Impacted Permanent Teeth in the Mixed Dentition: Pediatric Diagnosis, Surgical Exposure, and Orthodontic Traction

Permanent-tooth impaction during the mixed dentition is time-sensitive because eruption potential, root formation, arch space, and relationships with adjacent structures change during growth.This comprehensive narrative review evaluated evidence concerning pediatric diagnosis, interception, surgical exposure, orthodontic traction, treatment failure, and post-treatment outcomes.PubMed/MEDLINE, Embase, Scopus, and Web of Science were searched from inception through August 2026, with supplementary targeted searching.Diagnosis should integrate eruption symmetry and progression, space conditions, tooth-specific warning signs, and clinically directed imaging.Barrier removal and space provision may permit spontaneous eruption in favorable immature teeth, whereas primary-canine extraction may benefit selected palatal displacements but is not uniformly predictive.When definitive treatment is required, surgical access and orthodontic mechanics should be designed together.Evidence does not establish a universally superior exposure technique; tissue management, attachment placement, traction direction, and anchorage should follow anatomy and the intended eruption pathway.A defined path, usable space, stable anchorage, and staged movement away from vulnerable structures are more defensible than prescribing a named appliance or universal force threshold.Although alignment is often achievable in selected cases, periodontal, pulpal, root, esthetic, and stability outcomes remain relevant, together with repeat exposure, ankylosis, and adjacent-tooth injury.The literature is predominantly retrospective, concentrated on maxillary canines, and heterogeneous in definitions, protocols, and follow-up.The clinically responsible objective is not preservation of the impacted tooth at any cost, but selection of the strategy most likely to provide the growing child with a healthy periodontium, maintainable occlusion, and acceptable long-term restorative options.