To: Editor, The Angle Orthodontist. Response to: Recovery of multiple impacted maxillary teeth in a hyperdivergent Class I patient using temporary skeletal anchorage devices and augmented corticotomy. Kyung A. Kim; Hyeon-Shik Hwang; Kyu-Rhim Chung; Seong-Hun Kim; Gerald Nelson. Angle Orthod. 2018;88:107-121

We read with great interest this well-performed case report of Kim et al. of an 11-year-old male patient with multiple impacted teeth treated using temporary skeletal anchorage devices and augmented corticotomy. The presence of multiple impacted teeth is one of the most difficult treatment challenges during orthodontic treatment, both from a biomechanical and esthetic point of view. Therefore, due to the importance of the topic, we have three questions that we hope will provide more detailed information about the procedures performed: 1. As reported, the treated patient presented with multiple impacted teeth in the maxillary anterior region with several-related problems. Considering the difficulty of the case and the tooth impaction depth, the authors decided to perform two-stage surgical exposure. In this regard, could you please explain more clearly the reasons to perform a twostage surgical exposure (even considering the dilaceration of the central maxillary incisor) in a short period of time instead of one single surgical session? 2. For orthodontic traction of the impacted maxillary central incisor, why did you choose to use two mandibular fixation screw holes as a vertical force vector instead of using a maxillary sectional wire ending with an eyelet lightly tied with an elastic module or with a closed coil spring? 3. Lastly, what were the reasons for performing bone augmentation of the maxillary right anterior region during the orthodontic treatment instead of performing the same bone/gingival graft at the completion of the treatment with the final root and gingival margin position? We would like to compliment the authors for reporting this important case that raised interesting questions to discuss and suggest these different and alternative treatment methods. In this regard, it is our opinion that more studies evaluating different orthodontic and surgical procedures modalities for treating impacted teeth should be performed in the orthodontic field.