Please activate JavaScript!
Please install Adobe Flash Player, click here for download
ePaper created 2017-12-19, 09:12:26 | version 1.38.0
case report _ lateral incisors agenesis treatment Orthodontic management of maxillary lateral incisors agenesis Author_Dr Dan Andrei Iacob, Romania T he purpose of this article is to show the different modalities of treatment for upper lateral incisors agenesis. In daily practice, or- thodontists often meet cases of upper lateral incisors agenesis. The two common treatment options are: space closure, using canines to sub- stitute the missing lateral incisors, or space ope- ning for future restorations. _Introduction _ Theoretical considerations; _ The second most common agenesis, representing 20 % of the congenital missing teeth; _ The second most common agenesis (Euro- pe), after the mandibular second premolar; _ The most frequently missing tooth in the American population; _ Unilateral agenesis is often associated with dysmorphia or microdontia of the corresponding 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; _ 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 wellpro- portioned 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 al- lows for the immediate disclusion of mo- lars and premolars when making lateral or protrusive movements; _ Centric occlusion coinciding with centric relation. _Treatment strategies for canine substitution _ Angulate and extrude the canine to mi- mic 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 bra- cket on the upper canine; _ Adjust dental proportions as necessary: mesiodistal reductions on the upper cen- tral incisors to balance adjustments on the substituted canine. 20 cosmetic dentistry 4_2017