Congenitally Missing Maxillary Lateral Incisors: Update on the Functional and Esthetic Parameters of Patients Treated with Implants or Space Closure and Teeth Recontouring

Abstract

Maxillary lateral incisor agenesis (MLIA) is a condition that affects both dental esthetics and function in young patients, and represents an important challenge for clinicians. Although several treatment options are available, the mesial repositioning of the canines followed by teeth recontouring into lateral incisors; or space opening/maintenance followed by implant placement have recently emerged as two important treatment approaches. In this article, the current and latest literature has been reviewed in order to summarize the functional and esthetic outcomes obtained with these two forms of treatment of MLIA patients in recent years. Indications, clinical limitations and the most important parameters to achieve the best possible results with each treatment modality are also discussed. Within the limitations of this review, it is not possible to assert at this point in time that one treatment approach is more advantageous than the other. Long-term followup studies comparing the existing treatment options are still lacking in the literature, and they are necessary to shed some light on the issue. It is possible, however, to state that adequate multidisciplinary diagnosis and planning are imperative to define the treatment option that will provide the best individual results for patients with MLIA.

Pediatric Dentist-Pediatrician Cooperation in Early Diagnosis of Congenital Tooth Agenesis

“…Treatment options for congenital agenesis of the permanent maxillary lateral incisor teeth are generally in the form of conservation of the space resulting from congenital agenesis of the lateral tooth or orthodontic closure of this space (61). The preservation and restoration of the space in the region where the permanent maxillary lateral incisor tooth is missing allows for the maintenance of the natural position of the canine in the dental arch, the ideal class 1 molar occlusion and the continuity of the canine protected occlusion (62). This preserved space is later on restored with fixed/removable prosthodontics or implants when the growth of the patient is complete (61,62).…”

“…The preservation and restoration of the space in the region where the permanent maxillary lateral incisor tooth is missing allows for the maintenance of the natural position of the canine in the dental arch, the ideal class 1 molar occlusion and the continuity of the canine protected occlusion (62). This preserved space is later on restored with fixed/removable prosthodontics or implants when the growth of the patient is complete (61,62). Another approach to congenital agenesis of the permanent maxillary lateral incisor is the orthodontic closure of the mentioned tooth space.…”

“…Another approach to congenital agenesis of the permanent maxillary lateral incisor is the orthodontic closure of the mentioned tooth space. This approach is more preferable in cases with class 2 malocclusion, class 1 malocclusion with severe crowding in the maxillary dental arch in which extraction is indicated and in cases of proclined upper incisors (61,62). In this principle, the structure of the alveolar bone is preserved.…”

Substituting congenitally missing maxillary lateral incisors with implant-borne crowns: A topic still worth a discussion?

“…17 On the other hand, recent evidence suggests that good function, pleasing esthetics, and medium/ long-term stability can also be achieved after orthodontic space opening for either a cantilever resinbonded fixed dental prosthesis or for an implantsupported crown in the anterior maxilla. [18][19][20][21][22][23][24][25][26][27][28][29][30] However, implant placement bears the risk of the development of either periimplantitis or infraocclusion over time. Consequent problems with compromised dental esthetics and periodontal health can then only be resolved by complex interdisciplinary approaches.…”

“…56,57 If all these requirements are met, and excellent long-lasting patient compliance in terms of meticulous hygiene manoeuvres and regular recalls is maintained, excellent esthetic and periodontal stability 5 to 10 years after implant placement for substitution of congenitally missing maxillary lateral incisors has already been reported. 22,[27][28][29][30] However, a possible alternative implant solution -especially for unilateral agenesis-is to close the space of the lateral incisor by orthodontic mesialization of the canine, and to open a space for a future implant-borne crown posteriorly, in order to avoid potential long-term sequelae with a more anteriorly placed implant-supported crown. In order to illustrate both interdisciplinary treatment protocols, two exemplary patients with unilateral agenesis of a maxillary lateral incisor will be presented.…”