Impacted Permanent Teeth in the Mixed Dentition: Pediatric Diagnosis, Surgical Exposure, and Orthodontic Traction
8 affiliations
- 1College of Dentistry, Princess Nourah Bint Abdulrahman University, Riyadh, SAU
- 2College of Dentistry, King Saud bin Abdulaziz University for Health Sciences, Riyadh, SAU
- 3College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, SAU
- 4Faculty of Dentistry, King Abdulaziz University, Jeddah, SAU
- 5College of Dentistry, Umm Al-Qura University, Makkah, SAU
- 6Department of Dentistry, Ministry of Health, Tabuk, SAU
- 7Public Health, University of Essex, Colchester, GBR
- 8Pediatric Dentistry, Ministry of Health, Taif, SAU
Abstract
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.
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BibTeX
@article{almutlaq2026impacted,
title = {{Impacted Permanent Teeth in the Mixed Dentition: Pediatric Diagnosis, Surgical Exposure, and Orthodontic Traction}},
author = {Rama Almutlaq and Majid Alharthi and Faisal Albahkali and Abdullah Albadia and Wasan Koaban and Abdulaziz Alshalawi and Anas Alshammari and Sager Alyami and Mohammed Alsaadoun and Mohammed Alzahrani and Hamad Almuaiqly and Rahaf Mohammed and Azhar Aljalooud and Maryam Aljalooud and Fouad Althobaiti},
journal = {Cureus},
year = {2026},
month = oct,
doi = {10.7759/cureus.117401},
url = {https://europepmc.org/article/PMC/PMC13726899},
note = {CC BY},
}
RIS
TY - JOUR
TI - Impacted Permanent Teeth in the Mixed Dentition: Pediatric Diagnosis, Surgical Exposure, and Orthodontic Traction
AU - Rama Almutlaq
AU - Majid Alharthi
AU - Faisal Albahkali
AU - Abdullah Albadia
AU - Wasan Koaban
AU - Abdulaziz Alshalawi
AU - Anas Alshammari
AU - Sager Alyami
AU - Mohammed Alsaadoun
AU - Mohammed Alzahrani
AU - Hamad Almuaiqly
AU - Rahaf Mohammed
AU - Azhar Aljalooud
AU - Maryam Aljalooud
AU - Fouad Althobaiti
PY - 2026
DA - 2026/10/03
JO - Cureus
DO - 10.7759/cureus.117401
UR - https://europepmc.org/article/PMC/PMC13726899
AB - 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.
SN - 2168-8184
ER -