28
Management of inverted impacted primary incisors: An unusual case
A Kapur, A Goyal, S Jaffri
Unit of Pedodontics and Preventive Dentistry, Oral Health Sciences Centre, Post-graduate Institute of Medical Education and Research, Chandigarh, India
Oral Health Sciences Center, PGIMER, Chandigarh - 160 012
| Abstract|| |
The prevalence of impacted primary teeth has been reported to be very rare and it has been reported to occur in 1:10,000 times, most commonly involving the primary second molars. This report discusses the presence of an impacted inverted maxillary primary incisors and their management by surgical intervention in a 5 year old boy. The inverted primary maxillary central incisors were extracted and prosthetic rehabilitation was done to improve the esthetics, speech and psychosocial behavaviour of the child. Co-incidentally the permanent maxillary incisors were also found to be hypoplastic although the parents did not give any history of trauma to the maxillofacial complex. It is important for pediatric dental surgeons to carefully monitor the eruption of primary and permanent teeth for early identification and management of developmental anomalies.
Keywords: Impacted, inverted, primary incisors
|How to cite this article:|
Kapur A, Goyal A, Jaffri S. Management of inverted impacted primary incisors: An unusual case. J Indian Soc Pedod Prev Dent 2008;26:26-8
|How to cite this URL:|
Kapur A, Goyal A, Jaffri S. Management of inverted impacted primary incisors: An unusual case. J Indian Soc Pedod Prev Dent [serial online] 2008 [cited 2013 May 19];26:26-8. Available from: http://www.jisppd.com/text.asp?2008/26/1/26/40318
| Introduction|| |
Impaction of primary teeth is a rare phenomenon. Among the few instances of impacted primary teeth, the one most commonly impacted is the primary second molar ,,, followed by the maxillary and mandibular central incisors, ,,, the primary canines,  and the lateral incisors. ,, The least common impacted primary tooth, as suggested by the available literature, is the first molar. , Primary tooth impactions can occur because of various reasons, such as (i) mechanical obstruction in the path of eruption, which may include hard tissue abnormalities like odontomes, , soft tissue conditions such as myxofibrous hyperplasia and ameloblastic fibroma;  (ii) malpositioning of the tooth germ, either due to trauma or unknown reasons, ,,, leading to an abnormal path of eruption, which causes impactions due to lack of space (it is usually associated with malformed roots); , or (iii) primary failure of eruption, where one finds an impaction in spite of a well-formed tooth and availability of space; , this inherent capacity of a tooth to remain impacted has been associated with a strong genetic component by some authors  or considered an acquired condition, occurring due to a temporary alteration of the nerve activity in the region which, in turn, has an influence on the eruption process.  The successfully attempted treatment options for such teeth range from removal of the mechanical obstruction, which is followed by spontaneous eruption of the impacted tooth; opening of a surgical window, with or without application of orthodontic traction; and extraction of the impacted tooth, followed by space maintenance.
The purpose of this article is to present a case of inverted impacted primary incisors in a 5-year-old child and its management.
| Case Report|| |
A 5-year-old boy reported to our department with the chief complaint of absence of upper front teeth. The history, as reported by the parents, revealed that the teeth had never erupted. The family and medical histories were noncontributory. The parents could not recall any trauma to the oral cavity or the head and neck region. There was no history of caries or intraoral infection.
An intraoral examination revealed that the maxillary primary central incisors were missing. A mild bulge was visible between the erupted 52 and 62 at the mid-root level and the incisal edges of the impacted 51 and 61 could be palpated beneath the mucosal bulge [Figure - 1]. The remaining primary dentition was present and in normal shape and alignment. No abnormality was noted in the gingiva and alveolar bone. An intraoral periapical radiograph revealed the presence of impacted inverted 51 and 61 [Figure - 2]A. These teeth had well-developed crowns and only partially developed roots. Moreover, the underlying developing left permanent central incisor (21) showed abnormal crown morphology. A maxillary occlusal radiograph and a Panorex view were also taken to further confirm the position of the impacted teeth and the absence of any other abnormality in the dentition [Figure - 2]B and C.
Considering the age of the child, the position of primary central incisors, and the location and developmental stage of the permanent central incisors, it was decided to surgically remove the impacted primary central incisors. Informed consent was taken from the child's parents. Both impacted primary central incisors were surgically removed under local anesthesia (lidocaine with adrenaline 1:100,000), without disturbing the permanent central incisors. The procedure involved raising a mucoperiosteal flap, exposing the crowns of 51 and 61, and their removal [Figure - 3]. The child was very cooperative and tolerated the procedure well. He was recalled after 2 months and a removable partial denture was given for esthetic and psychosocial reasons [Figure - 4]. Periodic recall visits were advised to monitor the developing dentition. An intraoral periapical radiograph 8 months after the surgery showed the eruption pattern of the permanent central incisors to be in the proper direction [Figure - 5].
| Discussion|| |
An impacted tooth is usually associated with permanent dentition and is a rare entity during the development of primary dentition, with a reported prevalence ratio of 1:10,000.  Only a few cases of inverted impacted primary anterior teeth have been reported earlier, ,, with only one case involving the central incisors in the maxilla.  All these cases involved impactions due to abnormal positioning of the primary tooth germs, with no history of trauma. In the present case too, the malposition of the tooth germ may have been the cause of impaction, since no trauma was reported by the parents. Darwish et al .  have however suggested that trauma cannot be completely ruled out as an etiological factor, as the parents may not even be aware of the trauma which occurs in young children prior to the eruption of primary dentition. In our opinion, this observation may be more true when the underlying permanent counterpart also is either hypoplastic or of abnormal morphology.
Anterior primary maxillary impacted teeth are of concern to both the dentist and the parents because of the problems it poses for esthetics, speech, and mastication, and for its psychological effects. In the present case, the teeth were extracted because a normal eruption of the teeth was not likely to occur as they were inverted and also because it appeared that they may interfere with the development and eruption of the succedaneous tooth. A removable partial denture was given for esthetic reasons. A follow-up of the present case was planned to monitor the normal eruption of the maxillary permanent incisors. (A follow-up radiograph after 8 months showed normal direction of eruption of the permanent maxillary incisors, though their defective morphology became more evident. However, such teeth fail to erupt to a normal occlusal position within the time usually expected for their appearance).  The impaction may be primary, meaning that the teeth have never erupted due to some physical barrier in the eruption pathways (also known as primary failure of eruption) or it may be secondary impaction, in which, due to ankylosis, the teeth after eruption are re-impacted.  Mostly, impacted teeth are found in permanent dentition.  Pindborg stated that failure of a primary tooth to erupt occurs only rarely.  There are only a few reports of primary teeth impaction found in the literature. ,,,,,,, Bianchi and Roccuzzo found the prevalence of primary teeth impaction to be 1:10,000 (by screening 30,000 panoramic radiographs).  Most of the reported cases involve the impaction of the primary first and second molars. ,, Impacted primary anterior teeth are only rarely seen. ,,,,
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[Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4], [Figure - 5]
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