Study protocol for the management of impacted maxillary central incisors: a multicentre randomised clinical trial: the iMAC Trial

Abstract

Background: Failure of eruption of the maxillary permanent incisor teeth usually presents in the mixed dentition between the ages of 7 and 9 years. Missing and unerupted maxillary incisors can be regarded as unattractive and have a potentially negative impact on facial and dental aesthetics. The presence of a supernumerary tooth (or odontoma) is commonly responsible for failed eruption or impaction of the permanent maxillary incisors. The primary objective of this trial is to investigate the success of eruption associated with maxillary incisor teeth that have failed to erupt because of a supernumerary tooth in the anterior maxilla.Methods: This protocol describes an interventional multicentre two-arm randomised clinical trial. Participants meeting the eligibility criteria will be randomised (unrestricted equal participant allocation [1:1]) to either space creation with an orthodontic appliance, removal of the supernumerary tooth and application of direct orthodontic traction or space creation with an orthodontic appliance, removal of the supernumerary tooth and monitoring. The primary outcome of this trial is to determine the prevalence of successfully erupted maxillary central permanent incisors at 6 months following removal of the supernumerary tooth. Secondary outcome measures include (1) the effect of initial tooth position (assessed radiographically) on time taken for the tooth to erupt, (2) time taken to align the unerupted tooth to the correct occlusal position, (3) gingival aesthetics and (4) changes in the self-reported Oral Health Related-Quality of Life (OHRQoL) (pre-and post-treatment).Discussion: There is a lack of high-quality robust prospective studies comparing the effectiveness of interventions to manage this condition. Furthermore, the UK national clinical guidelines have highlighted a lack of definitive treatment protocols for the management of children who present with an unerupted maxillary incisor due to the presence of a supernumerary tooth. The results of this trial will inform future treatment guidelines for the management of this condition in young children.

Surgical orthodontic intervention for impacted maxillary permanent central incisors: A case series

“…The absence of a central incisor not only affects one's appearance but also has negative impacts on self‐esteem, functionality, and social interactions. Therefore, it is crucial to diagnose and address this issue at an early stage 7 …”

“…Therefore, it is crucial to diagnose and address this issue at an early stage. 7 Orthodontists often face a dilemma when deciding whether to remove the impacted tooth or guide it into its correct position. In cases where the central incisor is ankylosed to the surrounding bone, positioned unfavorably, or severely curved, extraction is usually recommended.…”

Uso do aparelho hyrax em paciente com extranumerário incluso: Relato de caso

“…Não existe pesquisas prospectivas randomizadas confrontando a eficiência dos dois tratamentos. Dessa forma investiga-se, se apresenta alguma distinção na erupção correta e na posição final com o alinhamento dos incisivos centrais superiores não erupcionados relacionado a um dente supranumerário não irrompido em seguida a extração do elemento supranumerário, criando espaço e no aguardo vigilante ou retirada do dente supranumerário, gerando espaço e aplicando tracionamento ortodôntico direto nos 6 meses iniciais posterior a cirurgia (Seehra et al, 2022).…”

Orthodontic-Surgical Management of Impacted Maxillary Central Incisor Related to Supernumerary Tooth: a Case Report

“…Delayed eruption can be attributed to many factors, and the presence of supernumerary is one of the commonest reasons for impaction and delayed eruption [3]. Presence of the supernumerary tooth has been found to cause impaction of permanent maxillary central incisor in 28-60% of the cases [8]. Impacted teeth are also associated with conditions like Apert syndrome, osteopetrosis, hypoparathyroidism, cleidocranial dysplasia, etc [3].…”