Objectives: The purpose of this paper is to describe the combined surgical, endodontic and orthodontic treatment of a case with bilateral impacted maxillary central incisors and exposed pulp on left side discovered during surgical exposure.
Methods: The subject is an 11-years-old boy with the appearance of his anterior teeth as chief complaint. He had a Class I skeletal pattern but end-to-end molar and canine relationship and no history of trauma to the maxilla. Radiographs confirmed presence of impacted upper central incisors. The adjacent lateral incisors were inclined toward the edentulous space. Treatment consisted extraction of upper first premolars, retraction of canines and lateral incisors for space opening with fixed orthodontic treatment, surgical exposure with apically-positioned flap and simultaneous shallow pulpotomy, MTA dressing and light-cured glass ionomer as temporary restoration to provide coronal seal of left incisor followed by forced eruption of both incisors. They were brought to its proper position after six months of active orthodontic treatment. Left central incisor was vital at follow up tests after 1, 4, 17 and 27 months.
Results and Conclusions: Endodontic treatment protocol for vital exposed pulp in an impacted tooth is similar to an erupted one and should be done at surgical exposure time. Atraumatic shallow pulpotomy, contamination prevention, proper pulp medication and specially providing coronal seal are critical to preserve pulp vitality. This process does not intervene with following orthodontic tooth movement.