Six upper incisors: what's next?

BACKGROUND

This case report describes our therapeutic approach taken in a girl with eruption disturbance of the upper anterior teeth. Two supernumerary teeth were involved, which required a combination of orthodontic and surgical treatment.

DIAGNOSIS

The initial situation in the upper anterior segment was characterized by two supernumerary mesial incisors, ectopic eruption of the distally located lateral incisors, and crowded tooth buds in the canine areas. Key decisions had to be made as to whether any teeth needed to be extracted and, if so, regarding the timing and sites of extraction. Removing teeth too early would have preempted a complete assessment of tooth quality, whereas late extraction would have carried a risk of eruption disturbance.

TREATMENT

Once the distal lateral incisors had erupted, the supernumerary mesial incisors were extracted and the central incisors (initially located in between) mesialized with a bracket appliance. Following space closure and mesialization of the lateral incisors, a functional appliance was used. Tooth 13 was erupting, while tooth 23 was displaced and subsequently aligned as part of the final bracket treatment.

CONCLUSION

To successfully treat eruption disturbances, a careful diagnostic workup is essential, including informative radiographs, personalized treatment planning, and correct decision-making as to whether teeth need to be extracted and regarding the timing and sites of extraction. Finally, the eruption of the canines should be monitored.