Impacted Central Incisors in the Upper Jaw in an Adolescent Patient: Orthodontic-Surgical Treatment--A Case Report  
[PERSON]  
1 Department of Interdisciplinary Medicine, University of Bari Aldo Moro, 70124 Bari, Italy; [EMAIL_ADDRESS] (A.P. ); [EMAIL_ADDRESS] (G.C. ); [EMAIL_ADDRESS] (S.C.); [EMAIL_ADDRESS] (M.G. ); [EMAIL_ADDRESS] (A.M.I. ); [PERSON](F.P. ); [EMAIL_ADDRESS] (F.C. ); [EMAIL_ADDRESS] (V.S. ); [EMAIL_ADDRESS] (B.R. ); [EMAIL_ADDRESS] (A.C.); [EMAIL_ADDRESS] (A.M.); [PERSON](M.C. ); [EMAIL_ADDRESS] (G.D.); [EMAIL_ADDRESS] (B.D.V. ); [EMAIL_ADDRESS] (F.L)
or impaction). These anomalies are also linked to age, sex, race or ethnicity. Both root developmental staging and patient age are used as criteria to diagnose prematurity or delayed eruption [1; 2; 3]. Eruption disorders are more frequent in the upper arch (69.9%) and the area of the incisors (51.2%). Furthermore, in 20.5% of cases, first-degree relatives present the same issue [4; 5]. Impaction of the upper central incisors is a rare occurrence (0.06-0.12%), more frequent in men than in women (1.5:1) [4; 6]. Traumatic and obstructive causes are the main factors related to impacted teeth [7]. Dental trauma at a young age could damage the non-erupted permanent tooth germ, reduce root development, and change eruption direction. This can lead to diacetated tooth development with a high risk of uneruption without an orthognathic-surgical therapy [8; 9]. Necrosis or ankylosis of a deciduous tooth and the simultaneous presence of systemic pathologies (endocrine diseases, cleidocranial dysostosis) can also determine dental inclusions [10; 11]. The main obstructive causes are: odontomas (complex or compound); follicular cysts; thick mucosa; bone tissue formed as a result of the early extraction of a deciduous tooth; and supernumerary teeth [8]. The most common obstructive cause is determined by supernumerary teeth (ST), 77.8% of the ST are found in the maxilla, and 97.2% are in the frontal region. In the anterior maxillary region, the presence of one or more supernumerary teeth along the midline (1.5% to 3.5%) hinders the eruption of the incisors (28% to 60%) [5; 12; 13; 14; 15; 16]. Although the percentage of upper central incisors uneruption or inclusion is low, its occurrence causes an aesthetic, phonetic and functional discomfort to the patient, arousing parents' concern [7; 14]. Parents of an impacted incisor affected child are usually motivated to seek an earlier orthodontic treatment than parents of a child with other orthodontic problems [8; 17; 18]. The diagnosis of impacted incisors is based on the clinical examination that ascertains and identifies the retained tooth. Palpating the corresponding alveolar area (both palatal and vestibular), a painless, incompressible, fibromatosisal bump can be appreciated [19]. The diagnosis needs to be completed by radiological examinations:  
1. Intraoral X-rays with periapical and occlusal projections confirm the presence, position and/or anomaly of the retained maxillary incisors and any underlying developmental anomaly or pathology. The buccolingual position of the non-erupted tooth can be localized using horizontal or vertical parallax. 2. Ortopanthomography X-ray (OPG X-ray) to evaluate the problem in relation to the entire arch, adjacent tooth and the staging of the eruption of the other dental elements. 3. Latero-Lateral Teleradiography (LLT) of the head with cephalometric trace to assess the height and inclination of the crown and root of the impacted tooth. 4. Cone-Beam Computed Tomography (CBCT) for a three-dimensional evaluation of impacted elements and surrounding structures. All these data allow us to correctly plan the treatment and the optimal direction of traction in order to have a correct extrusion of the impacted tooth with adequate periodontal support [19; 20; 21]. Early treatment is essential because the non-erupted maxillary central incisor can cause various issues:  
1. Compromission of the aesthetic aspect, phonation and alveolar ridge formation. 2.