Fibroepithelial Hyperplasia Impedes Eruption of Maxillary Central Incisor: A Case Report of Diagnostic and Occlusion Management

Abstract

Delayed eruption of a permanent maxillary central incisor is commonly associated with hard-tissue obstruction, trauma-related disturbances, or developmental abnormalities. Soft-tissue obstruction is less frequently emphasised as a primary factor in eruption delay. This case report describes the diagnosis and conservative management of delayed eruption of a maxillary left central incisor associated with localised fibroepithelial hyperplasia. An 11-year-old girl presented with incomplete eruption of the maxillary left permanent central incisor. Clinical examination showed a localised, thickened gingival band covering the erupting tooth and interfering with its movement towards the occlusal plane. The adjacent permanent incisors had erupted normally, and no relevant medical, systemic, hereditary, or trauma-related history was reported. A provisional diagnosis of delayed eruption secondary to localised gingival hyperplasia was made. Laser-assisted excision of the obstructing soft-tissue lesion was performed under local anaesthesia, and the crown of the affected incisor was surgically exposed. The excised tissue was submitted for histopathological examination. Microscopic findings showed stratified squamous epithelium with mild papillomatosis overlying collagenised fibrous connective tissue, without cellular atypia, dysplasia, or significant inflammatory infiltrate. These features were consistent with a benign fibroepithelial polyp. Postoperative healing was uneventful. At the one-month and six-month review, spontaneous eruption of the maxillary left central incisor was observed without orthodontic traction or additional surgical intervention. This case highlights the importance of including localised soft-tissue pathology in the assessment of delayed tooth eruption. Early recognition, histopathological confirmation, and conservative surgical removal of the obstruction may facilitate spontaneous eruption when favourable eruptive conditions are present.