As outlined above, in most cases the incisors will erupt
spontaneously or can be orthodontically erupted following
extraction of the mesiodentes. In some cases, the adjacent
primary teeth may also have to be extracted to create sufficient
space for eruption of the permanent teeth. In the rare
case that a central incisor cannot be erupted orthodontically
because of its position or ankylosis, 2 treatment options
exist: surgical repositioning or extraction and placement of
an implant. Prabhu and Manshi40 recommended surgical
repositioning when adequate space is available for the
incisor, the mesiodens is located parallel to where the root
of the aligned incisor would be, and slight modifications to
the socket can be made to accommodate the incisor.
Because there is a high risk of ankylosis after repositioning
of teeth, any malocclusions should be diagnosed and
comprehensive orthodontic treatment options presented to
the patient or the parents before surgical repositioning is
performed. Replacing an ankylosed tooth with an implant
may be a better option, as the risks of root resorption,
discolouration and periodontal compromise associated with
repositioning may be reduced. In such cases, orthodontic
treatment followed by prosthetic treatment with an implant
may be the optimal treatment. However, treatment options
must be considered individually in each case.