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Introduction: Eruption of central incisors occurs at a time when the mixed dentition starts to develop and their impaction is mostly a severe esthetic problem.Aim: Our aim was to assess the frequency of impaction of an upper central incisor and to analyse the factors which affect the successful outcome and the protocols for orthodontic treatment in cases of impacted upper central incisors.Materials and methods: In the present study, we used all medical records of 651 patients treated in our private practice over the last 3 years and also the medical records of 18 patients we diagnosed and treated for this problem over the last 8 years.Results: We found the ratio of impacted upper central incisors to be 1.4% as there were more male than female patients affected. There were 2.8% male patients and 0.7% female patients. The most frequent cause of impaction of the upper central incisor was the presence of mesiodentes and supernumerary teeth (55.5%), followed by presence of follicular cysts (44.4%) and odontoma collections (22.2%) or a combination of these.Several approaches have been used in treating the different positions of impacted incisors. It is necessary first to rotate the axle of the incisor and assure its root full bone coverage. We used directly TPA for support. In other patients, we waited for the spontaneous eruption after removal of the etiological factor and in another patient, we used conventional fixed techniques.Conclusions: It is important that dental doctors should monitor the formation of the dentition so that they detect the impacted tooth early in its development.

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Purpose: The low frequency of concomitant hypo-hyperdontia and the lack of established clinical protocols in treatment are our motives to analyse our experience in three different clinical cases and derive principles of clinical behaviour. Material and methods: Analysis of the documentation of the 2886 patients, from which three clinical cases were with CHH: case 1 – agenesis of the second upper primary molars and hyperdontia of the upper left lateral; case 2 – Hyperdontia of the upper primary and permanent left lateral and hypodontia of the lower left second premolar; case 3 - two supernumerary (left and right) canines and hypodontia of the lower right second premolar. Results: From all the patients diagnosed and treated by us, hypodontia was found in 7.38% (excluding third molar hypodontia); hyperdontia in 1.9% and only 0.1% have concomitant hypo-hyperdontia. In the three patients, hyperdontia occurs in the frontal segment, and the phenomenon of hypodontia covers the distal segments. Discussion: Following the treatment plans of all three clinical cases, the following stereotype is required as a treatment approach: Solving the problem of hyperdontia (extraction); Levelling dental arches; Solving the problem of hypodontia - placement of implants or closing the space; Retention. In practice, it is found that the solution starts with a relatively smaller problem - hyperdontia, especially in cases where we have access to these teeth. The more serious obstacle is hypodontia, which, if unilateral, leads to disruption of the occlusal ratios. Conclusion: CHH is a rare problem, and the treatment is long, and its favourable outcome depends on early diagnosis.

In the process of odontogenesis, a disturbance in the formation of the epithelium and mesenchyme can be observed and this can be manifested by atypical forms of dental development. Such biological phenomena with altered morphology are as follows: dens invaginatus (DI), dens evaginatus (DE), talon cusps, and double teeth (DT) or connate teeth (fusion and gemination). Patients with orthodontic anomalies who also exhibit teeth with morphogenetic disorders are presented in this article. Dens evaginatus and talon cusps pose orthodontic challenges in the treatment finishing phase. These reduce the possibility of achieving maximum intercuspidation between the lower and upper front teeth as well as poor incisor guidance. Other orthodontic challenges are as follows: the risk of occlusal trauma and periodontal loading of the antagonists and the possibility of accessory cusps to play the role of the inclined plane and lead to deviations in the closure of the lower jaw. The fused teeth can cause aesthetic and occlusal disturbances in the anterior segment. Furthermore, double teeth can lead to ectopic eruption or noneruption of adjacent teeth due to their increased crown size as is the case with one of the presented patients. This is because a double tooth occupies more space in the dental arch. If not diagnosed early, impaction of the adjacent tooth, violation of the occlusal ratios (Bolton/anterior), and exacerbation of the orthodontic deformity can be observed. The modern CBCT imaging is the best diagnostic method for identifying problems related to tooth positions or tooth germs.