2 Unerupted upper central incisor
Summary
Neil, a 9-year-old boy, presents with unerupted (Fig. 2.1). What are the possible causes and how would you manage the problem?
Examination
Intraoral examination
Why are the centrelines displaced?
The lower centreline shift is due to early unbalanced loss of in a potentially crowded arch.
What are the possible causes of the unerupted ?
How would you rate the likelihood in this case of each of the potential causes of unerupted listed in Box 2.1?
Congenital absence of is highly unlikely. It would be very rare for to be absent without other congenitally missing teeth.
Ectopic position of the tooth germ is a possibility but is more likely to be secondary to some pathological cause or the presence of a supernumerary tooth.
Dilaceration and/or displacement due to trauma can be excluded due to the absence of a relevant history.
A supernumerary tooth (Box 2.2) is the most likely cause of unerupted . With an incidence of 1–3% in the premaxilla, supernumerary teeth (particularly the late-forming tuberculate type) are associated with delay or non-eruption of an upper permanent central incisor.
Crowding is an unlikely cause. Although the upper labial segment is crowded, only very severe crowding would prevent erupting 2 years following its expected eruption time.