Orthodontic Treatment of a Congenitally Missing Maxillary Lateral Incisor

Abstract

Clinicians agree that tooth agenesis regardless of gender or race becomes more prominent in recent societies. The congenital absence of one or more maxillary lateral incisors is a challenge to effective treatment planning for the restorative dentist. The one-sided orthodontic approach of moving canines mesially to eliminate restorative procedures also leads to compromise. Adult patients presenting with malocclusions, missing lateral incisors, and anterior crowding, who request esthetic solutions without proper orthodontic treatment will get compromised results. The avoidance of establishing a stable occlusion, proper alignment and proper axial inclination of the teeth compromises esthetic and periodontal results. Evaluation of anterior smile esthetics must include both static and dynamic evaluations of frontal and profile views to optimize both dental and facial appearance. This article presents how orthodontics is related with other specialties in treating congenitally missing lateral incisor. One case is used to illustrate how orthodontic treatment is progressed in collaboration with other specialists. CLINICAL SIGNIFICANCEPatients with missing teeth, crowding, midline deviation, unesthetic gingival contours, or other restorative needs may require the interaction between different specialists. For the successful treatment of orthodontic-restorative patients, interdisciplinary team management is vital.

Maxillary Lateral Incisor Agenesis (MLIA)

“…For many authors this is the treatment of choice since it is able to get a good esthetic (Millar & Taylor 1995;Pinho, 2003;Park et al, 2010). When the solution is space closure, to obtain an optimal esthetic and functional result it must be assumed that the canines will be modified, so to look and function as lateral incisors.…”

“…Some consideration factors, when closing the space, must be followed: Negative maxillary tooth disharmony (DDM), with crowding in the anterior area (Bowden and Harrison 1994); Class I with crowding, where extractions at the lower arch are indicated (Millar and Taylor 1995;Rosa & Zachrisson, 2001); Mesialized canine and easily modified with an acceptable color, compatible with the adjacent teeth (Millar & Taylor, 1995); the yellowish color of the canines can be improved using the technique of selective vital teeth bleaching (Pinho, 2003); Value of incisors relation with Class II division 1 (Bowden & Harrison 1994); Malocclusion that do not require extraction of mandibular teeth, with respect to Class II canine and molar (Pinho, 2003;Park et al, 2010).…”

“…Before starting any treatment the professional is obliged to inform patients of the various options, their clinical implications, advantages and disadvantages, and what should be the best plan for their particular case. Several factors such as molar ratio, degree of incisors protrusion, facial patterns, skeletal arches interrelation, dental arch configuration, dental inclination, tooth shape, incisal contact, gingival margins contour, black triangles smile line, lip shape, and esthetic results should be considered in therapeutic options (Pinho & Neves 2001, 2003Park et al, 2010). Also, we have to take in consideration the position of the lip attachment at the nasolabial junction that has a profound effect on the esthetics of the profile (Park et al, 2010).…”

Genetic variations in MMP9 and MMP13 contribute to tooth agenesis in a Brazilian population

“…The prevalence of tooth agenesis ranges from 2.6% to 11.3% depending upon the studied population (4,5). Tooth agenesis may lead to various forms of dysfunction and orthodontic and prosthetic problems (6).…”

The treatment dilemma of missing maxillary lateral incisors‐Part I: Canine substitution and resin‐bonded fixed dental prostheses

“…Canine size, contours, shade, and gingival profile can detract from optimal esthetics. Correct leveling of the marginal gingival contours and the size discrepancy between the canine and first premolar can be potentially corrected by extruding the canine and, at the same time, intruding the first premolar . In a 2015 study by Rayner et al, rating a full‐face image with an ideal smile and digitally altered to display canine substitution, dental professionals rated smiles with canine substitution for lateral incisor agenesis less attractive than an ideal smile unless the size, shape, color, and gingival margin approximated that of the lateral incisor (Figure A through D).…”