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ePaper created 2018-03-13, 09:28:55 | version 1.38.0
| case report Tab. 1: Pre-treatment cephalometric data. Treatment results Discussion After 16 months, treatment concluded with the patient showing a significant profile improvement, a correction of the maxillary hypoplasia, anterior crossbite and Class III malocclusion with greater upper lip fullness, a balanced smile line, adequate gingival margins, levelling, and suit- able overjet and overbite. By replacing the congenitally missing lateral incisors with reconstructed canines and positioning reconstructed first premolars as canines, good occlusion was achieved (Figs. 4a–c). For the re-anatomisation of the canines and first pre- molars, we performed a laser diode gingivoplasty, then shaved the cusp tips of the canines and sculptured their distal and mesial borders with composite resin. Finally, we shaved and recontoured the palatal cusps of the first premolars to avoid premature contact at functional occlusion (Figs. 5a–j; Tab. 2). Many Class III patients elect not to undergo inva- sive treatment that involves surgery, extractions and/or implants, especially if treatment affects maxillary anterior teeth considered critical to overall smile aesthetics. When such aesthetic problems are presented, it is important that orthodontists have adequate training in and expe- rience and awareness of facial aesthetics to be able to offer more conservative solutions because such issues, if unresolved satisfactorily, can detrimentally affect the patients’ emotional state and self-esteem. The position of the maxillary and mandibular incisors determines facial harmony and a pleasing smile. Max- illary lateral incisor agenesis makes obtaining good treatment results a challenge, especially with reduced maxillary arch length, owing to the lack of these import- ant teeth. 16 ortho 1 2018