“All for one and a “One” for all”.

Objectives: Maxillary central incisors are the third most impacted teeth. Timely multidisciplinary management of unerupted maxillary central incisors (UMCI) is key to preventing prolonged functional and appearance-based anguish. Our objectives were to assess referral appropriateness of children with UMCI for joint paediatric-orthodontic management in a teaching hospital and orthodontic treatment burden pre- and post-lockdown.
Methods: A retrospective analysis was completed of consecutive patients (aged 6-to-16-years-old) who required surgical management under general anaesthetic for their UMCI between 2018-2021. Nine-years-old was selected as a proxy measure of age-appropriate referral. Liversidge and Molleson’s stage of root development was also recorded and inter-examiner reliability tested.
Results: Fifty-two children with 62 UMCI were identified; 69.3% were male. Mean age of referral was 8.8 years-old; 60.1% were referred age-appropriately. Most (53.2%) roots were at least half development (R½) at time of assessment. Supernumerary teeth were diagnosed in 82.7% of UMCI cases; both tuberculate (n=29/43) and conical (n=21/43). Almost all children had pre-surgery plain-film radiographs (90.4%) with 42.3% requiring CBCT; 77.3% of which had supernumeraries (n=17/22).

Mean age at surgery was 10.4 years-old. Prior to March 2020, mean time between listing and surgery was 4.3-months but, due to lockdown, this increased to 15.2-months. Most children required removal of supernumerary and exposure and bond of UMCI (54.7%).

The orthodontic burden of care was higher for patients who were referred above 9-years-old. Root development also impacted orthodontic treatment burden: 83.3% at level ≥R¾ required orthodontic treatment, compared to only 36.4% at ≤R¼. Mean time from surgery to tooth eruption was 2.2-years.
Conclusions: Our results show that conical supernumeraries can obstruct incisor eruption and should be removed; CBCT can aid surgical planning. COVID-19 has undoubtedly delayed care for these patients, the long-term treatment burden is currently unknown. Our findings suggest that primary care referrers should consider stage of root development not patient age alone.