Bilateral Maxillary Central Incisors’ Replacement with Canines in a Case of Severe Root Resorption

Impacted maxillary canines are a common developmental anomaly in pediatric patients and may cause root resorption of adjacent incisors. While involvement of the lateral incisors is frequently reported, severe resorption affecting all four maxillary incisors is rare and poses significant diagnostic and therapeutic challenges. Thus, early identification of canine displacement is crucial to prevent irreversible damage. An 11-year-old female patient in late mixed dentition presented with bilateral ectopically displaced maxillary canines, maxillary transverse constriction, and severe root resorption involving all four maxillary incisors. The available two-dimensional radiographs showed marked shortening and irregularity of the roots of all four maxillary incisors, consistent with advanced root resorption, along with the ectopically displaced maxillary canines. A multidisciplinary treatment approach was adopted. The four maxillary incisors were extracted to promote spontaneous canine eruption and facilitate subsequent orthodontic management. Rapid maxillary expansion was performed, followed by comprehensive orthodontic treatment based on a bidimensional approach. The canines were orthodontically guided into the position of the maxillary central incisors and reshaped to improve morphology and esthetics, while spaces were maintained for prosthetic replacement of the lateral incisors. Final rehabilitation included prosthetic restoration and periodontal surgery to optimize gingival architecture. Fixed appliance treatment lasted approximately 18 months, and a one-year clinical follow-up showed stable clinical conditions and satisfactory maintenance of the temporary restorations. This report describes an integrated multidisciplinary treatment strategy based on extraction of the compromised incisors, spontaneous canine eruption, bilateral canine-to-central-incisor substitution, and subsequent prosthetic and periodontal rehabilitation. The case underscores the importance of timely radiographic assessment and individualized multidisciplinary planning and illustrates the feasibility of canine substitution in a carefully selected pediatric patient.