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?
as he is 9 years old and the tooth has not yet appeared; 
is also erupting over 
and she dislikes the appearance.
was lost at about 6 years and 
erupted normally at 6.5 years. Unfortunately, Neil fell over while playing soccer with his class team 4 months ago and fractured 
, exposing the pulp, which was treated by a coronal pulpotomy and placement of calcium hydroxide.
.Examination
Intraoral examination
.
present.
, which also appears to be darker than the other incisors.
Why are the centrelines displaced?
is considerably smaller than an 
) has promoted the upper centreline shift, but this has been aggravated by inherent upper arch crowding.The lower centreline shift is due to early unbalanced loss of 
in a potentially crowded arch.
, the lower centreline should have been monitored at review visits. 
should have been extracted to balance for loss of 
when the centreline appeared to be migrating.
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.
is highly unlikely. It would be very rare for to be absent without other congenitally missing teeth.
can be excluded as there is no history of 
having erupted or of incisor trauma.
can be excluded also.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.
. 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.
erupting 2 years following its expected eruption time.
, a supernumerary or odontome. Other rarer lesions would need to be excluded.
and may produce no effect, a median diastema, incisor rotation or failure of 
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