Management of Missing Lateral Incisors - PowerPoint Presentation

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Management of Missing Lateral Incisors

MJDF/MFDS WoS Study Group

August 2020

Aetiology

Missing maxillary incisors 1-2% in Caucasian population. Represent 20% of all missing permanent teeth.

More common in females.

The most commonly missing teeth are lower 2

nd

premolar (40%), upper lateral incisor (24%) then upper second premolars (20%).

Agenesis of laterals is more common

bilaterally

than unilaterally. Follows autosomal dominant mode of inheritance with incomplete penetrance.

Aetiology

Ectodermal dysplasia-genetic affecting various ectodermal structures such as scant hair, nails, teeth (multiple hypodontia and abnormalities of tooth form), no sweat glands

Cleft lip and palate

Down’s syndrome

Early irradiation of tooth germs

Considerations

The most common complaint is aesthetic. If only one lateral incisor is missing, the contralateral tooth may be diminutive and peg shaped.

Management is to carry out the least invasive treatment that satisfies the expected aesthetics and function for the patient.

The patient will need to consider likely future funding for treatment (possibly implant dentistry).

Suspect missing laterals if not erupted by nine years old or not erupted within 6 months of contralateral tooth

Management Options

1 A

ccept situation (esp. if poor OH, poor motivation

)

2 Restorative camouflage of permanent or deciduous dentition (e.g. veneers or composite resin)

3 Orthodontic space closure and substitution of the canine for missing lateral+/- adjunctive restorative/periodontal treatment. This gives the most permanent result.

4

Orthodontic space opening at lateral site for prosthetic replacement by:

a

) Denture/retainer (usually temporary)

b) Tooth supported restoration –RRB

c) Single tooth implant

SPACE CLOSURE. This gives most permanent result, and the periodontal condition is best. You maintain alveolar bone height. Can be done

without

orthodontics if well timed, but most cases get a better result with ortho. Good aesthetic result, but biggest problem is more yellow colour of the canine. Good placement of bracket can torque the canine root, and crown shape can be recontoured at finish. Teeth can be bleached to lighten canine. Gingival margin can be placed in most aesthetic position with ortho.

Do not do this for Class III cases

- it may lead to catastrophic collapse of upper arch.

SPACE OPENING.

When indicated, appliances can be used to create enough space for prosthetic replacement that can be fixed or removable. If implant is planned, must have parallelism of roots, and enough space for implant placement (minimum 6.5mm).

NB Cannot place implant if patient younger than 18 yrs because the implant will behave as an ankylosed tooth & will infraocclude if the patient is too young (and still growing). Maxillary bone quality not as good as the mandible for implant placement, but if canine is distalised from lateral space, bone will be laid down by appositional bone formation. Can place teeth in very favourable position for construction of RRB. May need to be fixed-fixed design if potential for relapse high.

Management (Cont’d)

RESIN-RETAINED BRIDGES

Technically simple, minimally-invasive and fairly successful. Patient satisfaction high, but may see display of metal, loss of translucency and staining of resin. Rapid tooth movements if silent debond occurs- patient must be vigilant. Only use full preparation (conventional) bridges if teeth are heavily compromised e.g. heavily filled.

In part 2 MJDF, the examiners may move on from this to start asking about the design of RRBs and materials used. They may also ask about appropriate clinical situations for their use, or they also ask about RRBs following trauma.