Introduction

Temporary anchorage devices (TADs) and palatal appliances such as transpalatal arches (TPAs) have become integral components of contemporary orthodontic therapy by enabling effective anchorage control during complex tooth movement. Although these appliances demonstrate high clinical success rates, their use may be associated with biological complications including soft-tissue inflammation, mucosal hypertrophy, peri-implant irritation, and, in rare situations, complete mucosal embedding [1,2]. The risk of such complications is influenced by factors including appliance design, insertion depth, oral hygiene status, follow-up compliance, and the nature of the surrounding soft tissue. Previous reports have shown that appliances placed in non-keratinized mucosa are more susceptible to inflammatory tissue overgrowth and subsequent failure compared with those positioned within keratinized tissue [3].

Soft tissue (mucosal) embedding of orthodontic components represents an uncommon iatrogenic complication that may develop gradually due to chronic irritation and progressive soft-tissue proliferation over the appliance surface [4,5]. Patients frequently present with pain during mastication or speech, localized inflammation, difficulty in appliance maintenance, and psychological discomfort. In these situations, routine chairside removal may not be feasible, and surgical exposure becomes necessary to facilitate safe retrieval while minimizing trauma to adjacent periodontal structures [6,7].

This case series reports two unusual soft-tissue complications encountered during orthodontic treatment involving fixed appliances. One case presented with complete mucosal coverage of an orthodontic mini-implant, whereas the other involved partial embedding of the loop of a TPA due to soft-tissue overgrowth. Both complications were treated successfully by surgical retrieval under local anesthesia using a conservative scalpel-assisted approach, with uneventful healing and no postoperative complications. Although such events are uncommon, they can cause patient discomfort and interfere with ongoing orthodontic treatment if left unrecognized. These cases highlight the value of regular follow-up visits, careful evaluation of appliance-tissue relationships, and timely surgical management in achieving predictable clinical outcomes and preventing further complications. This work has not been previously presented in part or in full at any conference, symposium, or meeting.