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With
missing maxillary (upper) lateral incisors, there are two
possible treatment modalities. One is to close the missing
lateral incisor spaces and move the canine teeth next to
the central incisors. The canines would be reshaped to resemble
the lateral incisors. The second option is to maintain,
or open space of the missing laterals and replace the missing
laterals with (prosthetic) implants, bridges, or a removable
appliance. The following are advantages and disadvantages
of both procedures.
Restorative
Treatment
(Prosthetic Replacement of the Maxillary Laterals)
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ADVANTAGES
- Shape, size and color of the prosthetic teeth can be
somewhat controlled
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DISADVANTAGES
- Long term maintenance and replacement of prosthetic
teeth can somewhat prosthetic teeth
- Large financial commitment
- More elaborate home care (hygiene) required and potential
periodontal problems
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Space
Closure
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ADVANTAGES
- Only routine dental care of the canines
* See reference below
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DISADVANTAGES
- Shape, size, and color of the canines can not be controlled
- Stability: Space may open between the centrals and canines
- The reshaped canines may not look like laterals incisors
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*Robertsson S, Mohlin B. The congenitally
missing upper lateral incisor: A retrospective study of
orthodontic space closure versus restorative treatment.
European J Orthod. 2000; 22:697-710.
Conclusion: The study indicates orthodontic
space closure and canine replacement for missing lateral
incisors produces treatment results that appear stable,
better accepted by patients, and with less periodontal complications
than the use of fixed prosthetic bridge replacement.
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Robertsson
S, Mohlin B. The congenitally missing
upper lateral incisor: A retrospective study of orthodontic
space closure versus restorative treatment.
European J Orthod. 2000; 22:697-710.
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Missing
lateral incisors: Space closure vs.
Restorative treatment
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Objective:
To examine treated orthodontic patients with congenitally
missing upper lateral incisors managed either with orthodontic
space closure using canine replacement or space opening for
restorative prosthetics.
Design: Retrospective study
Methods: The patients'opinion of
their aesthetic results were determined through interviews,
as well as clinician assessment of aesthetic results, occlusal
function, and periodontal health. There were 50 patients,
30 treated with orthodontic space closure and 20 by space
opening and fixed prosthetic bridges (no implants), assessed
at a mean age of 26.0 years with the average time after completion
of treatment at 7.1 years. Patient opinions were determined
using an Aesthetic Index questionnaire and during a structured
interview as to satisfaction with tooth shape, color, space
distribution, and alignment symmetry. Authors, clinically
and using radiographs and study models, evaluated TMJ functional
status, periodontal condition, dental contact patterns, facial
morphology, and prosthetic quality of restorations.
Results: In the orthodontic space
closure group, 93% of subjects were satisfied with their aesthetic
results as to alignment, shape, and spacing. Their main complaint
was that the replacement canine teeth looked yellow. In comparison,
only 65% of the prosthetic group were very or moderately satisfied,
with the major complaint related to symmetry of the incisor
segment and differences in tooth shape and color. No clinical
differences in temporo-mandibular dysfunction were found between
groups; but the prosthetic subjects more commonly had plaque
retention and impaired periodontal health in the anterior
segments.
Conclusions: The study indicates orthodontic
space closure and canine replacement for missing lateral incisors
produces treatment results that appear stable, better accepted
by patients, and with less periodontal complication than the
use of fixed prosthetic bridge replacement.
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I
have reviewed the above information with Dr. Rinchuse and
have had an opportunity to ask questions in regards to space
closure vs. restorative treatment of missing upper lateral
incisors. |
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Signature |
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Date |
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