A 12-year-old female patient presented with a retained milk tooth and impacted tooth. Radiographs showed impacted tooth #11 and retained tooth #51. The treatment plan was to use a hyrax appliance to regain space between teeth #21 and #12 for orthodontic extrusion of #11, followed by extraction of #51 and exposure and bonding of #11 with a lingual button and wire to aid eruption into position.

2. • A 12 years old female patient
came to the Out patient
Department of Pedodontics
and Preventive Dentistry with
the chief complaint of
retained milk tooth in
anterior region of upper jaw.
• Fracture of 21 and 12

3. • Intra-oral periapical
radiograph showed
impacted 11 and
retained 51.
• Space between 21 and
12 is lesser than
mesiodistal width of
crown of 11

4. OPG and standard maxillary occlusal radiograph
showed impacted 11 and retained 51

5. Treatment plan:
• Regaining of space between 21 and 12 by
expansion with hyrax appliance &
• Followed by orthodontic extrusion

6. Local anesthesia administered
Full thickness flap raised from 13
to 22
Extraction of 51 done
Exposure of crown of 11 done with
the help of surgical bur

7. Isolation &
etching done
Bonding of lingual button on the
crown of 11 & a extension of wire is
attached to lingual button

8. Suture given, followed by application of periopack.

9. One week post operative, after
removal of suture
Space gained by hyrax
appliance and open coil
spring

10. Space gained , traction
given to the impacted
11
11 in position , just to erupt .

11. Erupted 11 , crown is
mesially tilted
After proper positioning of 11
is acheived
Frontal view