….Congenitally Missing Lateral Incisors
One of several reasons I appreciate having been a general dentist for a few years and now working as a specialist with local general/restorative dentists is combining orthodontic treatment with esthetic dentistry for permanent finished results.
Typically, the youngest patient seen for an orthodontic consult is around the age of 7. At this consult a missing lateral incisor can be diagnosed at that young age. Closing the space where the tooth (if one is missing) or teeth (if both are missing) is an esthetic and viable procedure that provides longterm results that are completed in the patient’s adolescence. Recent improvements in restorative dentistry including individual tooth bleaching, porcelain veneers and/or hybrid composite resin build-ups can yield results indistinguishable from natural dentitions. These improvements discussed can minimize potential problems with orthodontic space closure, when teeth are substituted into non-traditional positions. Longterm stability of the results is aided with a fixed retainer and removable back-up retainer.
Of course in treatment planning, it’s important to identify alternative procedures, including discussing the cost-risk-benefit ratios of each option. Osseointegrated implants are frequently discussed to replace the missing tooth/teeth. Unfortunately the timeline for optimum longterm results adds potential problems to this treatment option. These timeline issues are realized when a patient finishes orthodontic treatment at age ~13, receives retainers, and waits at least 4 (female) and up to 7 years (male) for skeletal growth to cease. During this time wearing a retainer consistently is frequently not done. If this happens, orthodontic re-treatment is needed to realign the teeth and spaces before implants can be placed. (see photos)
Teamwork and planning orthodontic with restorative dentistry can successfully treat patients with missing lateral incisors so the results look like an intact dentition. See you next month!
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4. Thilander B, et al. Orthodontic aspects of the use of oral implants in adolescents: a 10 year follow-up study. Eur J Orthod. 2001; 23:715-731.