Maxillary lateral incisor agenesis and microdontia: Minimally invasive symmetric and asymmetric esthetic rehabilitation

Maxillary lateral incisor agenesis is a condition that significantly compromises smile esthetics, which is particularly worrying in young patients. This article shows how the combination of non-invasive treatments and current restorative options may improve clinical outcomes following orthodontic treatment for symmetric and asymmetric maxillary lateral incisor agenesis and microdontia. Teeth were treated with conservative resin restorations in three separate cases: two of congenitally missing maxillary lateral incisors (i.e., unilateral and bilateral) and one of microdontia. After presenting the clinical results, this article summarizes how bleaching, enameloplasty, and bonding with composite resin can enhance esthetics and functions following orthodontic space closure. The cases reveal that carefully planned, methodically executed orthodontic and restorative approaches can achieve predictable, esthetic outcomes that will improve the patient’s self-esteem with a minimally invasive solution.

Extraction of first permanent molars severely affected by molar incisor hypomineralisation: a retrospective audit

Aim The aim of this study was to evaluate possible spontaneous space closure after extraction of first permanent molars in children and their eventual need for orthodontic treatment. Methods Twenty-seven children with at least one first permanent molar planned for extraction were enrolled in the study. The children were referred to the Department of Paediatric Dentistry, University of Oslo, between 2009 and 2017. All extracted teeth were severely affected by Molar Incisor Hypomineralisation and/or caries. The children and their parents had consented to extraction and follow-up. Data were analysed with SPSS 26. Results The age of the children was between 5.5 and 12.1 years (mean 8.7) at extraction. The mean follow-up time was 3.2 years (range 1.1–6.3). Sixteen children (59.3%) had all four molars extracted, five (18.5%) had three, five had two and one had one molar extracted. In the maxilla, the second permanent molar had erupted in the place of the first molar in all the children, and none of them needed orthodontic space closure. In the mandible, eight children (29.6%) needed orthodontic treatment to close the spaces after extraction. In three children, the second molar was not yet erupted and treatment need was not settled. Conclusion Extraction of severely affected first permanent molars before the eruption of the second molar is a treatment option causing little additional treatment in the majority of cases.

Trends in orthodontic management strategies for patients with congenitally missing lateral incisors and premolars

ABSTRACT Objectives To identify changes in orthodontic management strategies in patients with hypodontia seen in 2000, 2010, and 2017/2018 (during a 1-year period). Materials and Methods An assessment of the panoramic radiographs of 3701 patients from a Western Australian private practice identified 276 individuals demonstrating hypodontia. The location of missing teeth, age, sex, type of malocclusion, and the management strategies (space closure or opening) for each patient were noted. Results Most hypodontia involved agenesis of three or fewer teeth (90%). Maxillary lateral incisors and mandibular second premolars were the most commonly missing teeth. Female preponderance was noted. When considering treatment, the odds ratio for orthodontic space opening and prosthetic replacement in 2000 was 3.266 (P value = 7e-04; 95% confidence interval [CI], 1.464–4.633) compared with patients seen in 2010 and 1.632 (P value = 7e-04; 95% CI, 0.811–2.434) compared with patients in 2017/2018. For patients demonstrating bilateral absence of maxillary lateral incisors, the odds ratio for orthodontic space opening was 3.185 (P value = 0.0215; 95% CI, 1.182–9.243) compared with counterparts with unilateral agenesis. None of the factors investigated were significantly associated with the types of treatment planned/provided for the patients with missing mandibular second premolars. Conclusions Maxillary lateral incisors and mandibular second premolars were the most commonly missing teeth. A trend away from space opening and prosthetic replacement toward orthodontic space closure was observed from 2000 to 2017/2018. This may reflect a change in attitude toward prosthetic replacement options and/or greater optimism with biomechanical strategies since the implementation of temporary anchorage devices to assist in space closure.

Factors affecting the stability of maxillary extraction site closure

ABSTRACT Introduction: A side effect observed in cases treated with extractions is the instability of orthodontic space closure. Objective: The aim of this study was to investigate the influence of gingival invagination, presence of third molars and facial pattern, on the stability of orthodontic space-closure in the maxillary arch. Methods: Ninety-nine subjects (41 male and 58 female) with Class I malocclusion treated with four premolars extraction were evaluated. Extraction sites reopening and gingival invaginations were evaluated in scanned dental models in the posttreatment and 1-year posttreatment stages (mean age 16.1 years). Third molars presence was evaluated at 1-year posttreatment panoramic radiographs, and the facial pattern (SN.GoGn) was evaluated in the initial lateral headfilms. Multiple logistic regression analysis was used to estimate the influence of the aforementioned independent variables on the frequency of extraction space reopening. Results: Space reopening was observed in 20.20% of the subjects 1-year post-debonding. Gingival invaginations were present in 25.73% of quadrants after debonding and in 22.80% 1-year posttreatment. The mean pre-treatment SN.GoGn was 35.64 degrees (SD=5.26). No significant influence was observed of the three independent variables on the instability of extraction site closure. Conclusions: The presence of gingival invaginations, third molars and facial growth pattern do not seem to influence maxillary extraction sites reopening.

Comparison of the rate of orthodontic space closure, with and without probiotic supplements: A randomised control trial

To compare the rate of orthodontic space closure with and without systemic administration of probiotics. Cluster randomised controlled trial, an invivo RCT study. Forty-eight male patients undergoing orthodontic fixed appliance treatment were recruited based on purposive sampling technique and randomly allocated to group A (control) and group B (experimental). During retraction, the patients in the experimental group were given 90 probiotic capsules each and instructed to take one capsule per day along with breakfast for 90 days. The distance between the canine and 2nd premolar on the maxillary arch in both groups were measured using a digital vernier calliper. The measurements were taken before starting the retraction, after 30 days, after 60 days and after 90 days of retraction. The collected data was calculated and tabulated for statistical analysis. Independent t-test revealed that pre retraction, there was no statistically significant difference (p>0.05) between the control and experimental. Post retraction, there was significant (p<0.05) reduction in mean retraction value of the control group than the experimental group. Paired t-test showed a significant (p<0.05) reduction in the control group than experimental after 30 days of probiotic therapy month and a highly significant (p<0.01) difference between control and experimental groups after 60 days of probiotic therapy. There was no significant difference in the rate of orthodontic space closure between the groups after one month of probiotic therapy. There was a significant reduction in the rate of orthodontic space closure in the probiotic group when compared with the control group after two months of probiotic therapy.

Orthodontic Space Closure of a Missing Maxillary Lateral Incisor Followed by Canine Lateralization

Maxillary lateral incisor agenesis is the most prevalent developmental dental anomaly. The management of missing lateral incisor was either closure using canine as substitution or creation of space orthodontically for prosthetic replacement. A careful diagnosis and treatment plan are deemed essential to address the patient’s needs as the spacing is present in the esthetic region. Such problem is very challenging for orthodontists, prosthodontists, and general practitioners. This case report describes the orthodontic management of a 22-year-old adult female patient with missing upper left lateral incisor tooth and upper anterior spacing by closing the space with canine lateralization and reshaping to simulate it with the lateral incisor. However, some modifications in the treatment mechanics are crucial to achieve the optimal esthetic and to improve the occlusion. Space closure with canine lateralization option seems less invasive, treatment can be completed relatively in a short period of time, and its adaptation with the facial changes throughout life without having artificial prosthesis provided other factors favoring for this option.