Académique Documents
Professionnel Documents
Culture Documents
Missing upper
lateral incisors
Medical history
The patient is fit and well.
Family history
The patients mother had a number of teeth missing. They
had been replaced with a partial denture at an early age.
Examination
Extraoral examination
The patient has a skeletal class I appearance without facial
asymmetry. There is a slight deviation of the mandible to
the patients left-hand side on opening, but no limitation of
opening, temporomandibular joint clicks or crepitus or masticatory muscle tenderness.
Intraoral examination
SUMMARY
A 15-year-old boy presents to you in general dental
practice requesting closure of the spaces between
his upper front teeth. What is the cause and how can
a better appearance be achieved?
The patients soft tissues are healthy and his oral hygiene is
good, with no calculus deposits, gingival inflammation or
bleeding on probing. The teeth appear sound, with the
exception of a buccal amalgam restoration in the lower left
first molar.
Study models taken for treatment planning are shown in
Figure 50.1.
What are the possible causes for the absent lateral incisors?
What is the cause in this case?
Missing
Failure to erupt
History
Complaint
The patient does not wish to have gaps between his upper
front teeth.
History of complaint
His permanent teeth erupted at a normal age with large
spaces between them. The primary predecessors had all
been present and were exfoliated normally. None of the
permanent teeth has been extracted.
In this case the most likely cause for the missing lateral
incisors is genetic absence. Genetic absence of some teeth is
found in 37% of the population. The teeth most commonly
missing are, in descending order of frequency, third molars,
maxillary lateral incisors and second premolars. The absence
of maxillary lateral incisors is a hereditary trait in about 12%
CASE
50
236
Mi s s in g u pp e r lat e r al inci s o r s
of the population. The fact that the patients mother wore a
denture to replace missing teeth from an early age suggests a
possible familial aetiology. Trauma or extraction and their
related sequelae are readily excluded by questioning. The
other causes are discussed in Case 5.
Investigations
Treatment
What are the main treatment options? What are their
advantages and disadvantages?
Reason
Radiographs
Option
Orthodontic space
closure
Mi s s in g u pp e r lat e r al inci s o r s
50
B
a
CASE
237
CASE
50
238
Mi s s in g u pp e r lat e r al inci s o r s
What else has been done to improve the appearance of the
final result? Look closely and compare Figure 50.5b with
Figure 50.1.
The lower arch has been treated orthodontically. One lower
incisor has been extracted and the space gained has been
used to align the lower incisors and the lower right canine,
which was in crossbite. This has made a significant
contribution to the final appearance.