Aberrant positioning and displacement of the central incisor can disrupt the normal eruptive process. In general, inversely impacted maxillary central incisors do not undergo spontaneous eruption. Implementing traction and controlled extrusion for an inversely impacted maxillary central incisor displaying a high crown angulation angle poses substantial technical difficulty. The present study set out to explore whether orthodontic correction is feasible for severely inverted maxillary central incisors, drawing on case examples. Radiographic imaging quantified crown-axis angulation, root curvature severity, and the length of the already developed root. Surgical fenestration of the involved teeth was then performed, followed by traction delivered through a lingual arch appliance in combination with elastic forces. The average crown axis angulation reached 113°, the degree of root curvature was 97.3°, and root development stood at 36.1%. Even though crown axis inclination and root curvature were both markedly severe, every incisor was successfully moved into its proper location while retaining vitality, through coordinated surgical exposure and orthodontic forces. Orthodontic traction ought to commence during the incipient phase of incisor development, at a point when root formation has not yet advanced significantly, without regard to the presenting tooth angulation.
