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Despite their relatively low incidence, unerupted maxillary incisors have a sizeable impact on a patient's function, phonetics and aesthetics. Management of these teeth commonly involves surgical exposure and orthodontic traction. This report describes a previously unreported intra-operative finding. During surgical exposure of an unerupted maxillary incisor, the pulpal tissue was found to be continuous with the oral mucosa. Subsequent separation of the tissues resulted in pulpal necrosis, requiring endodontic management. Awareness of unique complications is required. To ensure valid consent, all risks and alternative treatment options for these must be clearly communicated.
CPD/Clinical Relevance: Despite meticulous planning, not all intra-operative complications can be anticipated, hence good patient communication is important.
Article
Eruption failure of maxillary incisor teeth typically presents in the mixed dentition, over the age of 7–9 years. The maxillary central incisor is the third most commonly impacted tooth, after the third molar and maxillary canine. The reported incidence level varies from 0.03% to 2.1%.1,2 Failure of eruption can broadly be attributed to space loss, obstruction or trauma.1,3
The maxillary midline is a common site for supernumerary teeth or odontomes, which provide a physical obstruction to eruption. Additionally, trauma to deciduous teeth can result in malformation or dilaceration to the permanent successor. A change in the position or morphology of a developing tooth can result in eruption failure.4
Notably, an absent or unerupted maxillary incisor can affect patient function, phonetics and aesthetics.5 Consequently, early diagnosis, thorough investigation and appropriate treatment planning are essential.
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