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Methods of applying traction to unerupted maxillary incisors and safety considerations

From Volume 12, Issue 3, July 2019 | Pages 106-110


Priti Acharya

BDS(Hons), MFDS RCS(Eng), MFGDP(UK), MSc, MOrth RCS(Eng), FDS Orth RCS(Eng)

Consultant Orthodontist, Eastman Dental Hospital, 256 Gray's Inn Road, London, WC1X 8LD, UK

Articles by Priti Acharya

Joanne M Collins

BDS(Hons), MFDS RCS(Ed), MSc, MOrth, FDS Orth, RCS(Eng)

Consultant Orthodontist, Eastman Dental Hospital, 256 Gray's Inn Road, London, WC1X 8LD, UK

Articles by Joanne M Collins


Unerupted maxillary incisors should be identified and managed promptly. When exposure and bonding of a gold chain to an unerupted tooth is indicated, there are multiple methods that can be used to apply traction to the tooth. This paper outlines the different methods available, their advantages and disadvantages and the important safety considerations. Treatment often utilizes small components which may pose an inhalation or ingestion risk if not used appropriately.

CPD/Clinical Relevance: This article reviews the different methods available to align impacted upper incisors. It details the advantages and disadvantages of each method and highlights the associated safety considerations.


Unerupted maxillary incisors can have a large detrimental impact on dental and facial aesthetics which can subsequently affect patient psychology and self-esteem.1,2,3,4 Missing front teeth can also affect function and the developing dentition and therefore should be identified and managed as early as possible.3,4

The overall incidence of unerupted maxillary incisors has been found to be 2.6% in the referred population5 and is more common in males.6 The normal age of eruption of maxillary central and lateral incisors is 7−9 years.7 Eruption is considered to be delayed if:4

The aetiology of delayed eruption can be hereditary or environmental, with common causes including supernumerary teeth, odontomes, previous trauma, early loss of deciduous teeth and retained deciduous teeth.4,8

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