Management of Unerupted, Inverted and Dilacerated Upper Central Incisor and Restoration with Natural Tooth Pontic and Fiber-Reinforced Resin Bridge

Abstract

Introduction: This is a case report of the combined orthodontic/surgical and restorative management of a patient with an unerupted central incisor which was inverted, dilacerated with extremely short root.Method: A 12-year-old male patient presented with esthetic concerns due to an unerupted upper left central incisor.Examination revealed an Angle's Class I malocclusion, which is complicated by an increased and traumatic overbite, as well as an increased overjet of 6mm, on skeletal base 1.The treatment objectives were set to correct the presenting malocclusion with the possibility of surgical extraction and auto-transplantation of the inverted tooth if adequate root length was observed.The orthodontic treatment was carried out using fixed appliance therapy with Roth 0.022 prescription appliances.Result: The orthodontic treatment lasted for 12 months.Upon surgical exposure, the tooth was found dilacerated with an extremely short fused root, thus there was a poor prognosis for auto-transplantation. Consequently, the tooth was extracted and its crown was utilized as a pontic for a long-term provisional bridge, using the fiber-reinforced composite material (Ribbond).This would provide function and esthetics while the patient was being prepared for implant therapy.Conclusion: The appearance of the finished result was esthetic and pleasing.The orthodontic treatment objectives were achieved, as the patient and parent were satisfied.Retention was achieved with the resin bridge in combination with upper Hawley's retainer.This is an acceptable method for the treatment of an inverted and dilacerated tooth that has a short root, which was already fused prior to presentation.