Smile aesthetics in patient with retained upper central incisor. Case presentation

Abstract

Background: In today's society, facial aesthetics play a fundamental role in social interactions. The smile is one of the most evaluated features when interacting with others. Recently, there has been increased interest in having an attractive smile, which is the main reason people seek orthodontic treatment. Anomalies in dentition can affect the aesthetics of a smile. The retention of upper central incisors has significant aesthetic and functional consequences because they affect the shape of the lips and phonation.

Objective: To describe the orthodontic-surgical treatment of a clinical case with an impacted upper central incisor to restore the aesthetics, function and psychological well-being of the patient.

Clinical case: A 10-year-old female patient with psychological impairment due to bullying at school.  She has a convex profile. There is a clinical absence of tooth 11, which has compromised the space for correct arch location. There is also an increased volume of hard tissue at the bottom of the vestibular sulcus, lateral to the upper median frenulum, and superior to the mucogingival line in the vestibular area. The panoramic X-ray shows that tooth 11 is retained in a mesioangular position in the alveolar process without reaching the occlusal plane (Nolla stage 9). There is a 7 mm overhang and a 2 mm overshoot. The molar ratio is neutrocclusion, and the Angle classification is Class I. The diagnostic process and meticulous treatment planning were carried out. The open surgical technique was selected by means of a vestibular flap of complete replacement with orthodontic traction.

Conclusions: Retained central incisors require good multidisciplinary management. Orthodontic-surgical treatment is an effective option for achieving adequate aesthetic and functional results.