Page 117 - 7. FINAL draft Compendium 2019 2020_22072022

MANAGEMENT OF A SEVERELY DILACERATED MAXILLARY CENTRAL INCISOR
COMPLICATED BY HYPODONTIA
NMRR-19-2115-49778

Azman N, Muniandy SD, Peariasamy K
Introduction: Unerupted upper anterior teeth can cause aesthetic and functional problems
in a growing child. Dilacerated tooth is managed by either surgical exposure and traction,
or surgical removal of the tooth based on the prognosis for proper alignment and long-
term survival of the tooth. Case Report: GXY, a 10-year-old Chinese girl with partially
erupted and dilacerated upper right central incisor (UR1) was referred for orthodontic
management. She had history of trauma on upper deciduous incisors at age 1 and a half
years old. GXY presented in mixed dentition stage development with a Class III
malocclusion on a Class I skeletal pattern complicated by a partially erupted and
dilacerated UR1 with the crown rotated 180°. In addition, the upper permanent canines
were congenitally missing. Radiographs showed UR1 was severely dilacerated and
malformed, with defective root formation. Although the prognosis of UR1 was poor, but
due to her young age and hypodontia, the UR1 was surgically exposed and gold chain
traction was carried out to allow the alveolar bone development. Discussion: This case
report illustrates the benefit of early surgical and orthodontic intervention of a severely
dilacerated incisor and interceptive measures taken to maintain the upper deciduous
canines whilst further facial growth and dental development occurs. Conclusion: Timely
interceptive multidisciplinary approach is crucial in the management of complex
malocclusions involving dental anomalies. Early exposure and gold chain traction of a tooth
of poor prognosis into the arch will encourage proper dento-alveolar development and
function which will facilitate implant supported prosthesis later on. Lesson Learnt:
Multidisciplinary management of a complex malocclusion if carried out at the optimal
timing can benefit the patient and improve her self-esteem during her growing years whilst
optimising the dento-alveolar development and function at the same time.

th
Presented at the Paediatric Dentistry Conference (CRiPD) 2019 on 7-9 August 2019
Dr Norain binti Azman
Dr Surguna Devi a/p Muniandy
Orthodontic Unit
Seri Kembangan Dental Clinic
Seri Kembangan Selangor

Dr Kalaiarasu Peariasamy
Department of Paediatric Dentistry
Sungai Buloh Hospital
Selangor

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