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

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

A multidisciplinary treatment of congenitally missing maxillary lateral incisors: a 14-year follow-up case report

Absence of the maxillary lateral incisor creates an aesthetic problem which can be managed in various ways. The condition requires careful treatment planning and consideration of the options and outcomes following either space closure or prosthetic replacement. Recent developments in restorative dentistry have warranted a re-evaluation of the approach to this clinical situation. Factors relating both to the patient and the teeth, including the presentation of malocclusion and the effect on the occlusion must be considered. The objective of this study was to describe the etiology, prevalence and alternative treatment modalities for dental agenesis and to present a clinical case of agenesis of the maxillary lateral incisors treated by the closure of excessive spaces and canine re-anatomization. A clinical case is presented to illustrate the interdisciplinary approach between orthodontics and restorative dentistry for improved esthetic results. In this report, the treatment of a girl with a Class II malocclusion of molars and canines with missing maxillary lateral incisors and convex facial profile is shown. Treatment was successfully achieved and included the space closure of the areas corresponding to the missing upper lateral incisors, through movement of the canines and the posterior teeth to mesial by fixed appliances as well as the canines transformation in the maxillary lateral incisors. This is a 14-year follow-up case report involving orthodontics and restorative dentistry in which pretreatment, post-treatment, and long-term follow-up records for the patient are presented.     

Treatment of a transmigrated and an impacted mandibular canine along with missing maxillary central incisor: A case report

IntroductionTreatment of a case with impacted canines is complex and numerous options are available ranging from disimpaction to forced eruption.ObjectiveThe objective of this case report was to describe the treatment of a 19-year-old male, with a skeletal Class II, dental Class II Division 1 malocclusion, prognathic maxilla, proclined maxillary incisors, with missing left maxillary central incisor and bilateral mandibular canine impaction.MethodologyThe orthodontic treatment plan included forced eruption of the impacted canines and conversion of maxillary left lateral incisor to central incisor.ConclusionProper diagnosis and implementation of orthodontic biomechanics can minimize the amount of prosthetic and surgical intervention needed in the management of transmigrated canine and smile designing.     

Maxillary impacted canine with congenitally absent premolars

Multiple treatment options are available to patients who have impacted canines in addition to congenitally absent premolars. Management options for impacted maxillary canines can include (1) continued observation, (2) extraction of the primary canine to aid spontaneous eruption, (3) uncovering and bonding of the impacted tooth and its eruption using orthodontic traction, (4) autotransplantation, and (5) extraction followed by prosthetic replacement. The options for the treatment of missing premolars can include the following: (1) maintaining the primary molars, (2) spontaneous space closure after early extraction of the primary molar, (3) autotransplantation, (4) prosthetic replacement, and (5) orthodontic space closure. In this case report, treatment of a patient with an impacted maxillary canine and agenesis of three second premolars will be presented.     

Prosthetic considerations in the restoration of orthodontically treated maxillary lateral incisors to replace missing central incisors: a clinical report

The treatment of young patients with missing maxillary incisors poses a challenge to prosthodontists and orthodontists. The 2 principal treatment options are (1) the reopening or maintenance of space for future autotransplantation and/or prosthodontic restoration of the missing teeth, or (2) total orthodontic space closure, followed by prosthodontic modification of the lateral incisors to simulate the central incisors. This article discusses only the second option and describes 2 alternative methods for the modification of crown anatomy. These procedures facilitate the orthodontic closure of missing central incisor spaces to ensure satisfactory, esthetic results.     

Valutazione multidisciplinare e trattamento delle agenesie degli incisivi laterali mascellari. Revisione della letteratura

Objectives

The purpose of this work was to identify the most effective treatment plan for missing maxillary lateral incisors by means of a review of the relevant literature published on this topic during the last 10 years.

Material and methods

Using the PubMed and Cochrane Library search engines, we selected articles published between 1999 and 2009 with the following Keywords: “congenitally missing lateral incisors”; “treatment option”; “long term clinical results”; “soft tissue aspects”; and “bone level”. Fifty articles were selected: 20 were eliminated; and 30 articles were considered relevant. Ultimately; only 11 articles proved useful for identification of the best treatment option for patients with missing maxillary lateral incisors.

Results

Our review confirms that the most frequently used approach in patients with missing maxillary lateral incisors is the multidisciplinary plan (orthodontics, implantology, prosthetics), but the current trend is to use orthodontic space closure alone whenever possible.

Conclusions

Treatment options for patients with missing maxillary lateral incisors include space closure or space reopening, and insertion of implants. Both options can be considered effective from both the functional and esthetic points of view.     

The congenitally missing upper lateral incisor. A retrospective study of orthodontic space closure versus restorative treatment

Orthodontic treatment for patients with uni- or bilateral congenitally missing lateral incisors is a challenge to effective treatment planning. The two major alternatives, orthodontic space closure or space opening for prosthetic replacements, can both compromise aesthetics, periodontal health, and function. The aim of this retrospective study was to examine treated patients who had congenitally missing lateral incisors and to compare their opinion of the aesthetic result with the dentists' opinions of occlusal function and periodontal health. In this sample, 50 patients were identified. Thirty had been treated with orthodontic space closure, and 20 by space opening and a prosthesis (porcelain bonded to gold and resin bonded bridges). The patient's opinion of the aesthetic result was evaluated using the Eastman Esthetic Index questionnaire and during a structured interview. The functional status, dental contact patterns, periodontal condition, and quality of the prosthetic replacement was evaluated. In general, subjects treated with orthodontic space closure were more satisfied with the appearance of their teeth than those who had a prosthesis. No significant differences in the prevalence of signs and symptoms of temporomandibular dysfunction (TMD) were found. However, patients with prosthetic replacements had impaired periodontal health with accumulation of plaque and gingivitis. The conclusion of this study is that orthodontic space closure produces results that are well accepted by patients, does not impair temporomandibular joint (TMJ) function, and encourages periodontal health in comparison with prosthetic replacements.     

Congenitally missing maxillary lateral incisors: treatment

The 2 major treatment approaches for congenitally missing maxillary lateral incisors are space closure via orthodontic therapy, or space opening to allow prosthodontic replacements either with a fixed prosthesis or single-tooth implant. Both of these treatment approaches can potentially compromise aesthetics, periodontal health, and function. It is essential for an interdisciplinary dental specialty team to establish realistic treatment objectives, communicate the sequence of treatment, interact during treatment, evaluate dental and gingival aesthetics, and position teeth to permit proper prosthetic treatment. If this interdisciplinary approach is used, the aesthetics and long-term dental health of the patient following treatment will be greatly enhanced.     

Valutazione estetica del sorriso in pazienti con agenesia degli incisivi laterali mascellari: revisione della letteratura

Objectives

Our aim was to identify the aesthetic parameters of the smile that should be assessed in patients with missing maxillary lateral incisors, by means of a review of the most recent literature on this topic.

Materials and methods

Using the most common search engines, such as Pub Med and the Cochrane library, we selected articles published between 1995 and 2010, which were indexed with the following Keywords “congenitally missing lateral incisors”, “aesthetic aspects”, “long-term clinical results”, “smile arc”, and “soft-tissue aspects”. Of the 28 articles selected, 10 were eliminated because they had follow ups <5 years or referred to sponsored studies. The remaining 18 articles only 12 articles were analyzed to identify the aesthetic parameters to evaluate in smile assessment of patients with missing maxillary lateral incisors.

Results

The review showed that when upper incisors are missing, good aesthetic results can be obtained with the traditional space-opening approach or with orthodontic space closure and mesialization of the lateroposterior sectors. However, clinicians currently prefer the orthodontic space closure option.

Conclusions

Treatment options for patients with missing maxillary lateral incisors include either space closure approaches and those based on space reopening and insertion of implants. Both offer good results in terms of smile aesthetics.     

正畸改善上切牙个别缺失的治疗效果

目的探讨正畸关闭间隙法治疗上切牙缺失的适应症，矫治方法及临床效果。方法利用正畸关闭间隙法对９例不同数目上切牙缺失的病例进行矫治。结果９例病例治疗后均达到较理想的临床效果。结论对上切牙缺失的治疗，正畸关闭间隙法能实现最大限度的美观、功能及稳定。     

Management of a Class I malocclusion with traumatically avulsed maxillary central and lateral incisors

This case report describes orthodontic space closure for managing an avulsed maxillary central incisor and a lateral incisor in a growing girl with a Class I deep bite malocclusion with moderate lower and mild upper crowding. The treatment approach moved a central incisor across the midline and substituted a lateral incisor for a central incisor, in combination with canine substitution. Veneers on all maxillary anterior teeth attained acceptable esthetics. The right central incisor was moved to serve as the avulsed left central incisor. The right lateral incisor was moved to the position of the right central incisor and restored. The canines on both sides were substituted as lateral incisors; the posterior occlusion was left in Class II. Mesialization of central and lateral incisors with prosthetic rehabilitation is an acceptable treatment option.     

Techniques for improving orthodontic results in the treatment of missing maxillary lateral incisors. A case report with literature review

We have presented a case report of the orthodontic treatment of a patient with congenitally missing lateral incisors and with skeletal and dental deep bite. Information was provided on methods to improve clinical orthodontic results. Different sections deal with (1) various diagnostic criteria for the best treatment approach, (2) variations in maxillary arch wire manipulation, (3) biomechanical considerations, (4) modifications of clinical crown by special procedures so that the canines resemble and function as lateral incisors, (5) functional considerations of the occlusion, and (6) details in finishing. Particular emphasis was placed on the use of a special design of closing loops for simultaneous space closure and intrusion of the anterior teeth. This article has discussed the principles of incisor and canine intrusion, and has demonstrated that the closing loops described are capable of intruding incisors with minimal side effects on the posterior teeth. It has also demonstrated how control of the mechanical variables dramatically increased the efficiency and effectiveness of intra- and extraoral forces in the treatment of malocclusion.     

Orthodontic intervention to a patient injured in a traffic accident

This case report describes the orthodontic treatment of a 29-year-old male who lost the maxillary bilateral central incisors as a result of a traffic accident. After emergency treatment for facial fracture by a plastic surgeon, the patient visited our orthodontic clinic. He had a concave profile, Class I molar relationship with slight maxillary retrusion, and crossbite of the maxillary bilateral lateral incisors. The interdental space was insufficient for prosthetic treatment of the missing maxillary incisors. Therefore, we planned to distalize the maxillary and mandibular molars to obtain appropriate interdental space for the prosthetic treatment of the missing teeth and to correct the crowding of the mandibular anterior teeth. The anterior crossbite was corrected, and appropriate overjet and overbite were obtained with functional occlusion after prosthetic treatment. This case report shows that the favorable occlusion and facial profile are obtained by the interdisciplinary treatment and discusses the specific problems which seen after the traffic accident.     

Space closing versus space opening for bilateral missing upper laterals – aesthetic judgments of laypeople: a web-based survey

Objective: To investigate the opinions of laypeople regarding the aesthetic outcome of treating patients with developmental absence of both maxillary lateral incisors using either orthodontic space closure (OSC) or space opening and prosthetic replacement (PR). Design: Cross sectional, web-based survey. Methods: A panel of five orthodontists and five restorative dentists examined post-treatment intra-oral images of 21 patients with developmental absence of both upper lateral incisors. A consensus view was obtained about the 10 most attractive images (5 OSC; 5 PR). The 10 selected images were used in a web-based survey involving staff and students at the University of Sheffield. In the first section, the participants were asked to evaluate the attractiveness of the 10 randomly arranged single images using a 5-point Likert scale. In the second section, an image of OSC was paired with an image of PR according to their attractiveness ranking by the clinician panel, and the participants were asked to indicate which of the two images they preferred. Results: The survey received 959 completed responses with 9590 judgements. The images of OSC were perceived to be more attractive (mean rating 3·34 out of 5; SD 0·56) compared with the images of PR (mean rating 3·14 out of 5; SD 0·58) (mean diff 0·21; P?Conclusion: Space closing was perceived to be more attractive than space opening by lay people. The findings have implications for advising patients about the best aesthetic outcome when both maxillary lateral incisors are missing.     

Orthodontic possibilities for young patients with missing maxillary incisors

In the orthodontic treatment of young patients with missing maxillary incisors one should make an effort to avoid prosthetic solutions. This not only applies to situations with agenesis of maxillary lateral permanent incisors, but also to those cases in which maxillary incisors cannot be maintained after trauma. Standard solutions are presented for various sagittal jaw relationships and types and number of teeth missing. Specific rules have to be observed for the closure of spaces due to missing teeth in order to reduce the occurrence of papillae retraction and to place the substituting teeth in such a position that their crowns can be built up to look like the originals. This requires mesiodistal angulations that deviate from the standard ones, a proper distribution of crown width and in most cases a permanent retention with a palatally bonded thin multistranded wire.     

上颌阻生尖牙牵引治疗后邻近切牙牙根吸收情况的研究

目的 分析上颌阻生尖牙正畸牵引治疗后邻近切牙的牙根吸收情况及可能的相关因素。方法 选取上颌尖牙阻生且符合标准的43例患者,年龄10～23岁,共60颗上颌埋伏阻生尖牙。上颌阻生尖牙正畸牵引治疗前后分别拍摄锥形束CT,分析阻生尖牙邻近切牙的牙根吸收程度,并对可能存在的相关因素进行分析。结果 上颌阻生尖牙正畸牵引治疗后,上颌中切牙发生轻、中、重度牙根吸收的概率分别为71.7%、15.0%、13.3%,上颌侧切牙发生轻、中、重度牙根吸收的概率分别为48.3%、36.7%、15.0%,上颌中切牙与侧切牙牙根吸收严重程度存在差异(P<0.05)。位于腭侧及颌骨内、低位且靠近面中线的阻生尖牙,在正畸牵引治疗后,侧切牙牙根吸收程度较重(P<0.05)。低位阻生尖牙牵引治疗后,中切牙牙根吸收较重(P<0.05)。牵引时间较长时,中切牙牙根吸收程度较重(P<0.05)。治疗前已发生牙根吸收的切牙,在阻生尖牙牵引治疗后发生的牙根吸收程度较重(P<0.05)。结论 上颌侧切牙在阻生尖牙正畸牵引治疗后,发生的牙根吸收程度较重。上颌阻生尖牙正畸牵引治疗后,邻近切牙牙根吸收情况与阻生尖...     

Restoration and retention of maxillary anteriors with severe root resorption.

BACKGROUND: The authors describe the treatment of three patients who had severe apical root resorption of maxillary lateral incisors caused by ectopically erupting canines. Ectopically erupting canines derive from a normal path of eruption and may cause resorption of the adjacent teeth. CASE DESCRIPTION: The authors present the three cases of severe root resorption caused by ectopically erupting canines. They then discuss various prosthetic options; the indications, advantages and disadvantages of various treatment modalities; the long-term retention and esthetic concerns of the patients; and the inherent limitations of restorative treatment. CLINICAL IMPLICATIONS: Increased tooth mobility and long-term retention are significant concerns in cases of patients who have severe root resorption. Attaining stability with lingual splinting can cause esthetic problems. An interdisciplinary approach is necessary to provide optimal care for the patient.     

Maxillary lateral incisor implants: planning with the aid of orthodontics

This article has discussed six guidelines for managing adolescent orthodontic patients who are missing their maxillary lateral incisors and will require implants to replace these teeth. The space for the crown and implant, the space between the apices of the roots of the central incisor and canine, the possibility of implant site development, the effect of space opening on the integrity of the adjacent papillae, the impact of altered passive eruption, and the method for determining the age of implant placement have been discussed in detail. The intent of this article has been to emphasize the importance of interdisciplinary decision-making when planning implants in young adolescent patients who are congenitally missing their maxillary lateral incisors.     

Root Shortening in Patients Treated with Two-step and En Masse Space Closure Procedures with Sliding Mechanics

Objective:To investigate the comparative amount of root shortening between two-step and en masse space closure procedures.Materials and Methods:Fifty-two patients were selected from a pool of patients satisfying the following inclusion criteria: no evidence of resorption on the pretreatment panoramic radiographs; no dental trauma; no dilacerations of incisor roots, anodontia, or impacted canines; complete root formation at the start of treatment; intact and caries-free incisors; no endodontically treated incisors; Angle Class I or II malocclusion; extraction of four first premolars; and space closure with moderate anchorage. Patients received treatment with either a two-step or an en masse procedure to close the extraction spaces after alignment and leveling with the same preadjusted appliances. Root shortening of the maxillary and mandibular incisors was evaluated on panoramic radiographs, taken before and after space closure, and measured in millimeters. Distortion of measurements caused by panoramic radiographs was corrected by using special metal rods ligated to brackets. Statistical comparisons of root shortening between space closure procedures were investigated with the two-sample t test.Results:No difference was found in the amount of root shortening between space closure procedures. The average root shortening of maxillary central and lateral incisors was 0.43 ± 0.12 mm and 0.58 ± 0.10 mm, respectively, and that of mandibular central and lateral incisors was 0.23 ± 0.07 mm and 0.22 ± 0.06 mm, respectively.Conclusion:No difference should be expected in root resorption between two-step and en masse space closure procedure.     

Multidisciplinary solution for an avulsed upper central incisor: case report

Abstract – This case report refers to an 18‐year‐old female who suffered from dental trauma when she was 7 years old caused by a bicycle accident. Her maxillary right central incisor was avulsed, and the left one was extrusively luxated. The left central incisor was correctly repositioned and immobilized with a semi‐rigid splint. The right one could not be found. She presented with class II malocclusion and severe negative arch‐length discrepancies in both arches. The treatment objectives were the following: recover smile esthetics by replacing the maxillary right central incisor, correct the class II relationship, and optimally reduce mandibular and maxillary crowding. Extractions of the maxillary left lateral incisor and the lower right first bicuspid were performed; thus, the maxillary right lateral incisor would function as a maxillary right central incisor, the canines would function as lateral incisors, and the first bicuspids would function as canines. This allowed for the malocclusion to be corrected while simultaneously reestablishing the smile esthetics, without the use of an osseointegrated implant. A good occlusion with coincident upper and lower midlines was achieved. After orthodontic therapy, the patient underwent periodontal surgery to improve her gingival margins. Subsequent teeth bleaching was performed, and the patient received six porcelain veneers. A combination of orthodontic space closure and prosthetic rehabilitation may be the best treatment option after severe traumatic tooth loss.