Interdisciplinary Management of a Skeletal Class III Malocclusion With Impacted Central Incisor and Lateral Incisor Revascularization: A Case Report

Abstract

Impacted maxillary incisors are rare and pose significant esthetic and functional challenges, particularly when associated with other dental anomalies and skeletal discrepancies. This case highlights the interdisciplinary management of such a complex case. An 18-year-old male presented with a missing maxillary left central incisor, a fractured maxillary right lateral incisor of uncertain prognosis, and a skeletal Class III malocclusion with anterior and lateral crossbite. Clinical examination, panoramic radiography, and cone beam computed tomography (CBCT) confirmed impaction of the maxillary left central incisor, presence of periapical pathology related to the lateral incisor, and a skeletal Class III pattern. Treatment included regenerative endodontic therapy for the lateral incisor, surgical exposure of the impacted central incisor using the closed-eruption technique, and biomechanically controlled orthodontic traction. Anchorage was reinforced with a transpalatal bar, and gradual third-order bends were applied for root torque control. The impacted central incisor was successfully aligned into the arch, the lateral incisor was preserved, and functional occlusion with corrected overjet and overbite was achieved. The treatment duration was 30 months, and bonded retainers were placed. The patient reported high satisfaction with both functional and esthetic outcomes. This case demonstrates how a patient-centered, multidisciplinary approach can yield predictable, stable, and esthetically pleasing results in the management of impacted maxillary incisors with concomitant anomalies.