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

Alveolar morphometry in young adults with and without agenesis of the upper lateral incisor: A retrospective study

INTRODUCTION

We aimed to compare alveolar morphometry in young adults with agenesis of the upper lateral incisor versus the side without agenesis and versus matched controls.

MATERIAL AND METHODS

In this observational retrospective study, cone beam computed tomography scans were obtained of 36 upper hemiarches from young adults aged 15 to 30 years. The hemiarches were distributed into three groups: group 1: 12 upper hemiarches presenting agenesis of the upper lateral incisor; group 2: 12 upper hemiarches from the opposite side without agenesis of the upper lateral incisor (control group 1); and group 3: 12 upper hemiarches without agenesis of the upper lateral incisor matched for age and sex with respect to the affected group (control group 2). A trained and calibrated investigator performed all the alveolar measurements at two different times, including sagittal, coronal and axial slices of each hemiarch. Paired Student's t-tests, Chi-square and repeated measures ANOVA with Bonferroni correction were used, (P<0.05).

RESULTS

Apical mesial evaluation of group 1 (4.22±1.19mm) was significantly lower (P<0.001) than that of groups 2 (6.72±1.17mm) and 3 (7.58±1.67mm). Apical distal evaluation also showed differences (P<0.001) among the three groups, with the dimension being smaller in group 1 with agenesis (4.53±1.14mm), followed by group 2 without agenesis (6.23±1.55mm) and the healthy control group 3 (7.73±1.71mm).

CONCLUSIONS

Lateral incisor agenesis significantly reduces the alveolar dimensions of the affected area. In cases of unilateral agenesis, the unaffected side also shows sequelae, with decreased dimensions compared to cases without agenesis. This condition should be taken into account when making therapeutic decisions regarding rehabilitation with implants or canine replacement.

Advancements in tooth autotransplantation

BACKGROUND

Tooth autotransplantation (AT) involves the surgical relocation of a tooth from 1 site in the mouth to another site within the same patient. This approach is a good option in a growing patient when dental implant placements or fixed bridges are not suitable and when preserving natural teeth is a priority. Tooth AT is a complex procedure that requires specialized skills from a multidisciplinary team with careful patient and tooth selection and treatment planning.

TYPES OF STUDIES REVIEWED

The authors provided a review of the state of knowledge and research on tooth AT and presented a case scenario and barriers to adoption, with a focus on the United States.

RESULTS

Success rates for tooth AT can vary depending on several factors, including the patient's overall health, specific tooth involved, skill of the dental surgeon, and postoperative care provided. Long-term outcomes of autotransplanted teeth have been cited in the literature with impressive longitudinal follow-up spanning up to 26 years. Results of several systematic reviews showed survival rates from 75% through 98%.

CONCLUSIONS AND PRACTICAL IMPLICATIONS

Adoption of tooth AT has grown over the years, owing to advancements in dental techniques, improved patient outcomes, and increased awareness among both dentists and patients. Increasing awareness and availability of tooth AT to replace missing teeth can provide a natural and functional alternative to traditional prosthetic options. Tooth AT helps preserve the alveolar bone in growing patients and can offer excellent esthetic and functional outcomes.

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.

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.

Modified orthodontic treatment of substitution of canines by first premolars: A case report

BACKGROUND

Canines are the most important teeth in the dentition. Usually, doctors choose to remove premolars rather than canines. Canine extraction is extremely rare in orthodontic treatment. However, dentists sometimes encounter situations in which canines require extraction due to defects caused by improper medical treatment.

CASE SUMMARY

The present study reports a case of a class II adult patient treated with the extraction of maxillary canines and right mandibular second premolar. After postactive treatment for 28 mo, then the canines were substituted by the upper first premolar, a satisfactory occlusal was established, the lips were competent, and the profile was improved. Intraoral pictures and X-ray data retrieved 3 years after the end of orthodontic treatment demonstrated the possibility of canine extraction and premolar substitution of canines in function and beauty.

CONCLUSION

The extraction of canines and substitution by first premolars could be a feasible orthodontic treatment.

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.

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.

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.

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 movement of a contralateral maxillary central incisor across the midpalatal suture

There are several options for replacing a missing maxillary central incisor in orthodontic treatment. Substituting a missing central incisor with the contralateral one can be a useful approach to reduce the number of teeth that require extraction during the treatment. Normal tooth movement across an ossified midpalatal suture (MPS) has only been observed in an animal experiment. Herein, we describe the treatment of a 26-year-old woman who had lost multiple teeth on one side, including the maxillary right central incisor, which required extraction due to endodontic failure. The maxillary left central incisor was moved into the position of the maxillary right central incisor. All other left maxillary teeth were moved mesially to close the space. After completion of orthodontic treatment, acrylic build-up was performed on the maxillary left lateral incisor, which underwent morphological modification to replicate the morphology of a maxillary right incisor. The patient was pleased with the treatment outcome. Cone-beam computed tomography provided evidence of tooth movement across the MPS. Although the movement of the tooth across the MPS is feasible, the treatment plan should also take other treatment options into consideration.

Canine substitution of congenitally missing maxillary lateral incisors in Class I and Class III malocclusions by using skeletal anchorage

INTRODUCTION

This prospective cohort study aimed to evaluate canine substitution supported by skeletal anchorage as a viable treatment protocol for patients with maxillary lateral incisor agenesis (MLIA) and skeletal Class I or Class III.

METHODS

Patients (n = 30) who met the following criteria were recruited: (1) bilateral MLIA or unilateral MLIA with a riziform contralateral incisor with a planned extraction; (2) skeletal Class I or Class III; and (3) dentoalveolar discrepancy in the mandible <5 mm. The archwire sequence routine was administered, combined with a rapid palatal expander, temporary intraoral skeletal anchorage device, and intermaxillary traction with Class III elastics. The results of the cephalometric analyses, peer assessment rating indexes, and the patient's smile self-evaluation using the visual analog scale were compared between initial and final treatments.

RESULTS

This study indicated that closing the space in patients with Class I or Class III malocclusion by using temporary intraoral skeletal anchorage devices in the mandible, along with Class III elastics, yielded satisfactory outcomes. Proper occlusion was established by mesialization of the maxillary teeth and correction of the intermaxillary discrepancy, thereby yielding beneficial and significant cephalometric changes after the treatment. The soft tissue profile was maintained when it was harmonious before the treatment and improved posttreatment in patients in whom the profile was initially inharmonious. All occlusions improved, as evidenced by the peer assessment rating index. Smile esthetics were also enhanced after orthodontic treatment for all patients.

CONCLUSIONS

Canine substitution may be safely offered to patients with Class I and Class III skeletal pattern and MLIA.

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.

Identification and appraisal of outcome measures used to evaluate hypodontia care: A systematic review

INTRODUCTION

Identification and appraisal of the outcome measures that have been used to evaluate hypodontia treatment and deliver services are essential for improving care. A lack of alignment between outcomes and patient values can limit the scope for patient-centered care. Our objectives were to identify and appraise the outcomes selected to evaluate hypodontia care.

METHODS

Data sources included 10 electronic databases and grey literature, searched using terms for hypodontia and its treatment methods. Study eligibility included mixed study designs to ensure comprehensive identification of outcomes, excluding case reports and case series with fewer than 10 participants and nonsystematic reviews. Participants and interventions involved people with hypodontia receiving any dental treatment to manage their hypodontia. Simulated treatment, purely laboratory-based interventions, and future treatments still in development were excluded. Research outcomes were identified and synthesised into 4 categories: clinical indicators, and patient-reported, clinician-reported, and lay-reported outcomes. No synthesis of efficacy data was planned, and consequently no methodologic quality appraisal of the studies was undertaken.

RESULTS

The search identified 497 abstracts, from which 106 eligible articles were retrieved in full. Fifty-six studies and 8 quality-improvement reports were included. Clinical indicators were reported in 49 studies (88%) including appearance, function, dental health, treatment longevity, treatment success and service delivery. Patient-reported outcomes were given in 22 studies (39%) including oral health-related quality of life, appearance, function, symptoms of temporomandibular dysfunction, and patient experience. Clinician-reported outcomes were limited to appearance. Variability was seen in the tools used for measuring outcomes.

CONCLUSIONS

There is a lack of rationale and consistency in the selection of outcome measures used to evaluate hypodontia care. Outcomes are largely clinician and researcher-driven with little evidence of their relevance to patients. There was a paucity of outcomes measuring access to care, quality of care, and cost. Evidence from hypodontia research is clinician-focused and likely to have limited value to support patients during decision making. Attempts to synthesise the evidence base for translation into practice will be challenging. There is a need for a core outcomes set with a patient-centric approach to drive improvements in health services.

An Alternative Approach for Space Opening in a Bilateral Maxillary Lateral Incisor Agenesis Patient using Miniplates

AIM

This case report aimed to present an orthodontic mechanic alternative for space opening in a patient missing maxillary lateral incisors, using miniplates as anchorage, associated with self-ligating brackets.

BACKGROUND

Dental agenesis affects the population causing esthetic and functional damages. The prevalence of missing maxillary lateral incisors should be considered for its significant rate and negative impact on smile esthetics.

CASE REPORT

This treatment was chosen based on the presence of balanced facial pattern, large canine anatomy, the need to improve dental occlusion to prevent further wear, and patient's esthetic complaint. To obtain the results, upper third molars were extracted, and two miniplates were installed to distalize the upper arch with no need for patient compliance or auxiliary devices. Self-ligating brackets were used to reduce friction on posterior teeth, thus facilitating movement with light force application. At the end of 19 months, the patient presented with class I good overbite and overjet, and adequate space for implant and prosthetics; also, good facial esthetic was maintained.

CONCLUSION

When indicated, space opening may provide excellent esthetics and functional results, and even more predictable results when skeletal anchorage miniplates are used to distalize all posterior teeth.

CLINICAL SIGNIFICANCE

Considering the high level of esthetic and functional compromise caused by dental agenesis, the technique hereby described represents a viable mechanic alternative within orthodontic possibilities.

Extraction of maxillary canines: Esthetic perceptions of patient smiles among dental professionals and laypeople

INTRODUCTION

Maxillary canines are generally considered important both cosmetically and functionally. Most claims on the importance of maxillary canines, however, have been based on expert opinions and clinician-based studies. There are no scientific studies in the literature reporting on their cosmetic importance or how laypeople perceive a smile treated by maxillary canine extractions. Our objective was to investigate whether there is any difference in the perceptions of patients' smiles treated by extracting either maxillary canines or first premolars, as judged by orthodontists, dentists, and laypeople.

METHODS

This retrospective study included 24 participants who had unilateral or bilateral extraction of maxillary permanent canines and fixed appliances in the maxillary and mandibular arches to comprehensively correct the malocclusion, selected from orthodontic patients treated at Chesterfield Royal Hospital NHS trust in the United Kingdom over the last 20 years. The control group of patients had extraction of maxillary first premolars followed by fixed appliances and finished to an extremely high standard judged by the requirement that they had been submitted for the Membership in Orthodontics examination. The finished Peer Assessment Rating scores for this group were less than 5. The end-of-treatment frontal extraoral smiling and frontal intraoral views were presented for both groups. The photographs were blinded for extraction choice and standardized for size and brightness using computer software (Adobe Photoshop CC version 14.0; Adobe Systems, San Jose, Calif). The work file was converted to an editable pdf file and e-mailed to the assessors. The assessor panel consisted of 30 members (10 orthodontists, 10 dentists, and 10 laypeople), who were purposely selected. The measures were rated on a 10-point Likert scale.

RESULTS

The attractiveness ratings were not statistically significantly different between the canine extraction and premolar extraction groups, with a mean difference of 0.33 (SD, 0.29) points. A 1-way repeated-measures analysis of variance to test the difference in scores among the laypeople, orthodontists, and dentists (n = 30) showed no statistically significant difference (Wilks lambda = 0.835; P = 0.138), and the Bonferroni test indicated that no pair-wise difference was statistically significant.

CONCLUSIONS

No statistically significant difference was found in the smile attractiveness between canine extraction and premolar extraction patients as assessed by general dentists, laypeople, and orthodontists. Further high-quality studies are required to evaluate the effect of canine extraction and premolar substitution on functional occlusion.