Traumatically intruded permanent incisors in mixed dentition: An innovative clinical technique for orthodontic extrusion

Abstract

Orthodontic management of traumatically intruded maxillary incisors in growing patients presents both biomechanical and developmental challenges. In mixed dentition, the lack of suitable posterior anchorage units limits conventional appliance use. This case report describes a simple and effective clinical technique for the orthodontic extrusion of intruded maxillary central incisors using a modified fixed palatal anchorage appliance in a 10-year-old boy. The appliance was bonded to the maxillary first permanent molars and included a contoured wire loop positioned anteriorly, serving as a stable anchorage point for extrusive force delivery. Intentional subluxation of the intruded teeth was performed before traction to disrupt potential ankylosis. Orthodontic buttons were bonded to the labial surfaces, and elastic modules were used for immediate force application. The design enabled absolute anchorage without stressing adjacent teeth or requiring patient compliance. After the initial extrusion, brackets and nickel-titanium wires were employed to refine alignment. The technique allowed controlled extrusion in an immature root without inducing complications. This appliance-based method proved advantageous because of its stability, hygiene, accessibility, and adaptability in the mixed dentition phase.