Space closure versus space opening for bilateral absent upper lateral incisors: what is the duration of orthodontic treatment?

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.

Interdisciplinary orthodontics-implants management of a challenging hypodontia case complicated by a class II division 2, bimaxillary retroclination

INTRODUCTION

The case in this study had moderate hypodontia, with both lower lateral incisors and the lower-left second premolar missing. A Class II division 2 relationship with severe crowding in the upper arch and a traumatic deep bite over a skeletal I base complicated the occlusion.

MATERIALS AND METHODS

The plan was to extract the upper first premolars to relieve upper arch crowding and the lower-left impacted second premolar to preserve the bilateral class I molar relationship. A class I occlusal relationship was achieved through space opening in the lower lateral incisors region and space closure in the upper and lower premolars regions.

RESULTS

The use of orthodontic screws for bite opening and anterior segment retraction, in conjunction with bi-metric slot size selection in bracket prescription, was effective in controlling incisor inclination and interincisal angle. The use of an implant fixture before beginning the finishing stage allowed for a reduction in total treatment time and facilitated the provision of the final prosthesis before debonding the case. As a result, the patient was able to receive a satisfactory occlusion on the day of debonding.

CONCLUSION

This case of moderate hypodontia was successfully resolved by combining space closure and space opening effectively. To solve the arch problems in such Class II division 2 cases with severe crowding, extractions were required. To complete the case, this was combined with intrusive and retractive mechanics. In hypodontia cases, implants are an excellent choice for both aesthetics and functional restoration.

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.

Esthetic Perception of Different Clinical Situations of Maxillary Lateral Incisor Agenesis According to Populations with Dental and Non-Dental Backgrounds: A Systematic Review and Meta-Analysis

Treatment of unilateral or bilateral maxillary lateral incisor agenesis is challenging, time-consuming, expensive, and requires careful treatment planning, predictability, and esthetics. This review aimed to identify differences in esthetic perception among orthodontists, general dentists, differentiated dentists, and laypersons, which may interfere with treatment options. EBSCO, PubMed, ScienceDirect, Cochrane Library databases, and Google Scholar were searched using keyword pairing and a Boolean expression, "(congenitally missing OR agenesis OR hypodontia) AND (maxillary lateral incisors) AND (esthetic perception OR smile) AND (laypersons OR dental professional OR general dentist OR orthodontists)." Reviews and case studies were excluded. A total of 13 studies were selected for qualitative analysis (adapted ROBINS-I) and 11 were selected for meta-analysis (p < 0.05) after being sub-grouped into "Opening vs. Closure" and "No remodeling vs. Dental remodeling vs. Dental and gingival remodeling" groups. A meta-analysis evaluated the magnitude of the difference between groups based on differences in means and effect sizes (α = 0.05; 95% CI; Z-value 1.96), revealing that the esthetic perception of maxillary lateral incisor agenesis treatment remains controversial even among professionals. Gingival remodeling was not valued compared to isolated dental remodeling. Studies lack rigorously comparable methodologies. Discussion with the patient is pertinent in doubtful situations, as the best treatment option remains unclear, and overtreatment should be avoided.

The prevalence and management of patients with hypodontia: A cross -sectional study

BACKGROUND

Hypodontia is one of the most common anomalies in dentistry. Hypodontia has a negative impact on oral health-related quality of life with patients best seen in a multidisciplinary clinic to improve treatment outcomes.

AIM

To investigate the prevalence of hypodontia and its association with other dental anomalies, as well as malocclusion, and to investigate the treatment planned for patients attending the clinic and whether the type of missing teeth affected the proposed treatment.

MATERIALS AND METHODS

Analysis of consecutive patients attending the hypodontia clinic at a dental hospital between February and November 2020. A total of 100 patients who met the inclusion criteria were identified. Data collected included the following: age/sex; number and type of missing teeth; pre-treatment occlusion; presence of other dental anomalies; and planned treatment.

RESULTS

A total of 100 patients (55% female; age range = 7-41 years; mean age = 18 years) were included. Of the cohort, 47% had a class I skeletal relationship and participants were significantly less likely to have a class III skeletal or incisor relationship; 45% had another dental anomaly with the most common being microdontia. Space opening was the preferred treatment option for those managed by orthodontic treatment with resin-bonded bridges most likely to be used for restoration of spaces, 86%.

CONCLUSION

Lower second premolars were the most commonly missing teeth. Participants were significantly less likely to have a class III incisor or skeletal relationship than class I or II. Space opening was the favoured approach for orthodontic treatment, particularly for maxillary lateral incisors.

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.