PMC6925821_01
Ectopic permanent 1.1, distalised, vestibularised, and overlapping the 1.2.
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The 9-year-old male patient (M.G.) presented a class 2 type malocclusion with the upper maxilla contracted and posterior right-left cross-bite as well as an ectopia of the 1.1 that was distalised, vestibularised, and overlapping the 1.2 (Figure 1).
OPT shows the mixed dentition and the presence of the supernumerary 1.1.
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The X-rays (Figure 2) showed an intraosseous inclusion of a supernumerary 1.1 in a mixed dentition situation.
TC cone beam shows the lack of vestibular bone tissue around the permanent 1.1.
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TC cone beam investigation showed the absence of the vestibular bone wall for the dental element (Figure 3) which turned out to be covered only by gingival mucosa. The lack of an adequate relationship between the alveolar and the dental element prevented successful orthodontic therapy; for this reason, the patient was referred for an intentional surgical replanting. The treatment was divided into three phases: 
Initial orthodontic treatment.
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Treatment. The first phase of the treatment involved orthodontic therapy using a functional arch for 10 to 12 months, a rapid palatal expander, and fixed upper and lower braces (Figure 4).
Local anaesthetic.
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After local infiltration with mepivacaina 1 : 100000 (Figure 5), a vestibular incision was made starting from the central incisor on the right side to the central incisor on the left.
Envelope flap, intrasulcular partial depth from 1.1 to 2.1.
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The incision, carried out using a Beaver 64, was intrasulcular type, partial depth without vertical release since this system guarantees a better closure of the flap at the end of the operation (Figure 6).
Extraction of the supernumerary 1.1 and preparation of the alveolar.
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After lifting the flap, the supernumerary 1.1 was extracted and the alveolar was suitably prepared to receive the permanent 1.1 (Figure 7).
Extraction of the permanent 1.1.
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At this point, the permanent 1.1 was extracted (Figure 8) and it was immediately replanted in the now empty alveolar which once held the supernumerary 1.1 (Figure 9).
Replanting of the permanent 1.1 in the alveolar of the supernumerary 1.1.
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At this point, the permanent 1.1 was extracted (Figure 8) and it was immediately replanted in the now empty alveolar which once held the supernumerary 1.1 (Figure 9).
Sutured flap.
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The replanted dental element was suitably splinted in order to keep it in place, and the flap was repositioned and sutured after the surgical site was accurately swabbed (Figure 10).
Final orthodontic treatment (a, b).
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Having repositioned the ectopic element in the dental arch, the orthodontic therapy continued with the refining phases to close the case (Figure 11).
6-year follow-up.
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At the 6-year checkup, the patient was found to have excellent stability of the replanted dental element that had been subsequently treated endodontically (Figure 12).