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Missing lateral incisors – anodontia

Missing lateral incisors – anodontia

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Anodontia: congenital absence of one or several teeth

When upper lateral incisors are missing, there are 3 possible treatments:

  1. Open the spaces and replace the missing teeth prosthetically.
  2. Close the spaces by moving the posterior teeth forward. The canines will replace the lateral incisors and the premolars will replace the canines; the teeth will be “modified” or reshaped accordingly.
  3. A combination of both: opening on one side and closing on the other side.

The examples below illustrate these different possibilities. #tag

1- Closing of the spaces and replacement of the lateral incisors by the canines

The upper canines were modified and brought closer to close the anterior spaces and thus replace the missing lateral incisors (arrows). This approach avoids having to use bridges, implants, etc. to replace the lateral incisors.

The upper canines were modified and brought closer to close the anterior spaces and thus replace the missing lateral incisors (arrows). This approach avoids having to use bridges, implants, etc. to replace the lateral incisors.

If a canine replaces a lateral incisor, its crown must be reshaped or modified so it looks as much as possible like a lateral incisor

When a canine replaces a lateral incisor, its crown must be reshaped or modified so it looks as much as possible like this lateral incisor (traced in black) and functions similarly. (Kokich 2005)

2- Opening of the space for the lateral incisors and prosthetic replacement of the lateral incisors

(A) Both upper lateral incisors are missing (anodontia) (arrows). (B) Opening of the spaces for the lateral incisors orthodontically to eventually replace them by implants. (C) During the treatment, with artificial teeth added on the "braces" for improved esthetics. (D) At the end of the treatment, teeth are added to maintain the width of the space until implants and final crowns are installed. The esthetics of these crowns will be better than the temporary teeth in place.

Not only crowns, but roots as well!

When dental implants are chosen to replace lateral incisors (or any other tooth), the position of the adjacent teeth to the missing teeth, and their root(s) in particular, is very important to allow an adequate positioning of the implant. If the roots are badly tipped or misaligned, the installation of a dental implant may be impossible. The orthodontist will work in collaboration with the general dentist or other specialists responsible for the installation of the implant (periodontist, maxillofacial surgeon) to position the teeth optimally to allow the installation of the implants.

To learn more on orthodontic corrections in the planning of dental implants, dental implants and see other examples.

Inadequate position of the roots to install dental implants

The upper central incisors are showing too much tipping and will therefore prevent the installation of a dental implant to replace the missing lateral incisors. (A) Before the treatment, the blue arrows indicate the missing lateral incisors. (B) These lateral incisors are replaced by prosthetic teeth bonded to the adjacent teeth. (C) A panoramic radiograph confirms the bad position of the central incisors. (D) Enlarged view of the radiograph and implants added in a simulation. The blue dotted lines represent the ideal position that the central incisors should have. (E) This patient opted for lingual braces for esthetic reasons.

Orthodontically uprighting of the dental roots to get a site ready for dental implants.

(A) Root parallelism and inadequate space between the roots during the orthodontic treatment. (B) After a few months, the roots are parallel and there is enough space to install dental implants in the toothless spaces.

3- Opening of the space on one side and prosthetic replacement on the other side

Orthodontic corrections to fill the spaces where lateral incisors are missing (anodontia).
(A) Anodontia of the upper lateral incisors (arrows) in a 41-year-old adult. (B) Closing of the space on the right side and opening of the space on the left side during the treatment. A prosthetic tooth supported by a bracket was installed on the orthodontic archwire for esthetic reasons. (C) Once the orthodontic corrections are finished, the right canine is against the lateral incisor and the space on the left is ready to receive a dental implant. The occlusion (interdigitation) on the right side presents more irregularities than on the left side where the canine has a “normal” position. (D) One year after the installation of the implant and the left crown, as well as a ceramic facet on the right canine that replaces the missing lateral incisor. (E) Smile before the treatment and after the prosthetic restorations. (F) Ceramic crown on the implant. (G) The gum tissue contour is well adapted to the crown.

Other restorative variations

Depending on the characteristics of the case, different restorative options using facets, crowns, dental implants, different kinds of bridges, etc. can be used.

Dental restorations to replace missing lateral incisors using orthodontics and prosthodontics

(A) Short and narrow right lateral incisor, congenital absence (anodontia) of the left lateral incisor. (B) The gingival contour of the right central and lateral incisors was modified to be more in harmony with the same opposing teeth and the right lateral incisor was rebuilt in composite material. A dental implant replaces the left lateral incisor. (C) Anodontia of both lateral incisors in a 19-year-old young woman. (D) Cantilevered bridges anchored to the canines replace the lateral incisors.

What are the benefits and disadvantages of each option?

Each option of treatment described previously offers benefits and disadvantages and each can be esthetically and functionally successful under certain conditions. 2, 3

Prosthetic replacement by dental implant

Closing of the space with the canine

Study on the perception of esthetics for the solutions to anodontia of lateral incisors

A study from Armbruster (2005)4 tried to determine how general dentists, orthodontists and other dental specialists were perceiving esthetic appeal relative to teeth on pictures of people who had missing lateral incisors that were either replaced by a butterfly bridge (bridge with wings bonded to the lingual surface of teeth), a dental implant or the closing of the space with canine substitution. These cases were compared to a control group composed of people who did not have any tooth missing.

Orthodontists preferred the pictures without any tooth missing, followed by the canines that replace the lateral incisors, the butterfly bridges and the dental implants. More dentists and other specialists would choose to replace the lateral incisors by implants for esthetic reasons. However, several of these clinicians mentioned that they would choose to bring the canines closer together for their own child.

To learn more on congenitally missing teeth and anodontia.

Other situations affecting the upper lateral incisors

Lateral incisors are not only affected by a relatively significant rate of congenital absence, but they also present formation defects that make them narrow, short and misshapen. Sometimes, these teeth can be “rebuilt” to give them a normal shape and dimension, but in certain cases, they can be extracted and the dentition is then treated as if there were congenitally missing teeth.

Narrow, short and misshapen lateral incisors extracted to be replaced by the canines.

(A, C; before the treatment) This 14-year-old teenager presents narrow and short lateral incisors (mostly the right one), as well as shorter roots than normal (B, D; after the orthodontic treatment) It was decided to extract the lateral incisors and move the canines forward to fill the spaces. The canines were reshaped.

Temporary replacement of the lateral incisors with anchorage mini-screws

Use of anchorage mini-screws to support a crown and preserve the alveolar bone after an orthodontic treatment

(A) 14-year-old boy with missing upper lateral incisors. The spaces were opened orthodontically to replace the missing teeth using dental implants to be installed only in several years. (B) To preserve the alveolar bone and minimize the risks of bone resorption, temporary anchorage devices are inserted where the lateral incisors should be (arrows). (C) Temporary crowns are fixated to the anchorage mini-screws. (D) Radiograph showing the anchorage mini-screws in place. (E) The mini-screws used to support a temporary crown are different; they include a central part to which a crown can be attached. (© Wilmes et Al, JCO 2014 5)

 


1- Fekonja A (October 2005). “Hypodontia in orthodontically treated children”. European Journal of Orthodontics 27 (5): 457–60

2-Congenitally missing maxillary lateral incisors: Restorative replacements. Kokich et Al. AJODO april 2011 – vol 139 – issue 4

3- Congenitally missing maxillary lateral incisors: Canine substitution, Zachrisson et al., AJODO april 2011 – vol 139 – issue 4

4- The congenitally missing maxillary lateral incisor. Esthetic judgement or treatment options. Part 1 and 2  Armbruster et al. World J Ortho 2005;6:369-75

5- Mini-Implant-Supported temporary Pontics, Wilmes, B. et Al, JCO July 2014 P.: 422-429

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