We report the case of an 11-year-old boy, who presented with difficult eruption due to a horizontally impacted maxillary premolar. Radiographic examination revealed a horizontally embedded maxillary left second premolar tooth embryo in close proximity with the first molar root. Treatment consisted of distal movement of the first molar to secure the eruption path, followed by opening and traction of the embedded tooth and improvement of torsion using a multi-bracket device. The direction of traction was determined based on dental computed tomography images. Subsequently, favorable results were obtained by guiding the tooth into the dentition without leading to root resorption of the adjacent teeth and abnormalities in periodontal tissues. The patient had a history of ipsilateral extraction of an odontogenic cyst, and based on his previous reports, the maxillary left first and second premolars showed marked distal tilting of the tooth axis, possibly due to expansion of the cyst.

In pediatric dentistry, it is important to identify factors that interfere with normal oral development at an early stage through regular intraoral examinations and radiographs. Interventions at the appropriate time are necessary to minimize invasive treatment.

In pediatric dental practice, we often encounter cases where teeth undergoing root formation develop pulp necrosis. In such cases, apexification is selected to close the apical foramen with bone-like hard tissue. Although there are various forms of root apex healing after apexification, it has been reported that physiological growth such as root elongation by dentin or increase in the thickness of the root canal wall by addition cannot be expected, and that the root apex after healing has a complex morphology. Therefore, it is often difficult to perform a tight root canal filling with the conventional lateral pressure root canal filling method using gutta-percha points (GPs). Therefore, when performing root canal filling with GPs on apexified teeth, it is necessary to carefully examine the apical morphology and closure status. In recent years, the widespread use of dental cone-beam computed tomography (CBCT) has made it possible to evaluate the anatomical structure of the craniofacial region in three dimensions. In addition, bioglass sealers (BG sealers) have excellent biocompatibility and are said to lead to the formation of crystals within dentinal tubules, high sealing properties, acid resistance, and physical strength, and are thought to be effective for root canal filling after apexification.

In this study, we performed apexification on a tooth with pulp necrosis due to trauma, and then examined the root canal closure status and root canal morphology using CBCT. The results revealed the formation of covering hard tissue and that the entire root canal had a complex structure. We report this case in which GP root canal filling using BG sealer gave good results.

Relocation of maxillary canine teeth is rarely performed in clinical practice ; depending on the position of the tooth embryo, it may cause root resorption of the adjacent teeth, making subsequent treatment more difficult. In the present case, we experienced the long-term management of a patient with skeletal mandibular prognathism who had transposed maxillary right canine and lateral incisor, and significant root resorption in the right central incisor. The patient, a 9-year-old girl, was referred to our clinic by her primary care physician, who noted an abnormal eruption direction of the maxillary right canine tooth. In the first phase of orthodontic treatment, the maxillary right central incisor was extracted and the maxillary right canine was orthodontically aligned in its place. The surgical procedure in the first phase of orthodontic treatment was performed at our pediatric dental clinic. In the second phase, orthognathic surgery for the skeletal mandibular protrusion was performed. Prosthodontic treatment was performed on the maxillary right canine teeth, which were aligned at the position of the maxillary right central incisor, and good esthetic and functional outcomes were achieved. In addition, through collaboration with pediatric dentistry, the oral environment was maintained well during the occlusal treatment period, and no caries was observed. Two years after the second phase of orthodontic treatment, a good occlusal relation was maintained.