T. B. Yordanova

Medical University – Sofia, Bulgaria, Faculty of Dental Medicine, Department of Orthodontics

Upper lateral incisors are widely accepted to be the second most frequent congenitally missing teeth after the lower second premolars. To correct deformities of this type, two basic clinical approaches can be used: orthodontic closure of space through mesial movement of the posterior teeth or opening enough space for subsequent prosthetic reconstruction.

Aim: To evaluate the possibility for orthodontic space opening as a preparation for subsequent prosthetic restoration of maxillary lateral incisors in skeletal class III non-growing patients.

Materials and methods: 9 non-growing patients with III skeletal class and hypodontia of the upper lateral incisors were enrolled in the study. We used a fixed appliance (braces) to treat the patients. Missing lateral incisors were replaced with single-tooth implant restorations. Approximal enamel reduction (stripping) was also necessary in the lower jaw.

Discussion: Due to the co-existing malocclusion (skeletal class III/progenia), we selected an orthodontic approach that allowed us to open up enough space and restore the number of teeth in the upper jaw. By correcting rotations of upper premolars, distal movement of upper canines and by buccal and distal inclination of upper posterior teeth we were able to create additional space in the maxillary dental arch.

Conclusion: Selecting the optimal treatment plan depends on the number and position of missing teeth, co-existing malformations, patient’s profile and also on the shape, color and condition of the neighboring teeth. Hypodontia cases usually require complex orthodontic-prosthetic approach, which is a prerequisite for achieving optimal functional and aesthetic restoration of the dentition.