Congenitally Missing Maxillary Lateral Incisors: Functional and Periodontal Aspects in Patients Treated with Implants or Space Closure and Tooth Re-Contouring

Abstract

To evaluate functional and periodontal aspects in patients with unilateral or bilateral congenitally missing maxillary lateral incisors, treated with either implants or space closure and tooth re-contouring. The sample consisted of 68 volunteers, divided into 3 groups: SCR - space closure and tooth re-contouring with composite resin (n = 26); SOI – implants placed in the area of agenesis (n = 20); and CG - control group (n = 22). A modified Helkimo questionnaire and the Research Diagnostic Criteria for Temporomandibular Disorders were used by a single, previously calibrated evaluator to assess signs and symptoms of temporomandibular joint disorder. The periodontal assessment involved the following aspects: plaque index, bleeding upon probing, pocket depth greater than 3 mm, gingival recession, abfraction, periodontal biotype and papilla index. The data were analyzed using Fisher's exact test and the nonparametric Mann-Whitney and Kruskal-Wallis tests (α=.05). No differences in periodontal status were found between treatments. None of the groups were associated with signs and symptoms of temporomandibular joint disorder. Both treatment alternatives for patients with congenitally missing maxillary lateral incisors were satisfactory and achieved functional and periodontal results similar to those of the control group.

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

“…However, previous prospective clinical studies have demonstrated that the premolar can be considered a suitable replacement for the canine [ 1 , 31 , 36 , 37 ]. In agreement with Robertson & Mohlin (2000) [ 1 ], a recent clinical study, showed that no differences in occlusal function, prevalence of cervical abfraction, or signs of TMD symptoms were present in patients treated with space closure and recontouring of the canines [ 18 ]. Additionally, the same clinical study also reported that in the majority of cases treated with space closure, canine disclusion (by premolar) was present, and neither canine nor group disclusion were found to be related with TMD [ 18 ], corroborating with previous studies [ 1 , 38 ].…”

“…Space opening for treatment with implants is indicated for patients whose upright maxillary incisors need to be protruded, or tipped labially, to help correct anterior crossbite or to gain upper lip support [ 16 ], and to obtain or maintain Angle Class I. Additionally, teeth adjacent to the MLIA should have parallel roots when implants are considered [ 16 , 17 , 50 ], and implant placement should only be performed after complete facial growth, at around 18-19 years for women and 20-21 years for men [ 22 ]. In general, due to the long time required for the treatment with space closure and recontouring of canines, adult patients generally opt for the treatment with implants [ 18 ]. For optimal implant placement, it is crucial to create an adequate orthodontic implant site in relation to the space needed, both coronally and apically [ 53 ].…”

“…Among the options available to the clinician are the possibility of space closure with mesial repositioning of canines, followed by teeth recontouring; or a combination of space opening and prosthetic replacement of the missing lateral incisor [ 14 - 18 ]. Different restorative approaches may be employed in the agenesis area, such as resin bonded fixed partial dentures (FPD), cantilevered FPDs, and conventional full-coverage FPDs.…”

An Alternative Approach for Space Opening in a Bilateral Maxillary Lateral Incisor Agenesis Patient using Miniplates

“…1,7 Although there is much controversy in the literature, 2,4,20 long-term follow-up studies are still needed to determine the stability of such treatments. However, it is safe to state that proper multidisciplinary diagnosis and treatment planning are imperative to define treatment options to provide the best result for each patient.…”

Authors’ response

“…[7][8][9] Because our group is interested in shedding more light on the topic of long-term outcomes of treatment for agenesis of the maxillary lateral incisors with orthodontic space closure vs space opening, we are currently collecting data from our treated patients 5 to 10 years posttreatment, with the goal to publish a study with comparative long-term results, of which only 5 exist in the current literature. [10][11][12][13][14] Ute…”