Minimally invasive segmental osteotomy for an ankylosed maxillary central incisor in a skeletal class II Patient: a case report

Ankylosis of an maxillary central incisor following dental trauma can be a major obstacle in orthodontic treatment, particularly in skeletal Class II patients when both retraction and impaction are required. This report describes a 21-year-old female with skeletal Class II malocclusion (ANB 10°), flared maxillary central incisors, and protrusive lips, with a history of dental trauma. Radiographs confirmed ankylosis of tooth 11 and external root resorption of tooth 21. The initial plan involved a non-surgical camouflage approach with four first premolar extractions, but treatment was halted when ankylosis prevented canine retraction. A single-incision, piezoelectric-assisted segmental osteotomy under local anesthesia was then carried out to retract and impact the ankylosed incisor segment while maintaining blood supply through intact facial and palatal pedicles. Gradual movement was achieved with power chains, followed by alignment and establishment of a functional occlusion. The active treatment time was 48 months. Post-treatment records showed a reduction in overjet from 8.0 mm to 2.0 mm, overbite from 6.5 mm to 2.0 mm, and an ANB change from 10.0° to 5.5°, with improved mandibular position and incisor inclination. Radiographs confirmed complete bone healing and preservation of gingival papillae. The patient's profile improved from convex to straight, with stable occlusion and no evidence of necrosis or other major complications. This case demonstrates that a minimally invasive, piezoelectric-assisted segmental osteotomy can be an effective and aesthetic-preserving option for treating ankylosed maxillary central incisors in skeletal Class II patients, offering precise bone removal, stable results, and minimal surgical trauma.