Moving an incisor across the midline: A treatment alternative in an adolescent patient

Abstract

A 13-year-old sought treatment for a severely compromised maxillary left central incisor and an impacted fully developed left canine. Extraction of both teeth became necessary. As the key component of the revised comprehensive treatment plan, the right maxillary central incisor was moved into the position of the left central incisor. All other maxillary teeth were moved mesially to close any gaps. Active orthodontic treatment was completed after 34 months. Frenectomy, minor periodontal surgeries, and bonded lingual retainers were used to improve aesthetics and stabilize the tooth positions. The patient was pleased with the treatment outcome. Cone-beam computed tomography provided evidence that the tooth movement was accompanied by a deviation of the most anterior portion of the median palatine suture. This observation may make relapse more likely if long-term retention cannot be ensured. Root resorption was not observed as a consequence of the major tooth movement.

Orthodontic movement of a maxillary incisor through the midpalatal suture

“…A recently published case report described treatment in a 13-year-old patient. 7 This is the first report showing the procedure performed in an adult patient. In addition, our case report has the uniqueness of showing the final results of tooth movement across the midpalatal suture documented by means of CBCT.…”

Orthodontic movement of a maxillary central incisor across the midline: a case report

“…Follin [6] also presented a case report in which a left maxillary incisor was moved into the midline to close the space of right central incisor which was removed due to an odontoma. Other successful orthodontic movements of the maxillary central incisors to the contralateral side were reported in gemination cases [7,9], and dental trauma cases [10,11].…”

Management of a Class I malocclusion with traumatically avulsed maxillary central and lateral incisors

“…Other studies reported that the suture bends to accommodate the tooth crossing the midline. 8,13 The maxillary midline was deviated from the facial midline during treatment. Another flaw was the proclination of the mandibular incisors necessitating long-term mandibular retainer wear.…”

“…8,9,13 This case study is the first presenting orthodontic space closure and canine substitution as an option for managing avulsed maxillary central and lateral incisors in a growing patient with a Class I malocclusion. This treatment included moving a central incisor across the midline and substituting a lateral incisor for a central incisor, in combination with canine substitution.…”

“…5 Orthodontic space closure with substitution of missing teeth should be considered when there is malocclusion. [5][6][7] Zachrisson, 7 Bosio et al, 8 and Pair et al 9 highlighted the importance of proper case selection for orthodontic substitution of missing central incisors.…”