Clinical options for incisors replacement in children with dental trauma: a case report

Background: Trauma to the maxillary central incisors often results in a poor prognosis, particularly due to root resorption. In severe cases, extraction of the affected incisors may be necessary as part of orthodontic treatment. Case: This case report details the successful replacement of two maxillary central incisors in a 12-year-old Chinese girl who presented with an unaesthetic dental appearance caused by trauma. Severe root resorption was observed in both maxillary central incisors, prompting the decision to extract them, along with the mandibular first premolars. After 31 months of active orthodontic treatment, the maxillary lateral incisors on both sides were successfully repositioned to replace the central incisors, resulting in a Class I molar relationship with an ideal overbite and overjet. In addition, periodontal remodeling of the maxillary anterior teeth was performed through gingivoplasty. Conclusion: The treatment resulted in both aesthetic improvement and functional restoration, addressing the patient’s concerns. Therefore, for the management of traumatic injuries in children’s maxillary incisors, a combined approach of orthodontic treatment and periodontal therapy can be adopted. This integrated method not only facilitates the physiological replacement of traumatized incisors without the need for prosthetic intervention but also ensures both aesthetic enhancement and functional rehabilitation.

Dental trauma; Incisors replacement; Orthodontic space closure; Periodontal surgery

[1] Laforgia A, Inchingolo AM, Inchingolo F, Sardano R, Trilli I, Di Noia A, et al. Paediatric dental trauma: insights from epidemiological studies and management recommendations. BMC Oral Health. 2025; 25: 6.

[2] Doğramaci EJ, Rossi-Fedele G, Jonest AG. Multi-disciplinary management of a patient with a post-traumatised incisor presenting concurrent replacement and inflammatory resorption: a case report. Australasian Orthodontic Journal. 2015; 31: 216–225.

[3] Vieira WA, Pecorari VGA, Gabriel PH, Vargas-Neto J, Santos ECA, Gomes BPFA, et al. The association of inadequate lip coverage and malocclusion with dental trauma in Brazilian children and adolescents—a systematic review and meta-analysis. Dental Traumatology. 2022; 38: 4–19.

[4] Londono J, Ghasemi S, Moghaddasi N, Baninajarian H, Fahimipour A, Hashemi S, et al. Prevalence of malocclusion in Turkish children and adolescents: a systematic review and meta-analysis. Clinical and Experimental Dental Research. 2023; 9: 689–700.

[5] Cobourne MT, DiBiase AT, Seehra J, Papageorgiou SN. Should we recommend early overjet reduction to prevent dental trauma? British Dental Journal. 2022; 233: 387–390.

[6] Bellamkonda P, Varghese E, Alasabi AN, Alshehri NM, Bhandary S, Krishnan R, et al. Traumatic dental injuries and their association with demographics and other predisposing risk factors in school children aged between 8–13 years: a descriptive, cross-sectional study. Indian Journal of Community Medicine. 2024; 49: 512–518.

[7] Dave HR, Samrit VD, Kharbanda OP. The extraction of maxillary lateral incisors for the treatment of a Class II crowded malocclusion: a case report. Australasian Orthodontic Journal. 2015; 31: 107–115.

[8] Dahlén A, Persson C, Lofthag Hansen S, Naoumova J. Longitudinal study of root resorption on incisors caused by impacted maxillary canines-a clinical and cone beam CT assessment. European Journal of Orthodontics. 2024; 46: cjae052.

[9] Maspero C, Fama A, Galbiati G, Giannini L, Kairyte L, Bartorelli L, et al. Maxillary central incisor root resorption due to canine impaction after trauma. Is the canine substitution for maxillary incisors a suitable treatment option? Two case reports. Stomatologija. 2018; 20: 102–108.

[10] Patel S, Saberi N, Pimental T, Teng PH. Present status and future directions: root resorption. International Endodontic Journal. 2022; 55: 892–921.

[11] Dokova AF, Lee JY, Mason M, Moretti A, Reside G, Christensen J. Advancements in tooth autotransplantation. Journal of the American Dental Association. 2024; 155: 475–483.

[12] Czochrowska EM, Skaare AB, Stenvik A, Zachrisson BU. Outcome of orthodontic space closure with a missing maxillary central incisor. American Journal of Orthodontics and Dentofacial Orthopedics. 2003; 123: 597–603.

[13] Konstantonis D, Brenner R, Karamolegkou M, Vasileiou D. Torturous path of an elastic gap band: interdisciplinary approach to orthodontic treatment for a young patient who lost both maxillary central incisors after do-it-yourself treatment. American Journal of Orthodontics and Dentofacial Orthopedics. 2018; 154: 835–847.

[14] Sabbah A. Smile analysis: diagnosis and treatment planning. Dental Clinics of North America. 2022; 66: 307–341.

[15] Orozco-Varo A, Arroyo-Cruz G, Martínez-de-Fuentes R, Jiménez-Castellanos E. Biometric analysis of the clinical crown and the width/length ratio in the maxillary anterior region. The Journal of Prosthetic Dentistry. 2015; 113: 565–570.e562.

[16] Rodrigues DM, Barreto L, Petersen RL, Ferreira V, Cavalcante DM, Barboza EDSP. Relationship between smile type and periodontal phenotype: a clinical and tomographic cross-sectional study. Journal of Dentistry. 2022; 122: 104160.

[17] Hansson S, Halldin A. Alveolar ridge resorption after tooth extraction: a consequence of a fundamental principle of bone physiology. Journal of Dental Biomechanics. 2012; 3: 1758736012456543.

[18] Mardas N, Macbeth N, Donos N, Jung RE, Zuercher AN. Is alveolar ridge preservation an overtreatment? Periodontology 2000. 2023; 93: 289–308.

[19] Abdelhafez RS, Talib AA, Al-Taani DS. The effect of orthodontic treatment on the periodontium and soft tissue esthetics in adult patients. Clinical and Experimental Dental Research. 2022; 8: 410–420.

[20] Arsić I, Marinković N, Pajević T, Marković J, Dragović M, Stamenković Z, et al. The impact of orthodontic extrusion on keratinized gingiva. Medicina. 2024; 60: 1157.

[21] Kugel B, Zeh D, Müssig E. Incisor trauma and the planning of orthodontic treatment. Journal of Orofacial Orthopedics. 2006; 67: 48–57.

[22] Veire A, Nichols W, Urquiola R, Oueis H. Dental trauma: review of common dental injuries and their management in primary and permanent dentitions. Journal of the Michigan Dental Association. 2012; 94: 41–45.

[23] Šimunović L, Špiljak B, Vranić L, Negovetić Vranić D. Treatment priorities and arrival time of traumatic dental injuries—an 8-year retrospective study. Dental Traumatology. 2024; 40: 11–21.

[24] Das P, Mishra L, Jena D, Govind S, Panda S, Lapinska B. Oral health-related quality of life in children and adolescents with a traumatic injury of permanent teeth and the impact on their families: a systematic review. International Journal of Environmental Research and Public Health. 2022; 19: 3087.

[25] Antunes LAA, Lemos HM, Milani AJ, Guimarães LS, Küchler EC, Antunes LS. Does traumatic dental injury impact oral health-related to quality of life of children and adolescents? Systematic review and meta-analysis. International Journal of Dental Hygiene. 2020; 18: 142–162.

[26] Soares AJ, Souza GA, Pereira AC, Vargas-Neto J, Zaia AA, Silva EJ. Frequency of root resorption following trauma to permanent teeth. Journal of Oral Science. 2015; 57: 73–78.

[27] Gladwin L, Darcey J. The consequences of dental trauma. Primary Dental Journal. 2023; 12: 72–82.

[28] Blum JS. The various forms of tooth resorption. Australian Endodontic Journal. 2024; 50: 191–201.

[29] Abbott PV. Prevention and management of external inflammatory resorption following trauma to teeth. Australian Dental Journal. 2016; 61: 82–94.

[30] Heboyan A, Avetisyan A, Karobari MI, Marya A, Khurshid Z, Rokaya D, et al. Tooth root resorption: a review. Science Progress. 2022; 105: 368504221109217.

[31] Hecova H, Tzigkounakis V, Merglova V, Netolicky J. A retrospective study of 889 injured permanent teeth. Dental Traumatology. 2010; 26: 466–475.

[32] Barnett F. The role of endodontics in the treatment of luxated permanent teeth. Dental Traumatology. 2002; 18: 47–56.

[33] Aroni MAT, Pigossi SC, Pichotano EC, de Oliveira GJPL, Marcantonio RAC. Esthetic crown lengthening in the treatment of gummy smile. International Journal of Esthetic Dentistry. 2019; 14: 370–382.

[34] Kovich V. Esthetics and anterior tooth position: an orthodontic perspective. Part I: crown length. Journal of Esthetic Dentistry. 1993; 5: 19–23.

[35] Gautam R, Nene P, Mehta K, Nene S, Hegde A, Jaju R. Treatment strategies for missing maxillary central incisor—an orthodontist’s perspective. Journal of Prosthodontics. 2014; 23: 509–513.

[36] de España C, Olivieri JG, Ortega-Martinez J, Morelló S, Roig-Cayón M, Durán-Sindreu F. Dental anxiety, cardiovascular changes and patient preconceptions toward implants and root canal treatments: an observational study. Journal of Clinical and Experimental Dentistry. 2022; 14: e809–e814.

[37] Li H, Wu X, Huang L, Xu X, Kang N, Han X, et al. External apical root resorption in orthodontic tooth movement: the risk factors and clinical suggestions from experts’ consensus. West China Journal of Stomatology. 2022; 40: 629–637.

[38] Lopatiene K, Dumbravaite A. Risk factors of root resorption after orthodontic treatment. Stomatologija. 2008; 10: 89–95.

[39] Yassir YA, McIntyre GT, Bearn DR. Orthodontic treatment and root resorption: an overview of systematic reviews. European Journal of Orthodontics. 2021; 43: 442–456.

[40] Roscoe MG, Meira JB, Cattaneo PM. Association of orthodontic force system and root resorption: a systematic review. American Journal of Orthodontics and Dentofacial Orthopedics. 2015; 147: 610–626.

[41] Dawood HM, Kroeger A, Chavda V, Chapple ILC, Kebschull M. Under pressure-mechanisms and risk factors for orthodontically induced inflammatory root resorption: a systematic review. European Journal of Orthodontics. 2023; 45: 612–626.

[42] Jamilian A, Perillo L, Rosa M. Missing upper incisors: a retrospective study of orthodontic space closure versus implant. Progress in Orthodontics. 2015; 16: 2.

[43] Barootchi S, Tavelli L, Majzoub J, Stefanini M, Wang HL, Avila-Ortiz G. Alveolar ridge preservation: complications and cost-effectiveness. Periodontol 2000. 2023; 92: 235–262.

[44] Yuan X, Cao H, Luo S. Influence of bone remodeling in extraction sites on tooth movement. West China Journal of Stomatology. 2003; 21: 307–310. (In Chinese)

[45] Abu Alhaija ES, Al Shayeb RA, Al-Khateeb S, Daher HO, Daher SO. A comparative assessment of the amount and rate of orthodontic space closure toward a healed vs. recent lower premolar extraction site. The Angle Orthodontist. 2022; 92: 463–470.

[46] Garber DA, Salama MA. The aesthetic smile: diagnosis and treatment. Periodontology 2000. 1996; 11: 18–28.

[47] Creagh J, Bohner L, Sesma N, Coachman C. Digital approaches to facially guided orthodontic and periodontal rehabilitation in the anterior esthetic zone: a case report. Journal of Esthetic and Restorative Dentistry. 2022; 34: 226–234.

[48] Alikhasi M, Yousefi P, Afrashtehfar KI. Smile design: mechanical considerations. Dental Clinics of North America. 2022; 66: 477–487.

[49] Hasija N, Bala M, Goyal V. Estimation of tooth size discrepancies among different malocclusion groups. International Journal of Clinical Pediatric Dentistry. 2014; 7: 82–85.

[50] Dagdiya MS, Kumari L, Motarwar AN, Richashree, Anand K, Prakash S. An assessment of the correlation between tooth size and agenesis of maxillary lateral incisor in subjects undergoing orthodontic treatment. Cureus. 2022; 14: e25642.

[51] Teichert-Filho R, Gomes MS, Grossi ML. Size, shape, alignment, and arrangement-4 steps to optimize dentofacial composition in smile design by using the patient-centered concept: a dental technique. The Journal of Prosthetic Dentistry. 2024; 131: 1008–1014.