Lila Muntadir (1), Ganendra Anugraha (2), Ervina Restiwulan Winoto (3), Eddy Heriyanto (4), Nur Masita Silviana (5)
Background: Double impaction of two teeth in the same region specifically tooth 22 and tooth 23 is a rare condition that requires a combined treatment approach involving fixed orthodontics and surgical exposure. Fixed orthodontic treatment is essential to prepare space, guide tooth movement after surgical exposure, prevent root resorption, and correct overall malocclusion. Surgical exposure is performed to expose the tooth crown, preserve the alveolar bone, avoid root exposure, and facilitate the attachment of buttons and ligatures. Impacted teeth can affect the stomatognathic system, facial growth, and aesthetics. The maxillary incisors and canines play a critical role in occlusion, masticatory function, and facial aesthetics, thus requiring appropriate management. Objective: To describe the management of a double impaction case in the anterior left maxillary region of a 19-year-old female patient using a combined approach of fixed orthodontic and surgical treatment. Methods: The patient underwent fixed orthodontic treatment and sequential extraction of premolars 14 and 24 to create space for the eruption of the impacted teeth and to correct the midline before surgical exposure. Post-surgical exposure, orthodontic treatment was continued to guide both teeth into proper alignment within the dental arch. Results: Teeth 22 and 23 successfully erupted with good occlusion. The patient's masticatory function and facial aesthetics improved over a 2-year period following surgical exposure. Conclusion: Fixed orthodontic treatment combined with surgical exposure is an effective strategy for managing double impaction of anterior teeth in the left maxillary region, considering the position of the crowns, tooth inclination, and root apex morphology of the impacted teeth.
Highlights:
Double impaction of teeth 22 and 23 is rare and affects function and aesthetics.
Combined surgical and orthodontic treatment effectively guided tooth eruption.
Treatment restored occlusion, midline, and facial aesthetics over 2 years.
Keywords: Anterior tooth double impaction, surgical exposure, fixed orthodontic treatment
De la Cruz Sedano GS, Ventura Flores AK, Jara Porroa JJ, Perona-Miguel de Priego GA. Erupción dentaria: bases moleculares. Un artículo de revisión. Rev Científica Odontológica. 2020;8(1):1–6.
Putri IT, Pramasari CN, Samad S. Klasifikasi gigi impaksi molar ketiga mandibula pada masa pandemi COVID-19 pasien di RSUD Abdoel Wahab Sjahranie : Studi Cross-sectional. Padjadjaran J Dent Res Students. 2024;8(2):277–83.
Saleh E. Odontektomi Impaksi Kaninus Maksila Bilateral Palatal dengan Anastesi Lokal. Insisiva Dent J Maj Kedokt Gigi Insisiva. 2020;9(2):66–71.
Silva DR, Shahinian AL. Odontoma malformation and disturbances of eruption subsequent to traumatic dental injuries: A literature review and a case report. Dent Traumatol. 2022 Apr;38(2):98–104.
Lwin CT, Cooney M, Goh M, Tham D, Nowak S. Factors Associated With Successful Surgical Exposure of Impacted Maxillary Canines. J Oral Maxillofac Surg. 2024 Jan;82(1):93–101.
Al-Kyssi HA, Al-Mogahed NM, Altawili ZM, Dahan FN, Almashraqi AA, Aldhorae K, et al. Predictive factors associated with adjacent teeth root resorption of palatally impacted canines in Arabian population: a cone-beam computed tomography analysis. BMC Oral Health. 2022;22(1):1–10.
Syahdinda MR, Nugraha AP, Triwardhani A, Tengku Ahmad Noor TNE binti. Management of impacted maxillary canine with surgical exposure and alignment by orthodontic treatment. Dent J. 2022;55(4):235–9.
Mockutė G, Klimaitė G, Smailienė D. The Morphology of Impacted Maxillary Central Incisors: A Systematic Review. Med. 2022;58(4).
Žarovienė A, Grinkevičienė D, Trakinienė G, Smailienė D. Post-treatment status of impacted maxillary central incisors following surgical-orthodontic treatment: A systematic review. Med. 2021;57(8).
Narmada IB, Putri AR. The Effect of Maxilla Impacted Canine Positions on Root Resorption of Adjacent Teeth Using Cone-Beam Computed Tomography Imaging. Acta Med Philipp. 2024;58(1):90–7.
Handayani HD, Pinurbo RH, Mahyuza A. Ekstraksi Impaksi Gigi 38 Buccoangular. Pros Dent Semin Univ Muhammadiyah Surakarta [Internet]. 2023;76–83. Available from: https://proceedings.ums.ac.id/index.php/densium/article/view/3100
Dharma M, Abdi MJ, Makmur ZZ. HUBUNGAN KLASIFIKASI IMPAKSI MOLAR KETIGA MANDIBULA DENGAN JARAK KANAL MANDIBULAR PADA RADIOGRAFI PANORAMIK DI KLINIK MEDICAL CENTER. IJOH Indones J Public Heal. 2024;2(2):286–94.
Mitsea A, Palikaraki G, Karamesinis K, Vastardis H, Gizani S, Sifakakis I. Evaluation of Lateral Incisor Resorption Caused by Impacted Maxillary Canines Based on CBCT: A Systematic Review and Meta-Analysis. Children. 2022;9(7).
Rachmawati I, Firman RN. Klasifikasi impaksi caninus rahang atas pada pemeriksaan radiograf panoramik dan CBCT sebagai penunjang odontomy. J Radiol Dentomaksilofasial Indones. 2020;4(2):35.
Alhasyimi AA, Indra P, Setijanto RD, Tajudin AM, Noviasari P, Rosanto YB. Open surgical exposure of two horizontally impacted maxillary incisors combined with orthodontic treatment: A case report. Int J Surg Case Rep [Internet]. 2024;118(April):109620. Available from: https://doi.org/10.1016/j.ijscr.2024.109620
Parlina C, Krisnawati K. Penatalaksanaan impaksi gigi premolar kedua bawah kiri tanpa exposure bedah pada perawatan ortodonti cekat
. J Kedokt Gigi Univ Padjadjaran. 2022;33(3):78.
Shin JH, Oh S, Kim H, Lee E, Lee SM, Ko CC, et al. Prediction of maxillary canine impaction using eruption pathway and angular measurement on panoramic radiographs. Angle Orthod. 2022;92(1):18–26.
Santosh K. Goje, Bhavna Dave. Normal pre‑eruptive inclinations of maxillary canine, lateral incisor, and first premolar in children aged 6–14 years Santosh. J Orthod Sci. 2023;1(2):1–7.