Orthodontic treatment for patients with uni- or bilateral congenitally missing lateral incisors is a challenge to effective treatment planning. The two major alternatives, orthodontic space closure or space opening for prosthetic replacements, can both compromise aesthetics, periodontal health, and function. The aim of this retrospective study was to examine treated patients who had congenitally missing lateral incisors and to compare their opinion of the aesthetic result with the dentists' opinions of occlusal function and periodontal health. In this sample, 50 patients were identified. Thirty had been treated with orthodontic space closure, and 20 by space opening and a prosthesis (porcelain bonded to gold and resin bonded bridges). The patient's opinion of the aesthetic result was evaluated using the Eastman Esthetic Index questionnaire and during a structured interview. The functional status, dental contact patterns, periodontal condition, and quality of the prosthetic replacement was evaluated. In general, subjects treated with orthodontic space closure were more satisfied with the appearance of their teeth than those who had a prosthesis. No significant differences in the prevalence of signs and symptoms of temporomandibular dysfunction (TMD) were found. However, patients with prosthetic replacements had impaired periodontal health with accumulation of plaque and gingivitis. The conclusion of this study is that orthodontic space closure produces results that are well accepted by patients, does not impair temporomandibular joint (TMJ) function, and encourages periodontal health in comparison with prosthetic replacements.

Objective: To evaluate morphologic stability and patient satisfaction at least 5 years after orthodontic treatment. Materials and Methods: Published literature was searched through the PubMed and Cochrane Library electronic databases from 1966 to January 2005. The search was performed by an information specialist at the Swedish Council on Technology Assessment in Health Care. The inclusion criteria consisted of a follow-up period of at least 5 years postretention; randomized clinical trials, prospective or retrospective clinical controlled studies, and cohort studies; and orthodontic treatment including fixed or removable appliances, selective grinding, or extractions. Two reviewers extracted the data independently and also assessed the quality of the studies. Results:The search strategy resulted in 1004 abstracts or full-text articles, of which 38 met the inclusion criteria. Treatment of crowding resulted in successful dental alignment. However, the mandibular arch length and width gradually decreased, and crowding of the lower anterior teeth reoccurred postretention. This condition was unpredictable at the individual level (limited evidence). Treatment of Angle Class II division 1 malocclusion with Herbst appliance normalized the occlusion. Relapse occurred but could not be predicted at the individual level (limited evidence). The scientific evidence was insufficient for conclusions on treatment of cross-bite, Angle Class III, open bite, and various other malocclusions as well as on patient satisfaction in a long-term perspective. Conclusions: This review has exposed the difficulties in drawing meaningful evidence-based conclusions often because of the inherent problems of retrospective and uncontrolled study design.

Associations between specific types of malocclusions and development of significant signs and symptoms of TMD could not be verified. There is still a need for longitudinal studies.

Motivation for the decision to undergo orthodontic treatment seemed to be social norms, and the beauty culture in their reference group and in society in general. The teenagers were not fully conscious of these external influences. Their opinion, as a group, was that they had made an independent decision to undergo orthodontic treatment.

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