One of several reasons I appreciate having been a general dentist for a few years and now working as a specialist with local general/restorative dentists is combining orthodontic treatment with esthetic dentistry for permanent finished results.
Typically, the youngest patient seen for an orthodontic consult is around the age of 7. At this consult a missing lateral incisor can be diagnosed at that young age. Closing the space where the tooth (if one is missing) or teeth (if both are missing) is an esthetic and viable procedure that provides longterm results that are completed in the patient's adolescence. Recent improvements in restorative dentistry including individual tooth bleaching, porcelain veneers and/or hybrid composite resin build-ups can yield results indistinguishable from natural dentitions. These improvements discussed can minimize potential problems with orthodontic space closure, when teeth are substituted into non-traditional positions. Longterm stability of the results is aided with a fixed retainer and removable back-up retainer.
Patient finished her orthodontic treatment at 17 years, with all of her natural teeth. No additional dental treatment needed.
Patient finished his orthodontic treatment at age 18 years with all of his natural teeth. No additional dental treatment needed.
Of course in treatment planning, it's important to identify alternative procedures, including discussing the cost-risk-benefit ratios of each option. Osseointegrated implants are frequently discussed to replace the missing tooth/teeth. Unfortunately the timeline for optimum longterm results adds potential problems to this treatment option. These timeline issues are realized when a patient finishes orthodontic treatment at age ~13, receives retainers, and waits at least 4 (female) and up to 7 years (male) for skeletal growth to cease. During this time wearing a retainer consistently is frequently not done. If this happens, orthodontic re-treatment is needed to realign the teeth and spaces before implants can be placed. (see photos)
Patient finished her orthodontic treatment at age 17 years, then went to a periodontist and dentist for 2 implants and 2 crowns to restore missing lateral incisors.
Top Left: Congenitally missing upper lateral incisors, Top Right: With retainer (flipper)
Bottom: Final after implants and crowns
Patient in treatment congenitally missing upper lateral incisors. He will finish his orthodontic treatment at age 17 years. Retainer will have denture teeth attached. Implants/crowns will be done in another year to replace missing lateral incisors.
Teamwork and planning orthodontic with restorative dentistry can successfully treat patients with missing lateral incisors so the results look like an intact dentition. See you next month!
References
1. Tuverson DL. Orthodontic treatment using canines in place of missing lateral incisors. Am J Orthod. 1970;58:109-127
2. Zachrisson BU. Remodeling teeth by grinding. Am J Orthod. 1975;68:545-553
3. Rosa M., Zachrisson BU. The space closure alternative for missing maxillary incisors:an update. J Clin Orthod 2010;44:540-549
4. Thilander B, et al. Orthodontic aspects of the use of oral implants in adolescents: a 10 year follow-up study. Eur J Orthod. 2001; 23:715-731.
