National clinical guidelines for the management of unerupted maxillary incisors in children

Key Points

  • Describes the updated national clinical guidelines for the management of unerupted maxillary incisors in children.

  • Presents the most up-to-date evidence to support clinical decision-making.

  • Informs GDPs who play an important role in managing the developing dentition.

  • Educates dentists on the issues that need to be considered when managing unerupted maxillary incisor teeth in children.

Abstract

This article summarises recently updated guidelines produced by the Clinical Governance Directorate of the British Orthodontic Society through the Clinical Standards Committee of the Faculty of Dental Surgery, Royal College of Surgeons of England (FDSRCS) on the management of unerupted maxillary incisor teeth in children. The maxillary incisor teeth usually erupt in the early mixed dentition but eruption disturbances can occur and are often attributable to local factors. A failure of eruption will affect the developing occlusion and potentially influence psychological development of the child. The general principles of management for delayed eruption or impaction of these teeth is to ensure that adequate space exists in the dental arch and to remove any obstruction to eruption. Consideration should also be given to further promoting eruption through surgical exposure of the incisor, with or without subsequent orthodontic traction. A number of factors influence the decision-making process, including patient age, medical history, potential compliance, aetiology and position of the unerupted incisor. Treatment planning should be complemented by careful clinical assessment and the use of appropriate special investigations. To optimise the treatment outcome a multidisciplinary specialist approach is recommended.

Access options

Rent or Buy article

Get time limited or full article access on ReadCube.

from$8.99

All prices are NET prices.

Figure 1
Figure 2
Figure 3
Figure 4: (A) Bilateral supernumerary teeth impeding eruption of the permanent maxillary incisors; (B) Extraction of the primary central incisors and supernumerary teeth (and first permanent molars) with surgical exposure and bonding of the 21; (C, D) Spontaneous eruption of the 11 and 21 without orthodontic traction.
Figure 5: (A, B) Impeded eruption of an 11 due to the presence of a supernumerary tooth.
Figure 6
Figure 7

References

  1. 1

    Yaqoob O, O'Neill J, Noar J et al. Management of unerupted maxillary incisors. 2016. https://www.rcseng.ac.uk/-/media/files/rcs/fds/publications/incisor-guideline-2016.pdf?la=en (accessed 22/05/17).

  2. 2

    Shaw W C, O'Brien K D, Richmond S, Brook P . Quality control in orthodontics: risk/benefit considerations. Br Dent J 1991; 170: 33–37.

    Article  Google Scholar 

  3. 3

    Paradowska-Stolarz A, Dubowik M, Szelag J, Kawala B . Dental anomalies in the incisor-canine region in patients with cleft lip and palate – literature review. Dev Period Med 2014; 18: 66–69.

    PubMed  Google Scholar 

  4. 4

    Suri L, Gagari E, Vastardis H . Delayed tooth eruption: pathogenesis, diagnosis, and treatment. A literature review. Am J Orthod Dentofacial Orthop 2004; 126: 432–445.

    Article  Google Scholar 

  5. 5

    Bartolo A, Camilleri A, Camilleri S . Unerupted incisors – characteristic features and associated anomalies. Eur J Orthod 2010; 32: 297–301.

    Article  Google Scholar 

  6. 6

    Mead S V . Incidence of impacted teeth. Int Orthod 1930; 16: 885–890.

    Google Scholar 

  7. 7

    Grover P S, Lorton L . The incidence of unerupted permanent teeth and related clinical cases. Oral Surg Oral Med Oral Pathol 1985; 59: 420–425.

    Article  Google Scholar 

  8. 8

    Di Biase D D . Midline supernumeraries and eruption of the maxillary central incisor. Dent Pract Dent Rec 1969; 20: 35–40.

    PubMed  Google Scholar 

  9. 9

    Tay F, Pang A, Yuen S . Unerupted maxillary anterior supernumerary teeth: report of 204 cases. ASDC J Dent Child 1984; 51: 289–294.

    PubMed  Google Scholar 

  10. 10

    Nik-Hussein N N . Supernumerary teeth in the premaxillary region: its effects on the eruption and occlusion of the permanent incisors. Aust Orthod J 1990; 11: 247–250.

    PubMed  Google Scholar 

  11. 11

    Moyers R E, van der Linden P G M, Riolo M L, McNamara J A Jr . Standards of Human Occlusal Development. Monograph 5, Craniofacial Growth Series 1976. Ann Arbor, Michigan, Centre for Human Growth and Development, University of Michigan.

  12. 12

    Thom A, Isaacson K . Radiographs in the Management of the Developing Dentition. In Selection Criteria for Dental Radiography. pp. 41–50. Faculty of General Dental Practice, 2013.

    Google Scholar 

  13. 13

    Isaacson K G, Thom A R, Atack N E, Horner K, Whaites E . Orthodontic Radiographs. Fourth Edition. British Orthodontic Society, 2015.

  14. 14

    Jacobs S G . Radiographic localization of unerupted maxillary anterior teeth using the vertical tube shift technique: the history and application of the method with some case reports. Am J Orthod Dentofacial Orthop 1999; 116: 415–423.

    Article  Google Scholar 

  15. 15

    Sedentexct, 2012. Radiation Protection 172: Cone Beam CT for Dental and Maxillofacial Radiology (Evidence-based guidelines). 2012. Available at www.sedentexct.eu/files/radiation_protection_172.pdf. (accessed March 2016).

  16. 16

    Patel A, Burden D J, Sandler J . Medical disorders and orthodontics. J Orthod 2009; 36: 1–21.

    Article  Google Scholar 

  17. 17

    Munns D . Unerupted incisors. Br J Orthod 1981; 8: 39–42.

    Article  Google Scholar 

  18. 18

    Leyland L, Batra P, Wong F, Llewelyn R . A retrospective evaluation of the eruption of impacted permanent incisors after extraction of supernumerary teeth. J Clin Paediatr Dent 2006; 30: 225–231.

    Article  Google Scholar 

  19. 19

    Di Biase D D . The effect of variations in tooth morphology and position on eruption. Dent Pract Dent Rec 1971; 22: 95–108.

    PubMed  Google Scholar 

  20. 20

    Chaushu S, Becker T, Becker A . Impacted central incisors: factors affecting prognosis and treatment duration. Am J Orthod Dentofacial Orthop 2015; 147: 355–362.

    Article  Google Scholar 

  21. 21

    Smailiene D, Sidlauskas A, Bucinskiene J . Impaction of the central maxillary incisor associated with supernumerary teeth: initial position and spontaneous eruption timing. Stomatologija 2006; 8: 103–107.

    PubMed  Google Scholar 

  22. 22

    Foley J . Surgical removal of supernumerary teeth and the fate of incisor eruption. Eur J Paediatr Dent 2004; 5: 35–40.

    PubMed  Google Scholar 

  23. 23

    Mason C, Azam N, Holt R D, Rule D C . A retrospective study of unerupted maxillary incisors associated with supernumerary teeth. Br J Oral Maxillofac Surg 2000; 38: 62–65.

    Article  Google Scholar 

  24. 24

    Ashkenazi M, Greenberg B P, Chodik G, Rakocz M . Postoperative prognosis of unerupted teeth after removal of supernumerary teeth or odontomas. Am J Orthod Dentofacial Orthop 2007; 131: 614–619.

    Article  Google Scholar 

  25. 25

    Bryan R A, Cole B O, Welbury R R . Retrospective analysis of factors influencing the eruption of delayed permanent incisors after supernumerary tooth removal. Eur J Paediatr Dent 2005; 6: 84–89.

    PubMed  Google Scholar 

  26. 26

    Patchett C L, Crawford P J, Cameron A C, Stephens C D . The management of supernumerary teeth in childhood-a retrospective study of practice in Bristol Dental Hospital, England and Westmead Dental Hospital, Sydney, Australia. Int J Paediatr Dent 2001; 11: 259–265.

    Article  Google Scholar 

  27. 27

    Foster T D, Taylor G S . Characteristics of supernumerery teeth in the upper central incisor region. Dent Pract Dent Rec 1969; 20: 8–12.

    PubMed  Google Scholar 

  28. 28

    Katz R W . An analysis of compound and complex odontomas. ASDC J Dent Child 1989; 56: 445–449.

    PubMed  Google Scholar 

  29. 29

    Andreasen J O, Andreasen F M, Andersson L (editors). Traumatic Injuries to the Teeth. Fourth edition. Wiley-Blackwell, 2007.

    Google Scholar 

  30. 30

    Andreasen J O, Ravn J J . Epidemiology of traumatic dental injuries to primary and permanent teeth in a Danish population sample. Int J Oral Surg 1972; 1: 235–239.

    Article  Google Scholar 

  31. 31

    Nashashibi I A . Orthodontic movement of a palatally displaced, dilacerated, unerupted maxillary central incisor. J Paedodont 1986; 11: 83–90.

    Google Scholar 

  32. 32

    Sandler P J, Reed R T . Treatment of a dilacerated incisor. J Clin Orthod 1988; 22: 374–376.

    PubMed  Google Scholar 

  33. 33

    Farronato G, Giannini L, Galbiati G, Maspero C . A 5-year longitudinal study of survival rate and periodontal parameter changes at sites of dilacerated maxillary central incisors. Prog Orthod 2014; 15: 3.

    Article  Google Scholar 

  34. 34

    Betts A, Camilleri G E . A review of 47 cases of unerupted maxillary incisors. Int J Paediatr Dent 1999; 9: 285–292.

    Article  Google Scholar 

  35. 35

    Bodenham R S . The treatment and prognosis of unerupted maxillary incisors associated with the presence of supernumerary teeth. Br Dent J 1967; 123: 173–177.

    PubMed  Google Scholar 

  36. 36

    Gregg T A, Kinirons M J . The effect of the position and orientation of unerupted premaxillary supernumerary teeth on eruption and displacement of permanent incisors. Int J Paediatr Dent 1991; 1: 3–7.

    Article  Google Scholar 

  37. 37

    Howard R D . The unerupted incisor. A study of the postoperative eruptive history of incisors delayed in their eruption by supernumerary teeth. Dent Pract Dent Rec 1967; 17: 332–341.

    PubMed  Google Scholar 

  38. 38

    Witsenburg B, Boering G . Eruption of impacted permanent upper incisors after removal of of supernumerary teeth. Int J Oral Surg 1981; 10: 423–431.

    Article  Google Scholar 

  39. 39

    Mitchell L, Bennett T G . Supernumerary teeth causing delayed eruption – a retrospective study. Br J Orthod 1990; 19: 41–46.

    Article  Google Scholar 

  40. 40

    Pavoni C, Franchi L, Lagana G, Baccetti T, Cozza P . Management of impacted incisors following surgery to remove obstacles to eruption: a prospective clinical trial. Paediatr Dent 2013; 35: 364–368.

    Google Scholar 

  41. 41

    Lygidakis N N, Chatzidimitriou K, Theologie-Lygidakis N, Lygidakis N A . Evaluation of a treatment protocol for unerupted maxillary central incisors: retrospective clinical study of 46 children. Eur Arch Paediatr Dent 2015; 16: 153–164.

    Article  Google Scholar 

  42. 42

    Royal College of Surgeons UK National Guidelines in Paediatric Dentistry. Guideline for the Use of General Anaesthesia (GA) in Paediatric Dentistry. Faculty of Dental Sugery Clinical Effectiveness Committee, 2008.

  43. 43

    McKeown H F, Sandler P J . The two by four appliance: a versatile appliance. Dent Update 2001; 28: 496–500.

    Article  Google Scholar 

  44. 44

    Becker A, Brin I, Ben-Bassat Y, Zilberman Y, Chaushu S . Closed-eruption surgical technique for impacted maxillary incisors: a postorthodontic periodontal evaluation. Am J Orthod Dentofacial Orthop 2002; 122: 9–14.

    Article  Google Scholar 

  45. 45

    Vanarsdall R L, Corn H . Soft-tissue management of labially positioned unerupted teeth. July 1977. Am J Orthod Dentofacial Orthop 2004; 125: 284–293.

    Article  Google Scholar 

  46. 46

    Chaushu S, Dykstein N, Ben-Bassat Y, Becker A . Periodontal status of impacted maxillary incisors uncovered by 2 different surgical techniques. J Oral Maxillofac Surg 2009; 67: 120–124.

    Article  Google Scholar 

  47. 47

    Vermette M E, Kokich V G, Kennedy D B . Uncovering labially impacted teeth: apically positioned flap and closed-eruption techniques. Angle Orthod 1995; 65: 23–32; discussion 33.

    PubMed  Google Scholar 

  48. 48

    Becker A, Shpack N, Shteyer A . Attachment bonding to impacted teeth at the time of surgical exposure. Eur J Orthod 1996; 18: 457–463.

    Article  Google Scholar 

  49. 49

    Noar J H, Gaukroger M J . Customized metal coping for elastic traction of an ectopic maxillary central incisor. J Clin Orthod 2000; 34: 585–589.

    PubMed  Google Scholar 

  50. 50

    Oliver R G, Hardy P . Practical and theoretical aspects of a method of orthodontic traction to unerupted teeth illustrated by three cases. Br J Orthod 1986; 13: 229–236.

    Article  Google Scholar 

  51. 51

    Henry P J, Laney W R, Jemt T et al. Osseointegrated implants for single-tooth replacement: a prospective 5-year multicentre study. Int J Oral Maxillofac Implants 1996; 11: 450–455.

    PubMed  Google Scholar 

  52. 52

    Kokich V G, Crabill K E . Managing the patient with missing or malformed maxillary central incisors. Am J Orthod Dentofacial Orthop 2006; 129: S55–63.

    Article  Google Scholar 

  53. 53

    Malmgren B . Decoronation: how, why and when? J Calif Dent Assoc 2000; 28: 846–854.

    PubMed  Google Scholar 

  54. 54

    de Souza R F, Travess H, Newton T, Marchesan M A . Interventions for treating traumatised ankylosed permanent front teeth. Cochrane Database Syst Rev 2015; CD007820.

  55. 55

    Czochrowska E M, Stenvik A, Album B, Zachrisson B U . Autotransplantation of premolars to replace maxillary incisors: a comparison with natural incisors. Am J Orthod Dentofacial Orthop 2000; 118: 592–600.

    Article  Google Scholar 

  56. 56

    Chaushu S, Zilberman Y, Becker A . Maxillary incisor impaction and its relationship to canine displacement. Am J Orthod Dentofacial Orthop 2003; 124: 144–150; discussion 150.

    Article  Google Scholar 

Download references

Acknowledgements

We acknowledge the contribution of Terry Gregg in the writing of the original guidelines. We also thank Tara Renton for helpful comments on the manuscript.

Author information

Affiliations

Authors

Corresponding author

Correspondence to M. T. Cobourne.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Seehra, J., Yaqoob, O., Patel, S. et al. National clinical guidelines for the management of unerupted maxillary incisors in children. Br Dent J 224, 779–785 (2018). https://doi.org/10.1038/sj.bdj.2018.361

Download citation

Further reading

Search