|Year : 2012 | Volume
| Issue : 3 | Page : 271-274
Management of a rare case of impacted primary central incisors in a 3-year-old child
A Sharma1, PB Sood1, A Singh2, S Sachdeva1
1 Department of Pedodontics and Preventive Dentistry, I.T.S Centre for Dental Studies and Research, Murad Nagar, Ghaziabad, Uttar Pradesh, India
2 Department of Oral and Maxillofacial Surgery, I.T.S Centre for Dental Studies and Research, Murad Nagar, Ghaziabad, Uttar Pradesh, India
|Date of Web Publication||21-Dec-2012|
Department of Pedodontics and Preventive Dentistry, I.T.S Centre for Dental Studies and Research, A 18, Ground Floor, Lajpat Nagar-III, New Delhi
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Impaction of primary anterior teeth is very rare. A tooth that fails to erupt into normal functional position by the time it normally should is considered impacted. A rare case of impacted dilacerated maxillary primary incisors in a 3-year-old child is presented. The diagnostic position of impacted primary incisors was determined using conical beam computed tomography (CBCT) to assist in surgical intervention with least surgical trauma to the tissues.
Keywords: Dilacerations, impacted tooth, primary incisors, unerupted tooth
|How to cite this article:|
Sharma A, Sood P B, Singh A, Sachdeva S. Management of a rare case of impacted primary central incisors in a 3-year-old child. J Indian Soc Pedod Prev Dent 2012;30:271-4
|How to cite this URL:|
Sharma A, Sood P B, Singh A, Sachdeva S. Management of a rare case of impacted primary central incisors in a 3-year-old child. J Indian Soc Pedod Prev Dent [serial online] 2012 [cited 2020 May 27];30:271-4. Available from: http://www.jisppd.com/text.asp?2012/30/3/271/105024
| Introduction|| |
Tooth impaction refers to a situation where a tooth fails to erupt into a normal functional position and remains unerupted beyond the normal time of eruption.  Impaction may be primary, meaning that the teeth never have been erupted or it may be secondary, meaning that the teeth after eruption are reimpacted.  Mostly unerupted or impacted teeth are found in permanent dentition. , Impaction of primary teeth is very rare especially in the maxillary anterior region. The prevalence of impacted primary teeth that has been reported is 1:100,000 and primary second molar is the most commonly involved.  Anterior primary maxillary impacted teeth poses problems for aesthetics, speech, mastication, and for psychological reasons thus they are of major concern for both dentist and parents. Early diagnosis and treatment of such cases allows favorable prognosis. The treatment options for impacted primary teeth range from observation with or without surgical removal, removal of the mechanical obstruction, surgical exposure with or without application of traction, and extraction of impacted tooth.
The purpose of this article is to present a rare case of impacted maxillary primary incisors in a 3-year-old child and its management.
| Case Report|| |
A 3-year-old boy reported to the department of Pedodontics and Preventive Dentistry with chief complaint of unerupted or missing upper front teeth. The family medical and dental histories were noncontributory. The parents were unable to recall any trauma to the oral cavity or head and neck region. Extraoral examination was noncontributory. Intraoral examination revealed that the primary maxillary incisors were missing [Figure 1]. The remaining primary dentition was present and was normal in shape and alignment. No abnormality was seen in the gingiva and alveolar bone.
Conical beam computed tomography (CBCT) of maxilla was done to evaluate the presence and position of unerupted 51 and 61. Tru-PAN orthopantomonogram was made, panoramic radiograph [Figure 2] and coronal section (CBCT) revealed impacted 51 and 61 [Figure 3]. Crown formation appeared to be complete till middle third only in respect to unerupted 11 to 14, 16, 21 to 24, 26, 31 to 34, 36, 41 to 44 and 46. The tooth bud of unerupted 21 appeared to be rotated mesially.
Axial section (CBCT) showed that unerupted 51 and 61 lying horizontally with their root tips lying labially and crown tips toward the palate [Figure 4]. Root formation of unerupted 51 and 61 appeared to be complete.
|Figure 4: Axial section (CBCT) showing that unerupted 51 and 61 lying horizontally with their root tips lying labially and crown tips towards the palate|
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Sagittal section (CBCT) showed impacted 51 and 61 in very close approximation to tooth bud of 11 and 21, respectively [Figure 5] and [Figure 6].
|Figure 5: Sagittal section (CBCT) showing impacted 51 in very close approximation to tooth bud of 11|
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|Figure 6: Sagittal section (CBCT) showing impacted 61 in very close approximation to tooth bud of 21|
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It was planned to remove impacted 51 and 61 under general anesthesia. Parents were informed about the procedure and written informed consent was taken. Preanesthetic evaluation and routine hematological investigation was carried out. Routine hematological investigation showed all parameters were within normal limits.
At a subsequent visit under general anesthesia, vestibular incision was placed from distal aspect of right maxillary canine to the distal aspect of left maxillary canine. Full thickness muco periosteal flap was raised to expose the impacted 51 and 61.The root tip of 51 and 61 were found lying labially without any over lying bone and the crown tips were palatally positioned covered with bone. The primary teeth were elevated from its position without causing any damage or pressure to tooth bud of 11 and 21. The muco periosteal flap was closed using 4-0 vicryl suture. Postoperative recovery was uneventful. Periodic recall visit were advised to monitor the developing dentition [Figure 7].
| Discussion|| |
Impaction of primary teeth is an unusual condition. The etiology of primary tooth impaction could be attributed to various reasons such as abnormal development or malpositioning of the tooth germ, either due to trauma or unknown reasons ,,, mechanical obstruction in the path of eruption  or primary failure of eruption.
In the present case the malpositioning of the tooth germ may have been the cause of impaction. It has been suggested that the parents may not be aware of the trauma, which occurs in young children prior to eruption of primary dentition, thus trauma cannot be ruled out as an etiological factor.  In our opinion in the present case trauma could have been the cause of malpositioning of the tooth germ and parents were not aware of the trauma since no trauma could be accounted for by the parents.
In the present case the roots of 51 and 61 were dilacerated [Figure 8]. Dilaceration is defined as a deviation from the normal axis of the tooth of 20° or more in the apical part of the root.  Dilaceration might occur anywhere along the length of the tooth, sometimes at the cervical portion or midway along the root or at the root apex, and this will depend on the extent of root that was formed at the time of injury.  The roots of 51 and 61 in the present case were dilacerated at an angle of approximately 80° and 55° to the long axis of the tooth, respectively. The direction of root dilacerations can be categorized as mesial, distal, labial/buccal, or palatal/lingual. In the present case, the direction of roots dilacerations for 51 and 61 were mesial.
The possible causes of dilacerations could be either due to mechanical trauma or an idiopathic developmental disturbance in cases that have no clear evidence of traumatic injury. 
CBCT is used most commonly in the assessment of bony and dental pathologic conditions, including fracture, structural maxillofacial deformity and fracture recognition, preoperative assessment of impacted teeth, and temporomandibular joint imaging, and in the analysis of available bone for implant placement. CBCT is capable of providing accurate, submillimeter-resolution images in formats allowing 3D visualization of the complexity of the maxillofacial region. This technology provides the practitioner with a modality that is extending maxillofacial imaging from diagnosis to image guidance of operative and surgical procedures. 
In the present case, maxillary primary incisors were extracted as the normal eruption of these teeth was not likely to occur and also because they may interfere with the development and eruption of the succedaneous tooth.
As the child in the present case was 3 years old, long-term follow up of the case was planned to monitor the normal eruption of the maxillary permanent incisors.
Impacted primary teeth may be associated with defects in the development and eruption of their permanent successors, a long-term observation is therefore necessary until the permanent successors erupt.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8]