In literature, there are currently contrasting opinions on the therapeutic choice for cases of dilacerated teeth.
The most commonly mentioned therapeutic solution in literature is surgical extraction and substitution with Maryland-bridge or prosthetic implants [7, 8] because of the technical difficulty involved in exposition and orthodontic alignment and the uncertain prognosis of such malformed teeth.
It is therefore difficult to establish the prognosis of impacted and dilacerated teeth when disincluded [9, 10]. This difficulty is enhanced when the tooth involved is a central maxillary incisor. Prognosis depends on both the seriousness and position of the dilacerations, as well as the formation of the root.
The follow-up results in the present study indicated a favorable prognosis for the dilacerated disincluded maxillary incisors if the treatment is performed with a meticulous surgical technique and appropriate post-operative control, both with apically positioned flap and closed eruption technique.
Disinclusion of impacted or dilacerated tooth can be facilitated by rapid palatal expansion to increase arch length [11–15].
The two different surgical approaches, if planned and performed in a good manner, do not influence the results obtained both in a short-term than in a long-term follow-up.
Healing in soft tissues was good and rapid at the end of therapy, and PDL space around the disincluded teeth could be seen on radiographs.
The results of the current study suggest that a normal gingival tissue, with its usual consistency, color, and stippled appearance, is established parallel with bone healing, regardless of the preoperative condition of gingival and alveolar mucosa.
Favorable healing of PDL depends on how many viable cells are preserved on the root; our findings suggested that clinically, satisfactory healing also takes place in the dilacerated disincluded teeth. From a periodontal point of view, CAL and PD values were observed at approximal sites.
Compared to the immediate post-treatment, all mesial, buccal, distal and palatal measurements and the mean CAL, PD, and REC values increased slightly during the follow-up period (1 year) and remain stable during the subsequent period, as shown by the measurement taken after 5 years.
These increases might have been due to continued maturation, the aging process, or organization of periodontal tissues after the teeth started to function.
All clinical measurements were as stable at the 5-year observation as a natural tooth.
Within the limits of this study, it was confirmed that disincluded dilacerated teeth simulate natural teeth, maintaining healthy periodontal support. With such a procedure, extractions can be avoided.