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.


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.

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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.
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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.

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Correspondence to M. T. Cobourne.

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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).

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