Close monitoring of the dentition is required after the
extraction of a mesiodentes. Approximately 6 months after
extraction of a mesiodens, clinical and radiographic reassessment
is recommended to determine if the tooth has erupted.
Lack of eruption has been attributed to diminished eruption
rate, significant root development, displacement of the tooth
from its normal position in the alveolar bone or insufficient
arch space into which the tooth can erupt.37 When there is
insufficient arch space, additional space can be created
orthodontically by means of a compressed coil spring
inserted before active eruption starts. If a tooth does not start
erupting within 6 to 12 months after extraction of the mesiodens
and sufficient arch space is available, surgical exposure
and orthodontic eruption of the unerupted incisor are
recommended. Closed exposure with simultaneous bonding
of an orthodontic attachment allows for orthodontic eruption
of the tooth along with its periodontal attachment.37,38
Before the surgical procedure, orthodontic appliances should
be placed on as many maxillary teeth as possible to serve as
appropriate anchorage to facilitate eruption of the incisor.
Before active orthodontic extrusion of the tooth begins, arch alignment should have progressed to a stable arch wire that
will maintain the integrity of the maxillary arch and prevent
intrusion or canting of the maxillary teeth as the impacted
incisor is erupted. Various elastic ligatures can be tied from
the arch wire to the bonded bracket, with or without a chain
on the unerupted incisor; this allows the tooth to be erupted
by the application of light forces, which avoids sequelae such
as root resorption, ankylosis or devitalization.39 The eruptive
process may take 6 to 18 months, depending on the original
position of the tooth. Care must be taken to erupt the tooth
along the correct path in 3 dimensions using only light
forces; heavy forces may cause devitalization of the tooth, in
addition to the known detrimental effects of heavy forces in
orthodontic tooth movement.