# Eruption Treatment of Impacted Teeth Following Surgical Obstruction Removal
## 4 Discussion  
Tooth eruption involves bone resorption to form an eruption pathway and interradicular bone formation, root growth, and bone apposition in opposing sides, all regulated by the dental follicle proper. The most common reason for lack of eruption is an abnormality in the dental follicle itself [19]. In this article, we present management options for treating a local physical obstruction associated with tooth impaction. Evidence shows that surgical removal does not necessarily yield spontaneous eruption of the impacted teeth. The rate of spontaneous eruption also depends on the chronological age of the patient [21, 26], the developmental stage of the root, the degree of apical displacement, inclination, curvature, and the depth of the impacted tooth, and the preservation of arch space [27]. The overall time for possible complete spontaneous eruption of incisors following the surgical removal of an obstructive object ranges between 7 months and 3 years (with an average of 20 months) [28]. If spontaneous eruption does occur, orthodontic intervention and its possible side effects, such as root resorption, pulp inflammation, gingival recession, inflammatory reaction, and enamel white spot lesions, are avoided [29]. However, approximately 42% of impacted teeth do not erupt spontaneously following the removal of an obstructive object [23]. Moreover, impacted teeth associated with complex odommas demonstrate a significantly lower rate of post-surgical spontaneous eruption compared to supernumerary tooth removal [23]. Consequently, orthodontic complications such as space closure by adjacent teeth or ectopic eruption of the impacted tooth occurs in 55% of these cases [28, 30], requiring additional surgery. Loss of space, as described in the first case presented in this article, dictated the need for a second surgical procedure for orthodontic brace cementation to enable active traction [10, 31, 32, 33, 34]. The risk of either a second or even a third unnecessary surgical procedure in the future [23], which may lead to subsequent orthodontic complications of loss of arch space and ectopic eruption [28, 30] in cases of spontaneous eruption, may deter some clinicians [20, 27]. Hence, they have advocated the application of immediate orthodontic active traction [20]. In the third case presented, the tooth impaction involved a complex odontoma and a severe horizontal inclined position, which may have led to an immediate orthodontic traction. Nevertheless, considering the patient's clinical aspects, i.e., favourable dental age [26], under-developed roots, and open apices, the clinical decision was to wait for the preferred spontaneous eruption. These treatment alternatives for the impacted incisors due to obstruction are to be known and seriously considered (Table 1) in every patient. As described, the third treatment modality seemed appropriate to enable spontaneous eruption with the benefit of preventing immediate orthodontic force loading, and avoiding additional surgery in case of eruption failure and the need for orthodontic traction. Thisconservative surgical-orthodontic treatment alternative is highly recommended in young patients due to the expectancy of their normal development potential and prevention of unnecessary orthodontic and additional surgical interventions.