Please activate JavaScript!
Please install Adobe Flash Player, click here for download
ePaper created 2017-09-06, 09:11:22 | version 1.38.0
case report lateral incisors agenesis treatment Orthodontic management of maxillary lateral incisors agenesis Author: Dr Dan Andrei Iacob, Romania The purpose of this article is to show the difer- ent modalities of treatment for upper lateral incisors agenesis. In daily practice, orthodontists often meet cases of upper lateral incisors agen- esis. The two common treatment options are: space closure, using canines to substitute the missing lateral incisors, or space opening for future restorations. Introduction · Theoretical considerations. · The second most common agenesis, repre- senting 20 % of the congenital missing teeth. · The second most common agenesis (Europe), after the mandibular second premolar. · The long axis of the central incisor and the canines should be slightly mesial to the gingival height of contour (Fig. 2). · The long axis of the upper lateral incisor should be coincidental to the gingival height of contour (Fig. 2). · Dental proportions: the width of well- proportioned teeth should be approximately 60 % to 75 % of their height (Fig. 3). Functional occlusion objectives · 3–4 mm of overbite. · 0–2 mm of overjet. · Anterior and canine guidance, which allows for the immediate disclusion of molars and premolars when making lateral or protrusive movements. · The most frequently missing tooth in the · Centric occlusion coinciding with centric American population. relation. · Unilateral agenesis is often associated with dysmorphia or microdontia of the corre- sponding contralateral tooth. Treatment alternatives · Space opening for future restorations. · Space closure–canine substitution of the lateral incisor. Treatment objectives · Optimal dentogingival aesthetics. · Functional occlusion. Optimal dentogingival aesthetics objectives · Gingival height of contour of the upper anterior teeth (Fig. 1): central incisors and canines are more superior than that of the lateral incisors. Treatment strategies for canine substitution · Angulate and extrude the canine to mimic · an upper lateral incisor relative to the gingival height of contour. Intrude the upper first premolar to mimic an upper canine relative to the gingival height of contour. · Apply lingual root torque to mimic the emergence profile of the lateral incisor and improve the emergence profile of the bulky gingival tissue of the substituted canine: use a lower second premolar bracket on the upper canine. · Adjust dental proportions as necessary: mesiodistal reductions on the upper central incisors to balance adjustments on the substituted canine. 20 ortho 2/2017