Concurrent impaction and transposition of the maxillary anterior teeth is unusual and may present a great challenge to dental practice. Early diagnosis and elimination of impacted anterior teeth helps provide esthetic and functional outcomes. This case report describes an 18-year-old female whose teeth 13, 11 and 23 (FDI tooth numbering) had dilacerated labial impaction. Teeth 53 and 63 were retained primary teeth. The patient was treated with extraction of teeth 53, 11, 23 and 63, and substitution of teeth 13 for 11, 14 for 13, and 24 for 23. Surgical exposure of tooth 13 was done to tract the impaction with double archwire technique into position 11. After 30 months of treatment, tooth 13 was successfully substituted for 11. Final occlusion was good, a pleasing smile arc was established and the patient was satisfied. This paper discusses principles of treating impaction, treatment mechanics and esthetic concerns relating to canine substitution.

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Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.