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cosmetic dentistry Italian Edition Vol. 4, 2017

case report _ lateral incisors agenesis treatment Fig. 37 Fig. 38 _ Skeletal Class III (Fig. 17); _ Dental Class I; _ Maxillary hypoplasia with lower arch dental compensations; Insufficient overbite and overjet; _ _ Upper spacing due to the laterals agene- sis (Fig. 18); _ Upper midline deviated to the right; _ Initial CR mounting (Figs. 19–21). Finally space analysis was carried out (Tables 1a & b). _Treatment plan It was concluded that maxillary hypoplasia was an indication for space opening. Considering the young age of the patient, the skeletal pattern and the high demands regarding aesthetics, it was decided to: _ Open spaces for two implants, but in the posterior area: 14 and 24; _ Substitute the laterals with canines; _ Temporary implants and crowns on teeth #14 and 24, until 18 years; _ Reshaping the canines and first premo- lars to match the shape of the lateral incisors and canines: direct composites restorations on teeth #13, 11, 21, and 23. _Treatment step by step: _ Upper bracket placement (Fig. 22): level and align the gingival margins, and cor- rect the torque on the upper canines who will substitute the lateral incisors; Implants space opening: substitute laterals with canines (Figs. 23–25) and substitute _ Fig. 39 Fig. 40 canines with first premolars (Figs. 26–28); _ Finishing and occlusal settling (Figs. 29–31); _ Verifying the implant site width (Fig. 32) and provisory implants and crowns pla- cement (Fig. 33). _Restorative phase At the end of orthodontic treatment, gingival margins were well aligned, midlines were centred and canines and first premolars were positioned to facilitate the restorative phase of treatment (Figs. 34–36). At this phase, a final CR mounting and wax-up was performed (Figs. 37–39), as well as the anterior teeth restorations (Fig. 40). Orthodontic treatment has improved both dental and facial aesthetics (Figs. 41–47) and the functionality of the occlusion (Figs. 48–52). Table 1a_Space analysis (Maxilla) Table 1b_Space analysis (Mandible) Table 1a Maxilla Crowding -5 mm Needed to create space for lateral incisors AP incisors position 0 mm Total -5 mm Table 1b Mandible Crowding -2 mm AP incisors position 0 0 mm Curve of SPEE -1 mm Total -3 mm cosmetic dentistry 4_2017 23

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