Adult patient treated with a miniscrew-assisted rapid palatal expansion combined with surgical exposure of three impacted teeth and several ageneses

This case report outlines the orthodontic management strategies employed for a young adult male patient presenting with a maxillary transverse deficiency and ectopically impacted bilateral maxillary canines and right second premolar requiring surgical exposure. In addition, the patient exhibited agenesis of all four mandibular permanent incisors. The treatment protocol encompassed three sequential stages: (1) correction of transverse deficiency through maxillary expansion using a miniscrew-assisted rapid palatal expansion appliance, (2) surgical exposure of the three ectopically impacted teeth through a closed eruption technique, and (3) orthodontic traction to stimulate their eruption and subsequent alignment. The treatment outcomes were successful, achieving satisfactory maxillary expansion, which enabled the establishment of a balanced occlusion. The ectopically impacted maxillary teeth erupted in their correct positions, with normal clinical crown height and a gingival line harmonious with the adjacent teeth. The strategic incorporation of cantilever arms enhanced the control of forces and traction vectors, mitigating potential stress and minimizing the risk of damage to the adjacent teeth.