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ePaper created 2017-09-06, 09:11:22 | version 1.38.0
case report lateral incisors agenesis treatment Fig. 22 Fig. 23 Fig. 24 Fig. 25 Fig. 26 Fig. 27 Fig. 28 Fig. 29 Fig. 30 Fig. 31 Fig. 32 Fig. 33 Fig. 34 Fig. 35 Fig. 36 22 ortho 2/2017 When is canine substitution appropriate? Occlusal considerations · Class II free of mandibular crowding: molars in full Class II and premolar brought forward to act as the canine, while remaining in a Class I relationship with the lower canine. · Class I with suficient mandibular anterior crowding that would necessitate premolar extractions on the lower arch. Profile · Flat. · Slightly convex profile. Canine size, shape and colour · The width at the cementoenamel junction: the wider the tooth, the more dificult it will be to mimic a lateral incisor. · Colour: canines are the teeth that are the most saturated with chroma. A canine that is smaller in shape and does not have an oversaturation of chroma would make an excellent candidate for canine substitution. Smiling lip level · Depending on how high the smile line is, it may show the canine eminence. · Large canines often have an obvious root prominence, and high lip levels may reveal that there is an unnatural eminence in the lateral sight. Clinical case A 13-year-old patient complaining about the aesthetic aspect of her smile was sent to my ofice by a general dentist with a diagnosis of the bilat- eral lateral incisors agenesis. The treatment started with an aesthetic anal- ysis of the patient’s face (Figs. 4–10), which was as follows: · Square face. · Slight facial asymmetry, with menton deviated to the right. · Maxillomandibular biretrusion (Fig. 10). · Correct curl of the upper lip. · Left side of the face is more flat compared with the right side. · Right eye slightly higher. · Insuficient display of the upper anterior teeth with lips in repose. Then occlusal analysis (Figs. 11–21) was performed: · Skeletal Class III (Fig. 17).