case_images: PMC6925821_01
case_images: Ectopic permanent 1.1, distalised, vestibularised, and overlapping the 1.2.
case_images: CRID2019-3956296.001.jpg
case_images: PMC6925821_01_CRID2019-3956296.001.jpg
case_images: fig1
case_images: 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).
case_images: OPT shows the mixed dentition and the presence of the supernumerary 1.1.
case_images: CRID2019-3956296.002.jpg
case_images: PMC6925821_01_CRID2019-3956296.002.jpg
case_images: fig2
case_images: The X-rays (Figure 2) showed an intraosseous inclusion of a supernumerary 1.1 in a mixed dentition situation.
case_images: TC cone beam shows the lack of vestibular bone tissue around the permanent 1.1.
case_images: CRID2019-3956296.003.jpg
case_images: PMC6925821_01_CRID2019-3956296.003.jpg
case_images: fig3
case_images: 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: 
case_images: Initial orthodontic treatment.
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case_images: fig4
case_images: 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).
case_images: Local anaesthetic.
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case_images: PMC6925821_01_CRID2019-3956296.005.jpg
case_images: fig5
case_images: 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.
case_images: Envelope flap, intrasulcular partial depth from 1.1 to 2.1.
case_images: CRID2019-3956296.006.jpg
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case_images: fig6
case_images: 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).
case_images: Extraction of the supernumerary 1.1 and preparation of the alveolar.
case_images: CRID2019-3956296.007.jpg
case_images: PMC6925821_01_CRID2019-3956296.007.jpg
case_images: fig7
case_images: After lifting the flap, the supernumerary 1.1 was extracted and the alveolar was suitably prepared to receive the permanent 1.1 (Figure 7).
case_images: Extraction of the permanent 1.1.
case_images: CRID2019-3956296.008.jpg
case_images: PMC6925821_01_CRID2019-3956296.008.jpg
case_images: fig8
case_images: 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).
case_images: Replanting of the permanent 1.1 in the alveolar of the supernumerary 1.1.
case_images: CRID2019-3956296.009.jpg
case_images: PMC6925821_01_CRID2019-3956296.009.jpg
case_images: fig9
case_images: 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).
case_images: Sutured flap.
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case_images: PMC6925821_01_CRID2019-3956296.010.jpg
case_images: fig10
case_images: 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).
case_images: Final orthodontic treatment (a, b).
case_images: CRID2019-3956296.011.jpg
case_images: PMC6925821_01_CRID2019-3956296.011.jpg
case_images: fig11
case_images: Having repositioned the ectopic element in the dental arch, the orthodontic therapy continued with the refining phases to close the case (Figure 11).
case_images: 6-year follow-up.
case_images: CRID2019-3956296.012.jpg
case_images: PMC6925821_01_CRID2019-3956296.012.jpg
case_images: fig12
case_images: 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).