The management of developmentally absent maxillary lateral incisors – a survey of orthodontists in the UK

Agenesis of Maxillary Lateral Incisors: Treatment Involves Much More Than Just Canine Guidance

Objective:

In this study, we aimed highlight some clinical features present in patients whose maxillary lateral incisors are missing, and proposed more logical, rational and predictable solutions to inform decision making in rehabilitation procedures.

Methods:

Literature review and discussion.

Conclusion:

Choosing the best possible treatment for congenital absence of maxillary lateral incisors depends on the multidisciplinary diagnosis of facial, occlusal, functional and periodontal features. It also depends on the individual long-term stability, and it does not only rely on canine-guided disocclusion.

Esthetic perception of maxillary lateral incisor agenesis treatment by canine mesialization

The objective of this study was to evaluate perception of the smile in maxillary lateral incisor agenesis (MLIA) cases treated by mesialization of a canine.

MATERIAL AND METHODS

Nine images were digitally modified from the same frontal intraoral photograph to simulate various treatment options for space closure in MLIA. A questionnaire was submitted to laypersons (303), general dentists (215), prosthodontists (55) and orthodontists (81). Statistical tests with a significance level of P<0.05 were used.

RESULTS

The views of MLIA treatment judged to be most attractive showed unilateral dental and gingival reshaping. All study groups considered the simple dental reshaping of the mesial edge of the canine to be attractive. In the analysis of the images grouped together for both unilateral and bilateral MLIA, the view showing dental and gingival reshaping was considered the most attractive whereas unmodified mesialization was considered the least attractive.

CONCLUSION

Regarding the space closure treatments, although all groups regarded simple dental reshaping of the canine to be attractive, the dental professionals considered gingival and crown reshaping to be more esthetic. In contrast, laypersons were not significantly responsive to this dental and gingival modification as compared to only slight reshaping of the mesial edge of the cusp of the mesialized canine in MLIA.

Treatment for agenesis of maxillary lateral incisors: a systematic review

OBJECTIVES

To compare the efficacy and safety of three orthodontic treatment modalities for agenesis of maxillary lateral incisors: 1) closing the space with the reshaped canine substituting the lateral incisor, 2) opening the space with placement of a conventional fixed bridge, and 3) opening the space with placement of a single-unit implant and an implant-supported crown.

SETTING

Brazilian Cochrane Center and Universidade Federal de São Paulo, Brazil.

MATERIAL AND METHODS

The following databases were investigated: Cochrane Register of Controlled Trials (Edition 12, 2011), EMBASE (from 1974 to December 2011), MEDLINE (from 1965 to December 2011), LILACS (from 1966 to November 2011), and Odontology Brazilian Bibliography Database (from 1966 to November 2011). Conference abstracts, main Brazilian dissertations and theses databases, and reference lists were handsearched. This systematic review included randomized or quasi-randomized controlled trials (RCTs) including women aged 15 years or over and men aged 21 years or over who received one of the interventions stated above. Two observers independently evaluated all the studies regarding eligibility criteria and assessed the risk of bias of included studies.

RESULTS

No studies were included in the review as no RCTs were found. Most of the evidence comes from case reports and narrative reviews on case reports and from three studies with a single post-intervention evaluation and non-comparable control groups with high risk of bias.

CONCLUSIONS

There is no scientific evidence for any of the three most common types of treatment for agenesis of the maxillary lateral incisors. RCTs into this issue are still necessary.