Substitution of the microdontic lateral incisor with the palatally impacted canine: A case report

BackgroundThe extraction of the maxillary lateral incisor(s) for orthodontic purpose is uncommon. When a malformed lateral incisor is present along with an impacted canine and arch length discrepancy exists, the decision regarding extraction becomes critical.MethodsA case of unilateral microdontic maxillary lateral incisor associated with the palatally impacted canine and arch length discrepancy is described. The discrepancy existed due to Class II molar relation on the same side. After achieving the alignment of the upper arch with fixed appliance, the impacted canine was surgically exposed. Attachment was bonded to its lingual surface and the flap was resutured. Extrusive force was applied to the canine with a Kilroy spring. As the canine erupted in the oral cavity, the lateral incisor was extracted and the canine was aligned in the arch. Cosmetic reshaping of the canine and first premolar was done to resemble lateral incisor and canine, respectively, to improve aesthetics. Later, the lower arch was bonded, and the final finishing with interarch detailing was carried out.ResultsThe impacted canine substituted for the lateral incisor in form and function, resulting in an improvement in the smile. The case was finished in Class II molar relation on one side and Class I molar relation on the other with normal overjet and overbite. The occlusion was stable at 2 years after debonding.ConclusionThis report presents an effective alternative method for the management of an impacted tooth associated with the adjacent anomalous tooth, thereby reducing the complexity and duration of the treatment.