Timing of extraction of supplemental maxillary lateral incisors and eruption of the maxillary canine: a case series of four patients with CBCT evaluation

Background: Supplemental maxillary lateral incisors are relatively uncommon dental anomalies that may interfere with the normal eruption of the permanent maxillary canine. Although early extraction is frequently recommended, the optimal timing of intervention relative to canine root development remains unclear, particularly in situations where eruptive guidance is compromised. Cases: This descriptive case series presents four pediatric patients with impacted supplemental maxillary lateral incisors who underwent thorough clinical and radiographic evaluation using panoramic radiography and cone-beam computed tomography (CBCT) at various stages of maxillary canine root development. The main factors considered were the extraction timing of supplemental incisor extraction in relation to canine root formation, morphology of the lateral incisors, buccopalatal position of the supplemental tooth, and local space conditions. After extraction of the supplemental lateral incisors, spontaneous eruption of the maxillary canines occurred in three of the four cases. In one case, early extraction, combined with unfavorable local factors, was followed by ectopic eruption that necessitated surgical exposure and orthodontic traction. Conclusions: Within the limitations of this descriptive case series, extraction of supplemental maxillary lateral incisors after sufficient canine root development, corresponding to Nolla stages 6 to 8, may promote favorable eruption of the maxillary canine. The eruption outcome appears to depend not only on the timing of extraction but also on local anatomical and space-related factors. Comprehensive evaluation of these factors, including CBCT-based assessment when indicated, may help minimize the need for additional surgical or orthodontic intervention.

Supplemental lateral incisor; Maxillary canine; Eruption guidance; Extraction timing; Cone-beam computed tomography

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