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.
Subscribe to Journal
Get full journal access for 1 year
only $20.79 per issue
All prices are NET prices.
VAT will be added later in the checkout.
Rent or Buy article
Get time limited or full article access on ReadCube.
All prices are NET prices.
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).
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.
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.
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.
Bartolo A, Camilleri A, Camilleri S . Unerupted incisors – characteristic features and associated anomalies. Eur J Orthod 2010; 32: 297–301.
Mead S V . Incidence of impacted teeth. Int Orthod 1930; 16: 885–890.
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.
Di Biase D D . Midline supernumeraries and eruption of the maxillary central incisor. Dent Pract Dent Rec 1969; 20: 35–40.
Tay F, Pang A, Yuen S . Unerupted maxillary anterior supernumerary teeth: report of 204 cases. ASDC J Dent Child 1984; 51: 289–294.
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.
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.
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.
Isaacson K G, Thom A R, Atack N E, Horner K, Whaites E . Orthodontic Radiographs. Fourth Edition. British Orthodontic Society, 2015.
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.
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).
Patel A, Burden D J, Sandler J . Medical disorders and orthodontics. J Orthod 2009; 36: 1–21.
Munns D . Unerupted incisors. Br J Orthod 1981; 8: 39–42.
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.
Di Biase D D . The effect of variations in tooth morphology and position on eruption. Dent Pract Dent Rec 1971; 22: 95–108.
Chaushu S, Becker T, Becker A . Impacted central incisors: factors affecting prognosis and treatment duration. Am J Orthod Dentofacial Orthop 2015; 147: 355–362.
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.
Foley J . Surgical removal of supernumerary teeth and the fate of incisor eruption. Eur J Paediatr Dent 2004; 5: 35–40.
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.
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.
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.
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.
Foster T D, Taylor G S . Characteristics of supernumerery teeth in the upper central incisor region. Dent Pract Dent Rec 1969; 20: 8–12.
Katz R W . An analysis of compound and complex odontomas. ASDC J Dent Child 1989; 56: 445–449.
Andreasen J O, Andreasen F M, Andersson L (editors). Traumatic Injuries to the Teeth. Fourth edition. Wiley-Blackwell, 2007.
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.
Nashashibi I A . Orthodontic movement of a palatally displaced, dilacerated, unerupted maxillary central incisor. J Paedodont 1986; 11: 83–90.
Sandler P J, Reed R T . Treatment of a dilacerated incisor. J Clin Orthod 1988; 22: 374–376.
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.
Betts A, Camilleri G E . A review of 47 cases of unerupted maxillary incisors. Int J Paediatr Dent 1999; 9: 285–292.
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.
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.
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.
Witsenburg B, Boering G . Eruption of impacted permanent upper incisors after removal of of supernumerary teeth. Int J Oral Surg 1981; 10: 423–431.
Mitchell L, Bennett T G . Supernumerary teeth causing delayed eruption – a retrospective study. Br J Orthod 1990; 19: 41–46.
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.
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.
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.
McKeown H F, Sandler P J . The two by four appliance: a versatile appliance. Dent Update 2001; 28: 496–500.
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.
Vanarsdall R L, Corn H . Soft-tissue management of labially positioned unerupted teeth. July 1977. Am J Orthod Dentofacial Orthop 2004; 125: 284–293.
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.
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.
Becker A, Shpack N, Shteyer A . Attachment bonding to impacted teeth at the time of surgical exposure. Eur J Orthod 1996; 18: 457–463.
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.
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.
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.
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.
Malmgren B . Decoronation: how, why and when? J Calif Dent Assoc 2000; 28: 846–854.
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.
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.
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.
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.
About this article
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
Dental Update (2020)
Electronic Journal of General Medicine (2019)