Lateral incisor and canine substitutions associated with the extraction of a horizontally impacted maxillary central incisor with root dilaceration

Orthodontic traction poses significant challenges, requiring careful evaluation of risks and benefits to determine the most appropriate course of action, whether through traction or extraction. This case report describes the orthodontic treatment of a 13-year-old female with an impacted maxillary central incisor and insufficient arch space to accommodate the impacted tooth. Considering the horizontal position of the impacted incisor, the risk of damage to the adjacent tooth roots, and the lack of space, extraction of the impacted tooth and 3 premolars followed by the reshaping of 3 maxillary teeth through restorative dentistry was the optimal treatment approach. After treatment, the patient exhibited a straight facial profile, an esthetically pleasing smile, and normal overbite and overjet, along with well-established occlusion. Evaluation of potential treatment approaches revealed that the disadvantages of attempting orthodontic traction outweighed the benefits, making extraction of the unfavorably positioned impacted incisor the safer option. This case report underscores the importance of understanding orthodontic mechanics and employing multidisciplinary treatment approaches, including restorative dentistry, to achieve excellent esthetic and functional outcomes.