Dual Obstruction of Maxillary Central Incisor Eruption by Multiple Morphologically Distinct Supernumerary Teeth: A Case Report on Surgical-orthodontic Management

Delayed eruption of maxillary permanent incisors is one of the most common clinical problems in children. The presence of supernumerary teeth is one of the most common local factors in this situation. This case study highlights the benefits of a combined surgical and orthodontic approach for managing complex cases with multiple presentations of morphologically diverse supernumerary teeth. A 9-year and-6-month-old boy complaining of abnormal appearance of maxillary left central incisors. The clinical and radiographic examination included cone-beam computed tomography, which revealed the presence of multiple morphologically distinct mesiodens and tuberculate supernumerary teeth obstructing and displacing the maxillary left permanent central incisor. A treatment decision based on the surgical intervention to remove these supernumerary teeth under general anesthesia, followed by orthodontic traction to extrude the unerupted tooth to its normal position. Early intervention with combined surgical removal and active orthodontic traction is considered one of the best approaches for managing complicated cases with multiple occurrences of different types of supernumerary teeth, thereby promoting the eruption of maxillary permanent incisors.