Congenitally missing maxillary lateral incisors: Canine substitution

"In Their Own Words": Families' Experiences With Tooth Autotransplantation for the Replacement of Maxillary Incisors in Children

OBJECTIVES

To examine families' experiences, including motivation and barriers to undergoing tooth autotransplantation (AT), and their perceptions of associated esthetic and functional outcomes.

METHODS

Semi-structured, in-depth-interviews (IDIs) were conducted in person with families who had children that underwent the AT procedure. Interviews were audio recorded and transcribed. Transcripts were coded and thematically analyzed both deductively and inductively. A facilitators and barriers matrix and journey maps were created to draw inferences on patterns arising from main themes.

RESULTS

Twenty families selecting AT as a solution for a missing maxillary incisor were recruited and interviewed. Overall, all families interviewed had a positive experience with the AT procedure. Motivating factors for undergoing the AT procedure included wanting an earlier intervention for the missing incisor, wishing to mitigate negative psychosocial effects, and the anticipated positive outcomes that would last into adulthood. Barriers to uptake of the AT procedure included the lack of dental practitioner awareness of AT as a potential solution and a large number of appointments and travel. Families were also initially concerned over potential complications that could arise from their child undergoing this procedure. The cost of the procedure was both a barrier and a facilitator for treatment.

CONCLUSIONS

The study results demonstrate that the overall AT is favorably considered by the families of growing children for the replacement of maxillary incisors and highlight factors that may act as motivators or barriers to its uptake.

Systemic Factors Affecting Orthodontic Treatment Outcomes and Prognosis - Part 1

This article explores the intersection of various systemic conditions with orthodontic treatment. Renal diseases, including chronic kidney disease and renal transplant, present challenges such as delayed tooth eruption and gingival overgrowth, necessitating careful orthodontic planning and collaboration with physicians. Liver diseases, particularly hepatitis, heighten the risk of periodontal disease and mandate strict infection control measures during orthodontic procedures. Ehlers-Danlos syndrome poses challenges related to collagen fragility, rapid tooth movement, and orthodontic relapse. Autoimmune diseases like diabetes mellitus and juvenile idiopathic arthritis require tailored orthodontic approaches considering oral complications and joint involvement.

Systemic Factors Affecting Orthodontic Treatment Outcomes and Prognosis-Part 2

This article explores the various challenges systemic conditions can pose before and during orthodontic treatment. Cardiovascular conditions like infective endocarditis require antibiotic prophylaxis before certain orthodontic procedures are started. Patients with bleeding disorders require special considerations in regards to viral infection risk and maintenance of excellent atraumatic oral hygiene. Orthodontists play an important role in early identification of signs and symptoms of eating disorders and should deal with these patients sensitively. Congenital disorders, craniofacial anomalies, and nutritional deficiencies require special considerations and should be addressed appropriately before orthodontic treatment is started.

Treatment of absent maxillary lateral incisors: orthodontic space closure and associated procedures

Missing maxillary lateral incisors can be treated either with orthodontic space closure or preservation of the edentulous space for tooth replacement. Orthodontic space closure coupled with non-invasive post-orthodontic cosmetic dentistry is a compelling option compatible with optimal function, favourable aesthetics, and periodontal health in the long-term. We present the rationale for space closure and detail contemporary clinical strategies underpinning interdisciplinary treatment planning and excellence in finishing.

Digital planning in joint orthodontic-restorative care

Combined orthodontic-restorative treatment represents an increasing proportion of our practice, mirroring increasing provision of adult orthodontics and refinements in appliance design. By harnessing simple digital technology, it may be possible to promote more predictable aesthetic, biological and functional interdisciplinary outcomes. In particular, digital approaches can be embedded in the diagnostic and treatment planning phase, enhancing our communication with patients and colleagues while also permitting more detailed analysis and more refined planning.

Cleft lip and palate outcomes: Multidisciplinary approach for comprehensive management

In patients with cleft lip and palate the most common associated dental problem is lateral incisor agenesis, often associated with lack of support and definition of the nasal tip. In many cases, adhesions deriving from surgical procedures and skeletal discrepancy make orthognathic surgery and rhinoseptoplasty unavoidable. In the present case report a dental rehabilitation with canine substitution and prosthetic-implant treatment in a posterior area is described. The use, during rhinoseptoplasty, of a customized titanium prosthesis, which provides projection for the tip of the nose, is also introduced. The patient was administered two questionnaires in order to assess the psychological aspects related to the cleft outcomes and the influence that the treatment conveyed.

Conservative interdisciplinary management for a congenitally missing maxillary lateral incisor in an adolescent patient

A congenitally missing lateral incisor tooth is commonly associated with both short and long-term clinical dilemmas, particularly for a growing patient. A unilaterally missing maxillary lateral incisor tooth creates a significant dental asymmetry in the critical aesthetic zone of the smile and potentially increases the difficulty of any subsequent orthodontic and restorative treatment. Carefully planned interdisciplinary management is required to address the challenges of anterior dental asymmetry, unilateral orthodontic space closure and to alleviate the concerns that accompany restorative implant placement in the anterior maxilla. The use of skeletal temporary anchorage devices has increased the predictability of orthodontic space closure, particularly for missing maxillary lateral incisor cases which were previously considered to be unsuitable.

Open surgical exposure of two horizontally impacted maxillary incisors combined with orthodontic treatment: A case report

INTRODUCTION

Maxillary anterior teeth that have not erupted may substantially alter the appearance of the teeth and face. Orthodontists often encounter a clinical challenge while dealing with an impacted maxillary incisor, which creates space problems in the anterior region. The purpose of this paper is to describe the well-synchronized orthodontic and surgical treatment of a horizontally impacted maxillary central incisors.

CASE PRESENTATION

A male patient, aged 27, presented with a complaint of unerupted two maxillary front teeth. This resulted in the displacement of adjacent teeth into the vacant region. An intraoral examination revealed a Class II molars on both sides, a deep curve of the space with a 2.3 mm overjet, and an edge-to-edge bite of 0.1 mm. The 3D cone beam computed tomography (CBCT) imaging unveiled a labial impacted and a rotation of approximately 90 degrees (horizontal impacted) on both central maxillary incisors.

DISCUSSION

The self-ligating bracket was installed and orthodontic traction aligned the affected tooth in the dental arch. To reach the labial surface of the impacted incisor, open surgical exposure by window excision of soft tissues with a laser was preferable due to the large bulge in the sulcus. Because self-ligating bracket systems employed modest pressures to position the maxillary right central incisor in the arch, the window surgical technique did not produce gingival scarring or increased clinical crown length.

CONCLUSION

The impacted upper central incisor was successfully treated using a collaborative interdisciplinary (surgical-orthodontic) approach, which resulted in a favorable aesthetic and functional outcome.

The Prevalence of Congenitally Missing Permanent Teeth in a Sample of Orthodontic and Non-Orthodontic Caucasian Patients

BACKGROUND

Hypodontia represents a notable clinical and public health concern.

OBJECTIVE

To assess the prevalence of congenitally missing permanent teeth in a sample of orthodontic/dental patients of Caucasian origin originating from the Greek island of Lesvos.

MATERIALS AND METHODS

Panoramic X-rays from 621 children and adolescents, aged 9 to 16 years (average age 12.5 years), 521 seeking orthodontic care (orthodontic group) and 100 seeking dental care (non-orthodontic group) were examined to identify congenitally missing permanent teeth.

RESULTS

The orthodontic group exhibited a 5.5% prevalence of congenitally missing permanent teeth (2.8% females; 2.7% males), while the non-orthodontic group showed a prevalence of 4% (3% females; 1% males). The descending order of prevalence for missing tooth types was as follows: lower second premolars, upper laterals, lower central incisors, lower canines, upper second premolars, and lower second molars. Among orthodontic patients with missing teeth, 62% presented with an Angle's Class II malocclusion. Hypodontia was most frequently observed in the mandible. No statistically significant differences were observed between the orthodontic and non-orthodontic groups in terms of the percentage of children and types of congenitally missing teeth.

CONCLUSIONS

Congenitally missing teeth were observed in about 4-5% of the studied population with a female predilection. The lower second premolar was the most commonly absent tooth, followed by the maxillary lateral incisors. An Angle's Class II malocclusion was present in the majority of orthodontic patients with hypodontia, mostly in the mandible.

Implant-supported crowns on maxillary laterals and canines-a long-term follow-up of aesthetics and function

OBJECTIVES

To assess the long-term aesthetic and functional aspects of implant-supported crowns in lateral (ISC-L) and canine positions (ISC-C).

MATERIALS AND METHODS

Thirty-two patients (14 males, 18 females, mean age: 23.1, SD:2.0) with an ISC-L or ISC-C participated in this prospective cohort study at baseline (T0) and in the long-term follow-up (T1, mean years: 11.1, SD: 1.0). Twenty-four patients (11 males, 13 females) participated in T1. Patient-reported outcomes (PROM) were rated using surveys with questions related to aesthetics and function. The colour of the implant crown and the buccal gingiva, the appearance of the papilla, periodontal health and temporomandibular disorder (TMD) outcomes were assessed in a clinical examination. The Mann-Whitney, Chi-square and Signed Rank tests were performed.

RESULTS

Patients with an ISC-L and ISC-C were equally satisfied with the crown shape and colour at T0 and T1. No differences in TMD outcomes were reported by the patients and no clinical signs of TMD were observed. At T1, ISC-C had more bleeding on probing and a three mm greater pocket depth than ISC-L (p = 0.03, p = 0.01, respectively). At T0, operators graded the crown colour of ISC-L as being too dark (35%) and ISC-C as being too light (40%). At T1, no difference was seen between the two groups regarding crown colour, gingiva colour and the papilla (p = 0.2749, p = 0.2099, p = 0.8053, respectively).

CONCLUSIONS

The PROM and clinical examination show that ISC-L and ISC-C are equivalent with regard to aesthetics and function in the long term.

CLINICAL RELEVANCE

Although ISC-L and ISC-C are aesthetically and functionally comparable in the long term, ISC-Cs are more likely to impact periodontal health.

Tooth agenesis: An overview of diagnosis, aetiology and management

Patients with one or more developmentally absent teeth are routinely encountered in dental practice. Tooth agenesis can be associated with significant functional, aesthetic and psycho-social problems. The present article provides an overview of the prevalence and aetiology of tooth agenesis, as well as the condition's clinical characteristics and management options with reference to the evidence base. A timely diagnosis can facilitate the appropriate planning and management which might not be straightforward, and patient care will likely require multi- and inter-disciplinary input. It is critical that dental care practitioners are aware of the clinical characteristics and management options for tooth agenesis.

Maxillary Impacted Canine and Upper Lateral Incisor Agenesis Treatment with "Canine First Technique" and Clear Aligners: A Case Report

The aim of this study was to show a case of an impacted canine in an adult patient with agenesis of the maxillary lateral incisor treated with clear aligners (CA). A 19-year-old male with a persistence of 5.3 and absence of 1.2 came to our department of the School of Orthodontics at the University of Federico II in Naples and asked for an aesthetic treatment. The Canine First approach was used to surgically expose the canine and pull it into the dental arch. In order to ensure long-term aesthetic, periodontal, and occlusal results, a treatment with CAs to close the space through the mesial placement of the canine and the enameloplasty of the tooth crown was performed. At the end of the treatment, the occlusal objectives were achieved.

A cost analysis of orthodontic space closure and implant treatment in patients missing maxillary lateral incisors with a long-term perspective

OBJECTIVE

Few studies within orthodontics present both economic and clinical findings. Missing maxillary lateral incisors is a frequently occurring anomaly. The treatment alternatives most used are orthodontic space closure and prosthetic replacement of the missing tooth. Our aim is to compare the total societal costs of orthodontic space closure (SC) and implant therapy (IT) in patients missing maxillary lateral incisors.

METHODS

Records of 32 patients treated with SC (n = 18) or IT (n = 14) due to missing maxillary lateral incisors were retrieved from the archives. Direct costs and indirect costs in the short- and long-term were analysed using a cost analysis with a societal perspective up of to 12 years post-treatment.

RESULTS

Comparing cases treated with SC and IT, the difference in direct short-term costs for treatment is €735.54, whereas SC is the least costly. There is no difference between SC and IT in short-term parent loss of productivity, long-term loss of productivity, costs for transportation, or direct long-term costs. A difference was found between SC and IT-in favour of SC-when comparing patients' loss of productivity (P = 0.007), short-term societal costs (P < 0.001), long-term societal costs (P = 0.037), and total societal costs (P < 0.001).

LIMITATIONS

There is a limited number of patient records. Local factors such as subsidies, urban versus rural areas, taxes, etc. can influence monetary variables, so the transferability to other settings may be limited.

CONCLUSION

Patients treated with SC have a lower total societal cost compared to patients treated with IT. There was a difference in productivity loss for patients between SC and IT; however, concerning other indirect parameters and direct long-term costs, there was no difference between the two treatments.

Orthodontic treatment of traumatically avulsed maxillary central incisors with bimaxillary dentoalveolar protrusion in an adult female: a case report

BACKGROUND

Clinicians agree that obtaining and retaining good treatment results for missing maxillary central incisors owing to trauma is not easy. Management of adult patients with permanent maxillary central incisor loss who visit the clinic with high expectations for aesthetics and function pose a significant diagnostic dilemma. Therefore, esthetic and functional outcomes should be taken into consideration when deciding the proper treatment method. The treatment described in this study aimed to reestablish smile esthetics by proposing an effective multidisciplinary clinical approach that includes orthodontic-prosthetic-periodontal procedures, optimally reduced lip protrusion, center dental midlines, and establishment of stable occlusion.

CASE PRESENTATION

The patient was a 19-year-old adult female with bimaxillary arch protrusion who had been wearing removable dentures for several years since the loss of her maxillary central permanent incisors. A multidisciplinary treatment including the extraction of two mandibular primary premolars was adopted. The treatment plan consisted of orthodontic space closure by shifting the adjacent teeth towards the central incisor spaces combined with appropriate morphologic remodeling and gingival reshaping to obtain good aesthetic and functional results. The duration to complete the orthodontic treatment was 35 months. Clinical and radiographic results after treatment suggested smile harmony with an improvement in the facial profile, good function of the occlusion, and a positive effect on bone remodeling in the area of the missing incisors during orthodontic tooth movement.

CONCLUSIONS

This clinical case illustrated the necessity for using multidisciplinary methods involving orthodontic, prosthodontic, and periodontic procedures to treat an adult female patient with bimaxillary arch protrusion and long-term absence of anterior teeth due to severe trauma.

Permanent Tooth Agenesis and Associated Dental Anomalies among Orthodontically Treated Children

(1) Background: Tooth agenesis is one of the most common developmental dental anomalies often affecting the maxillary incisors area and premolar regions. (2) Purpose: The aim of this study was to assess the prevalence and distribution of permanent tooth agenesis and the associated dental abnormalities among orthodontically treated children. (3) Materials and Methods: This study was carried out utilizing 3000 pretreatment records of children who underwent orthodontic treatment, 1780 (59%) females and 1220 (41%) males, aged 10-25 years (mean age 15 years). Tooth agenesis and other dental anomalies were surveyed using their panoramic radiographs, according to gender, pattern, and location. The level of statistical significance was set at p < 0.05 using t-test or Chi-Square tests. (4) Results: The total number of missing teeth, excluding third molars, was 518 (17%) found in 326 (11%) children. The majority were the maxillary lateral incisors, which was 176 teeth (34%) (p < 0.05). Of them, 111 (63%) were in females, and 65 (37%) were in males. The second most common missing tooth was mandibular second premolars, which was 137 teeth (26%), followed by missing 73 (14%) maxillary second premolars. Impacted teeth had the highest associated dental anomaly prevalence (14.3%), while transposition showed the lowest anomaly prevalence (0.5%). (5) Conclusions: A prevalence of 11% for tooth agenesis was detected in this study. More teeth were missing in the maxilla compare with the mandible. A significant association was found between missing maxillary lateral incisors and missing premolars (p < 0.05). Associated dental anomalies included an increased number of peg-shaped maxillary lateral incisors, palatally displaced and impacted maxillary canines, ectopic teeth, and infra-occluded (submerged) primary second molars.

Closure of maxillary lateral incisor agenesis space in unilateral cleft lip and palate: a digital model assessment

OBJECTIVE

To compare dental positional and gingival parameters of maxillary anterior teeth in unilateral cleft lip and palate (UCLP) after orthodontic treatment with canine substitution due to lateral incisor agenesis.

METHODS

This split-mouth study comprised 57 subjects with UCLP (31 male, 26 female) and agenesis of maxillary lateral incisor at the cleft side, from a single center. Canine substitution was completed after the secondary alveolar bone graft. Dental models were taken between 2 to 6 months after debonding (mean age: 20.4 years). The following variables were measured in the maxillary anterior teeth: crown height, width, proportion, and symmetry, as well as steps between incisal edges, gingival margins, tooth mesiodistal angulation and labiolingual inclination. Paired t-tests with Bonferroni post-hoc correction was used for comparisons between cleft and non-cleft sides (p<0.05).

RESULTS

At the cleft side, canines replacing missing lateral incisors had a higher crown height (0.77mm) and an increased width (0.67mm), and first premolars showed a shorter crown height (1.39mm). Asymmetries were observed in the gingival level of central and lateral incisors, with a greater clinical crown at the cleft side (0.61 and 0.81mm, respectively). Cleft side central incisors were more upright than their contralaterals (2.12º).

CONCLUSIONS

Maxillary anterior teeth demonstrated positional, size and gingival height differences between cleft and non-cleft side after space closure of maxillary lateral incisor agenesis. Slight asymmetries in tooth position and gingival margin in the maxillary anterior teeth should be expected after orthodontic treatment in UCLP patients.

A Multidisciplinary Approach to Maxillary Lateral Incisor Agenesis (MLIA): A Case Report

Maxillary lateral incisor agenesis (MLIA) is a condition that significantly compromises smile esthetics and is a particular concern in younger patients. The treatment options include orthodontics for space opening with rehabilitation or space closure with canine camouflage. Currently, there is some controversy regarding the most appropriate treatment. In this case report, we propose a multidisciplinary approach through the combination of orthodontic treatment, frenectomy, and a restorative finishing stage with composite resin and dental implants. More specifically, this treatment was planned to orthodontically close the anterior space by opening the premolar area for subsequent placement of implants and enameloplasty with a composite resin. The replacement of a missing lateral incisor by an implant is a predictable treatment approach, but it might best be deferred until dental maturity and then accurately placed in a well-developed site through a multidisciplinary approach. Precluding the closure of the anterior spaces and the opening of the posterior zone for implant placement, allows for a more stable and appealing esthetic and functional rehabilitation for young patients, in whom esthetic appearance and self-esteem play a primary role.

Agenesis of maxillary lateral incisors: diagnosis and treatment options

Introduction:

There are different possibilities of orthodontic planning for cases with congenital absence of maxillary lateral incisors. This subject divides the opinion of orthodontists and oral rehabilitation clinicians, due to the advantages and disadvantages of each treatment option, which may involve opening spaces for future implants and/or prosthetic restorations, or closing the spaces by positioning the maxillary canines in the place of lateral incisors. The correct diagnosis and careful evaluation of each patient allow to determine the best therapeutic approach. This paper discusses the main topics to be considered when planning these cases.

Objectives:

To evaluate the main aspects related to orthodontic treatment planning in cases of congenital absence of maxillary lateral incisors, to aid the decision-making, with clinical and scientific basis.

Maxillary space closure using a digital manufactured Mesialslider in a single appointment workflow

New digital technologies, many involving three-dimensional printing, bring benefits for clinical applications. This article reports on the clinical procedure and fabrication of a skeletally anchored mesialization appliance (Mesialslider) using computer-aided design/computer-aided manufacturing (CAD/CAM) for space closure of a congenitally missing lateral incisor in a 12-year-old female patient. The insertion of the mini-implants and appliance was performed in a single appointment. Bodily movement of the molars was achieved using the Mesialslider. Anchorage loss, such as deviation of the anterior midline or palatal tilting of the anterior teeth, was completely avoided. CAD/CAM facilitates safe and precise insertion of mini-implants. Further, mini-implants can improve patient comfort by reducing the number of office visits and eliminating the need for orthodontic bands and physical impressions.

Late alveolar bone grafting in complete unilateral cleft lip and palate (UCLP): Biomechanical considerations for the success of orthodontic finishing

Orthodontic treatment in patients with cleft lip and palate (CLP) is challenging. Alignment of the maxillary segments and orthodontic levelling of the teeth adjacent to the cleft area are important before alveolar bone grafting (ABG), in the permanent dentition. In this clinical report, orthodontic procedures, before and after late ABG, are described as an alternative that can optimise the orthodontic and periodontal results. The gingival margins of the teeth adjacent to the cleft area were levelled. Root divergence was corrected. Interdental papilla and improvement of the periodontal condition were obtained.

Class III malocclusion with traumatic unilateral maxillary central incisor loss treated using orthodontic miniscrews: a case report

The present article reports the successful non-extraction orthodontic treatment using miniscrew anchorage in a patient who presented with maxillary left central incisor loss and unstable jaw movements. The chief complaints of the 23-year-old female patient were her protruding teeth and crowding of the mandibular anterior segment. The patient lost her maxillary left central incisor as a result of a traumatic injury during childhood. However, the crown was saved and attached to the adjacent teeth. The patient was diagnosed with a skeletal Class III and Angle Class III dental malocclusion. The jaw movements determined by a 6 degrees of freedom jaw movement recording system were unstable and irregular. Miniscrew anchorage was applied for distalisation of the maxillary right dentition and the mandibular dentition during non-extraction treatment. The maxillary left dentition was mesialised using miniscrew anchorage to close the space as a result of the lost maxillary left central incisor. After an active treatment duration of 36 months, the patient achieved a Class II molar relationship on the left side, a Class I on the right side, an optimal overjet and overbite, and a pleasing facial profile. Despite the asymmetric molar relationships, functionally stable and smooth jaw movements were established. The skeletal, occlusal and functional stability remained satisfactory after a 2-year retention period. In conclusion, miniscrew anchorage was valuable in supporting asymmetric tooth movement during non-extraction appliance treatment in a patient who presented with traumatic unilateral tooth loss.

Bidimensional system for space closure treatment of missing lateral incisors: 10 years follow-up

INTRODUCTION:

Missing lateral incisors represent a common condition that normally requires specific anchorage conditions to be treated with space closure mechanics to protract upper teeth creating a proper occlusal relationship.

CASE PRESENTATION:

Two cases showing Class II malocclusion with missing lateral incisors in developing age are presented, both treated with the same approach of maximum anterior anchorage applied using the Bidimensional Technique system. Long-term follow-up of 10 years is shown.

MANAGEMENT AND OUTCOME:

Bidimensional technique is a modified edgewise technique that uses sliding mechanics for protraction of the posterior segments by placing vertically slotted brackets of different sizes on the anterior (.018” x 0.025”) and posterior teeth (.022” x 0.028”). When a .018” x .022” wire is inserted in the .018” x .025” brackets slot on the incisors, third-order control is created in the incisor segment while the wire is undersized in the rest of the arch. Lateral brackets have been positioned on the canines, while the canine brackets have been positioned on the first premolars respecting a differential bonding height able to produce canine extrusion and first premolars intrusion and proper torque expression. Full Class II molar relationship and Class I substituted canine relationship has been reached in both cases and kept stable in the long-term follow-up (10 years).

DISCUSSION:

The described approach provided anterior anchorage with more simple mechanics expressing the anterior torque with a full engagement concept and adding few auxiliaries (uprighting springs) which do not require compliance.

Laypeople and dental professionals' perception of the aesthetic outcome of two treatments for missing lateral incisors

Objective

To investigate laypeople and dental professionals' opinions of the aesthetic outcome from implant therapy (IT) and orthodontic space closure (SC) for missing maxillary lateral incisors.

Material and methods

Evaluation was performed by three groups: laypeople 20–30 years of age (n = 26), laypeople 50–70 years of age (n = 26) and orthodontists (n = 25). The assessors viewed photographs of 44 different cases treated with IT or SC, and made an evaluation of the aesthetics.

Results

The gingival color adjacent to the replaced tooth was rated as having better aesthetics in the SC cases (p = 0.000). The orthodontists preferred the aesthetics of the dentition in the SC cases (p = 0.042). The young laypeople, compared to the older laypeople and orthodontists, were more dissatisfied with the color of the tooth replacing the missing lateral incisor in SC cases (p = 0.043).

Conclusion

The color of the gingiva adjacent to the implant‐supported crowns had a lower aesthetic rating than the SC group. Laypeople rated both treatments as equally good. The orthodontists had a slight preference for the aesthetics in the SC cases.

Multidisciplinary management of congenitally missing lateral incisors: A minimally invasive approach

The following case report demonstrates how a multidisciplinary team approach can be utilized successfully for the minimally invasive esthetic treatment of congenitally missing maxillary lateral incisors through space closure and canine re-anatomization.

Trends in orthodontic management strategies for patients with congenitally missing lateral incisors and premolars

OBJECTIVES

To identify changes in orthodontic management strategies in patients with hypodontia seen in 2000, 2010, and 2017/2018 (during a 1-year period).

MATERIALS AND METHODS

An assessment of the panoramic radiographs of 3701 patients from a Western Australian private practice identified 276 individuals demonstrating hypodontia. The location of missing teeth, age, sex, type of malocclusion, and the management strategies (space closure or opening) for each patient were noted.

RESULTS

Most hypodontia involved agenesis of three or fewer teeth (90%). Maxillary lateral incisors and mandibular second premolars were the most commonly missing teeth. Female preponderance was noted. When considering treatment, the odds ratio for orthodontic space opening and prosthetic replacement in 2000 was 3.266 (P value = 7e-04; 95% confidence interval [CI], 1.464-4.633) compared with patients seen in 2010 and 1.632 (P value = 7e-04; 95% CI, 0.811-2.434) compared with patients in 2017/2018. For patients demonstrating bilateral absence of maxillary lateral incisors, the odds ratio for orthodontic space opening was 3.185 (P value = 0.0215; 95% CI, 1.182-9.243) compared with counterparts with unilateral agenesis. None of the factors investigated were significantly associated with the types of treatment planned/provided for the patients with missing mandibular second premolars.

CONCLUSIONS

Maxillary lateral incisors and mandibular second premolars were the most commonly missing teeth. A trend away from space opening and prosthetic replacement toward orthodontic space closure was observed from 2000 to 2017/2018. This may reflect a change in attitude toward prosthetic replacement options and/or greater optimism with biomechanical strategies since the implementation of temporary anchorage devices to assist in space closure.

Association between hypodontia of permanent maxillary lateral incisors and other dental anomalies

Introduction:

Tooth agenesis is often associated with other tooth anomalies, such as microdontia, delayed eruption and ectopic eruption. Moreover, they may be found all in the same individual, as certain genetic mutations may have a variable phenotypic expression. Treatment of cases of hypodontia of anterior teeth should not involve only opening or closing space for prosthetic rehabilitation. Individuals with hypodontia of permanent maxillary lateral incisors may have teeth with a mesiodistal width smaller than that of patients with a normal dentition, and which may need reshaping to achieve an esthetic and functional occlusion.

Objective:

This clinical case report discusses the association of hypodontia of permanent maxillary lateral incisors with other tooth anomalies and their treatment alternatives.

When to Substitute a Missing Upper Lateral With a Canine: A Simplified Approach

Introduction:

The upper lateral incisor is the most commonly missing tooth in the anterior segment. It leads to esthetic and functional imbalance for the patients. The ideal solution is the one that is most conservative and which fulfills the functional and esthetic needs of the concerned individual. Canine substitution is evolving to be the treatment of choice in most of the cases, because of its various advantages. These are special cases that need more time and effort from the clinicians due to space discrepancy in the upper and lower arches, along with the presentation of individual malocclusion.

Aims and Objectives:

Malocclusion occurring due to missing laterals is more complex, needing more time and effort from the clinicians because of space discrepancy, esthetic compromise, and individual presentation of the malocclusion. An attempt has been made in this article to review, evaluate, and tabulate the important factors for the convenience of clinicians.

Method:

All articles related to canine substitution were searched in the electronic database PubMed, and the important factors influencing the decision were reviewed. After careful evaluation, the checklist was evolved.

Result:

The malocclusions in which canine substitution is the treatment of choice are indicated in the tabular form for the convenience of clinicians. Specific treatment-planning considerations and biomechanics that can lead to an efficient and long-lasting result are also discussed.

Conclusion:

The need of the hour is an evidence-based approach, along with a well-designed prospective randomized control trial to understand the importance of each factor influencing these cases. Until that time, giving the available information in a simplified way can be a quality approach to these cases.

Orthodontic Space Closure of a Missing Maxillary Lateral Incisor Followed by Canine Lateralization

Maxillary lateral incisor agenesis is the most prevalent developmental dental anomaly. The management of missing lateral incisor was either closure using canine as substitution or creation of space orthodontically for prosthetic replacement. A careful diagnosis and treatment plan are deemed essential to address the patient's needs as the spacing is present in the esthetic region. Such problem is very challenging for orthodontists, prosthodontists, and general practitioners. This case report describes the orthodontic management of a 22-year-old adult female patient with missing upper left lateral incisor tooth and upper anterior spacing by closing the space with canine lateralization and reshaping to simulate it with the lateral incisor. However, some modifications in the treatment mechanics are crucial to achieve the optimal esthetic and to improve the occlusion. Space closure with canine lateralization option seems less invasive, treatment can be completed relatively in a short period of time, and its adaptation with the facial changes throughout life without having artificial prosthesis provided other factors favoring for this option.

Solutions for atypical problems in the incisors area: a transdisciplinary challenge

Introduction:

A significant increase in the number of adults in search of orthodontic treatment has raised a new challenge for orthodontists: the need to interact with other specialties to achieve excellent results, particularly when dealing with smile aesthetics and facial balance. Several factors should be considered to respond to their demand: adequate tooth leveling and alignment, individual tooth proportions between adjacent teeth and their contralateral teeth, shape and natural appearance of each tooth and gingival architecture, which should all be in agreement with facial harmony. Maxillary or mandibular incisors congenitally missing or lost due to caries or trauma and tooth-size discrepancies (Bolton) are some of the important aesthetic challenges for an integrated orthodontic treatment.

Objectives:

This study describes cases that illustrate the clinical challenges of treating the anterior area, as well as the multidisciplinary strategies required for their resolution.

Conclusion:

The increasingly frequent multidisciplinary orthodontic treatments of complex cases seem to effectively maximize aesthetic and functional results using a combination of procedures conducted by specialists in related areas, such as Surgery, Prosthetics, Implantology, Restorative Dentistry and Periodontics.

Concomitant permanent maxillary canine agenesis and transposition treated with extractions and lingual brackets

This case report describes the successful orthodontic treatment for a healthy woman with maxillary canine-premolar transposition associated with rare hypodontia of the contralateral canine. The treatment included extraction of the transposed maxillary right and deciduous maxillary left canines and 2 mandibular second premolars. The objectives of the treatment were to (1) correct the upper midline deviation and the occlusal plane cant, (2) move the maxillary first premolars into the canine position, (3) retract the mandibular incisors to improve the facial profile, and (4) reduce the labial protrusion. Orthodontic treatment was carried out with the lingual technique in the maxillary arch and esthetic ceramic brackets in the mandibular arch. The segmented mechanics were effective, fast, and consistently promoted the necessary movement without side effects. The smile line was improved, resulting in an ideal and esthetic gingival exposition, with the borders of the maxillary teeth following the lower lip smile curvature. The patient achieved ideal dentofacial esthetics, achieved better dental and functional occlusion, was pleased with her improved facial contour, and as a result, showed an improved self-image.

Orthodontic management of a non-syndromic patient with concomitant bimaxillary hypohyperdontia: a case report

Introduction:

Tooth agenesis is one of the most common dental anomalies; however, the concomitant occurrence of opposite dental numerical variation of hypohyperdontia is extremely rare.

Objective:

To report the successful orthodontic management of a patient with non-syndromic concomitant bilateral agenesis of mandibular canines and two midline inverted supernumerary maxillary teeth.

Case report:

21-year-old female patient with a chief complaint of protrusive right maxillary central incisor. The patient was diagnosed with a mild Class II skeletal base, Angle Class III molar relationship and increased overjet associated with hypohyperdontia. Anterior open bite accompanied with tongue-thrusting habit were also observed. Two temporary anchorage devices (TADs) were implanted at the buccal side of the maxillary molar region to control vertical height. Anterior teeth retraction was done after extraction of the maxillary first premolars, to improve the excessive overjet. The treatment mechanics involved lingual brackets system for the maxillary arch and transpalatal arch for anchorage control.

Results:

The total active treatment period was 35 months. Acceptable occlusion with increased bite force and contact area as well as functional excursion were established without interference, following complex orthodontic treatment with premolar substitution. The resultant occlusion and a satisfactory facial profile were maintained after 29 months of retention.

Conclusion:

The present case report provides implications regarding the orthodontic treatment of hypohyperdontia-associated substitution for missing teeth as an effective option for improving aesthetic and functional aspects.

Mini-Implant-Assisted En Masse Protraction of Maxillary Posterior Segment

Protraction of posterior teeth to close the spaces in patients with congenitally missing maxillary lateral incisors is challenging. Mini-implants are a reliable source of anchorage for this purpose. This case report demonstrates the application of a T-bar protraction appliance with a palatal mini-implant for en masse protraction of posterior teeth into the lateral incisor space in an adolescent patient. The patient's occlusion and esthetics were significantly improved, and ideal overjet and overbite were obtained after 30 months of treatment. Follow-up records six months after the completion of the treatment displayed stable results.

Canine edge width and height affect dental esthetics in maxillary canine substitution treatment

Background

To investigate the effect of canine edge width and height on dental esthetics in maxillary canine substitution treatment.

Methods

A total of 127 canine substitution treatment cases were screened and evaluated by a panel of orthodontic experts and laypersons in the pilot study. The top five subjects with the esthetically most pleasant canine substitution were included in the study, resulting in 140 computerized images displaying only the upper dentition, with different canine edge widths (0%, 12.5%, 25%, 37.5%, 50%, 62.5%, and 75% of the central clinical width) and heights (− 0.5 mm, 0 mm, 0.5 mm, and 1.0 mm vertically relative to the central incisor edge) finally used for the esthetic evaluation by 101 observers (41 orthodontists and 60 laypersons). The ordered logistic regression analysis, the univariate analysis of variance, the chi-square, and Fisher’s exact tests were used for statistical analyses.

Results

The most esthetic canine shape for canine substitution was found to be a shape with the edge width of 62.5% of the central incisor width and the edge height of 0.5 mm gingival to the central incisor edge (P < 0.05). The canine edge width of 50–75% and height of 0.5–0 mm gingival to the central incisor edge were generally considered to be esthetic by all observers. Orthodontists and laypersons had the same ranking on the top two most esthetic canine shapes (edge width and height 62.5% and 0.5 mm gingival; 50% and 0 mm incisal) as well as the bottom two most unesthetic canine shape (0% and 0.5 mm gingival; 75% and 1 mm incisal). Male and female observers generally had similar esthetic grades and rankings on the canine shapes (P > 0.05).

Conclusions

The most esthetic canine shape for canine substitution is a shape with the canine edge width of 62.5% of the central incisor width and the edge height of 0.5 mm gingival to the central incisor edge. The different collocations of the canine edge width and height affect dental esthetics of the canine during canine substitution treatment.

Semi-permanent Substitution of Maxillary Anterior Teeth: TADs Supported Approach

The present paper describes a technique for intermittent replacement of missing anterior edentulous spans which in simple, logical, less time consuming and cost-effective. The objective was to incorporate a rigid framework as a long edentulous span had to be replaced, along with miniscrews at two different angulations, thus restricting the effect of perioral and masticatory forces in an effective manner

Torturous path of an elastic gap band: Interdisciplinary approach to orthodontic treatment for a young patient who lost both maxillary central incisors after do-it-yourself treatment

Spacing between the maxillary anterior teeth is a common concern for young patients and their parents. Patients often consider a diastema to be an annoying but minor problem; they might consult their general dentists for help, or try to address the issue themselves by applying elastic "gap bands." Moreover, parents, without any informed consent, sometimes accept this erroneous method as an easy and inexpensive treatment approach. A 9-year-old boy had severe acute periodontitis involving the maxillary central incisors caused by the placement of an elastic band and its apical migration. Despite periodontal and surgical interventions, the maxillary central incisors were finally extracted, and the patient started orthodontic treatment. The orthodontic treatment plan included maxillary lateral incisor substitution to replace the lost central incisors and mesialization of the maxillary posterior dentition. An interdisciplinary approach with excellent cooperation among the orthodontist, general dentist, and other dental specialists obtained an esthetically pleasing and optimized functional result. Treating the diastema between the anterior teeth with elastic gap bands and without fixed orthodontic appliances should be avoided. Patients should seek proper orthodontic advice for even small-scale orthodontic problems to prevent catastrophic outcomes, as exhibited in this case report.

New perspective for evaluation of tooth widths in patients with missing or peg-shaped maxillary lateral incisors: Quadrant analysis

INTRODUCTION

Missing or peg-shaped maxillary lateral incisors can affect the mesiodistal dimensions of the dentition.

METHODS

The pretreatment casts of patients with bilateral (BMLI, n = 35) or unilateral (UMLI, n = 29) missing maxillary lateral incisors or bilateral peg-shaped maxillary lateral incisors (BPLI, n = 16) were evaluated. The mesiodistal widths of all permanent teeth except the second and third molars were measured, and the sums of total and quadrant tooth widths were calculated. The results were compared with a control group (n = 32) with normal maxillary lateral incisors. A quadrant analysis was performed by comparing the quadrants with lateral incisor agenesis, peg-shaped lateral incisors, and normal lateral incisors with each other. Statistical analysis was performed by 1-way analysis of variance followed by Tukey and Tamhane tests.

RESULTS

In the BMLI and BPLI groups, significant reductions in individual tooth widths and total tooth widths were seen. The size discrepancies were the greatest in the maxillary central incisors and decreased gradually from the incisors to the molars. Compared with the control group, the tooth-size discrepancy was more pronounced in the BPLI group followed by the BMLI and UMLI groups. Due to the variability in clinical presentations of the UMLI group, the association with the reduction of the tooth sizes was not significant. But the quadrant analysis showed that in quadrants with a missing or peg-shaped lateral incisor, the teeth were significantly narrower than in quadrants with normal incisors; this indicates the importance of the contralateral side in unilaterally affected patients during analysis.

CONCLUSIONS

Bilateral missing or peg-shaped maxillary lateral incisors were significantly associated with reduction of individual mesiodistal tooth widths as well as their total and quadrant sums. Patients with a unilaterally missing lateral incisor should be analyzed individually with quadrant analysis, since the variability in the contralateral side would affect the traditional analysis results.

Lingual Treatment of an Adult Patient with a Simplified Extraction Protocol

Successful orthodontic treatment of adult cases depends on the biological, mechanical, and esthetic requirements of patients. While customized lingual appliance systems meet the esthetic expectations of the patients, they provide improved patient comfort, have three-dimensional mechanical control, and can be used for the treatment of all types of malocclusions. This report demonstrated the use of fully customized lingual orthodontic brackets for treating an adult case with extraction.

Orthodontic Canine Substitution for the Management of Missing Maxillary Lateral Incisors May Have Superior Periodontal and Esthetic Outcomes Compared to an Implant- or Tooth-Supported Prosthesis

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION

Prosthetic replacement vs space closure for maxillary lateral incisor agenesis: A systematic review. Silveira GS, Almeida NV, Pereira DMT, Mattos CT, Mucha JN. Am J Orthod Dentofacial Orthop 2016; 150(2):228-37.

SOURCE OF FUNDING

None listed TYPE OF STUDY/DESIGN: Systematic review.

[Congenitally missing maxillary lateral incisors: long-term periodontal and functional evaluation after orthodontic space closure with first premolar intrusion and canine extrusion]

INTRODUCTION

The aims of this investigation were to evaluate associations between orthodontic space closure (including first premolar intrusion and canine extrusion for esthetic reasons) and periodontal tissue deterioration over a 10-year period in subjects with one or both missing maxillary lateral incisors and to investigate the occurrence of signs or symptoms of temporomandibular disorder (TMD).

METHODS

This was a retrospective cohort study comprising patients treated by the same orthodontist. The agenesis group included 26 consecutive adolescent and young adult patients (9 male, 17 female) treated with space closure. The control group consisted of 32 orthodontic patients (12 male, 20 female) with no missing teeth and no need for extractions. In the agenesis group, full-mouth probing pocket depths and bleeding on probing were recorded at six locations for each of 657 teeth (3942 periodontal sites). In the control group, comparative data were collected for the maxillary first molars, premolars, canines, and lateral incisors, a total of 264 teeth (1584 periodontal sites). Mobility and gingival recession were also evaluated. Patients in both groups completed questionnaires concerning symptoms related to TMD.

RESULTS

The full-mouth assessments in the agenesis group generally demonstrated periodontally healthy conditions, with probing depths below 4 mm and few bleeding sites. Some slight recessions were found, mostly on molars and second premolars, and there was normal mobility of first premolars that substituted for canines. Comparisons between the agenesis and control groups showed no statistically significant differences for the maxillary teeth regarding increased pocket depth (≥ 4 mm) or increased mobility. Interproximal sites in the agenesis group showed less bleeding on probing than in the control group; this was statistically significant. Anterior teeth in the agenesis group did not show any more recession than in the controls. In addition, we observed no difference in signs or symptoms between the two groups; this might be due to the limited sample size or the drawbacks of the surveys of TMD through subjects' recall. Thus, the long-term periodontal tissue health and the incidence of dysfunction or TMD signs were similar in the space-closure agenesis group and in the control group of nonextraction orthodontic patients.

CONCLUSIONS

Orthodontic space closure including first premolar intrusion and canine extrusion in patients with missing lateral incisors does not incur risks for periodontal tissue deterioration or TMD in the long term.