Congenitally missing mandibular second premolars: clinical options.

INTRODUCTION: Congenital absence of mandibular second premolars affects many orthodontic patients. The orthodontist must make the proper decision at the appropriate time regarding management of the edentulous space. These spaces can be closed or left open. IMPLICATIONS: If the space will be left open for an eventual restoration, the keys during orthodontic treatment are to create the correct amount of space and to leave the alveolar ridge in an ideal condition for a future restoration. If the space will be closed, the clinician must avoid any detrimental alterations to the occlusion and the facial profile. SIGNIFICANCE: Some early decisions that the orthodontist makes for a patient whose mandibular second premolars are congenitally missing will affect his or her dental health for a lifetime. Therefore, the correct decision must be made at the appropriate time. PURPOSE: In this article, we present and discuss various treatment alternatives for managing orthodontic patients with at least 1 congenitally missing mandibular second premolar.

Perceptions of dental professionals and laypersons to altered dental esthetics: asymmetric and symmetric situations.

INTRODUCTION: Previous studies evaluated the perception of laypersons to symmetric alteration of anterior dental esthetics. However, no studies have evaluated the perception of asymmetric esthetic alterations. This investigation will determine whether asymmetric and symmetric anterior dental discrepancies are detectable by dental professionals and laypersons. METHODS: Seven images of women's smiles were intentionally altered with a software-imaging program. The alterations involved crown length, crown width, midline diastema, papilla height, and gingiva-to-lip relationship of the maxillary anterior teeth. These altered images were rated by groups of general dentists, orthodontists, and laypersons using a visual analog scale. Statistical analysis of the responses resulted in the establishment of threshold levels of attractiveness for each group. RESULTS: Orthodontists were more critical than dentists and laypeople when evaluating asymmetric crown length discrepancies. All 3 groups could identify a unilateral crown width discrepancy of 2.0 mm. A small midline diastema was not rated as unattractive by any group. Unilateral reduction of papillary height was generally rated less attractive than bilateral alteration. Orthodontists and laypeople rated a 3-mm distance from gingiva to lip as unattractive. CONCLUSIONS: Asymmetric alterations make teeth more unattractive to not only dental professionals but also the lay public.

Managing congenitally missing lateral incisors. Part III: single-tooth implants.

UNLABELLED: Three treatment options exist for the replacement of congenitally missing lateral incisors. They include canine substitution, a tooth-supported restoration, and a single-tooth implant. Selecting the appropriate treatment option depends on the malocclusion, anterior relationship, specific space requirements, and condition of the adjacent teeth. The ideal treatment is the most conservative option that satisfies individual esthetic and functional requirements. Today, the single-tooth implant has become one of the most common treatment alternatives for the replacement of missing teeth. This article closely examines the many interdisciplinary issues that arise when treatment planning the placement of single-tooth implants in patients with congenitally missing lateral incisors. The specific criteria that must be evaluated illustrate the importance of an interdisciplinary treatment approach to achieve optimal esthetics and long-term predictability. This is the final article of a three-part series discussing the three treatment alternatives for replacing congenitally missing lateral incisors. CLINICAL SIGNIFICANCE: When treatment planning single-tooth implants to replace congenitally missing lateral incisors, an interdisciplinary approach is necessary to provide the most predictable treatment outcome.

Managing congenitally missing lateral incisors. Part II: tooth-supported restorations.

Three treatment options exist for the replacement of congenitally missing lateral incisors: canine substitution, a tooth-supported restoration, or a single-tooth implant. Selecting the appropriate treatment option depends on the malocclusion, the anterior relationship, specific space requirements, and the condition of the adjacent teeth. The ideal treatment is the most conservative alternative that satisfies individual esthetic and functional requirements. This article closely examines the three options when replacing a missing lateral incisor with a tooth-supported restoration. These options are a resin-bonded fixed partial denture, a cantilevered fixed partial denture, and a conventional full-coverage fixed partial denture. The specific criteria that must be evaluated for each option is addressed to illustrate the importance of interdisciplinary treatment planning to achieve optimal esthetics and long-term predictability. This article is the second of a three-part series discussing the three treatment alternatives for replacing congenitally missing lateral incisors.

Managing congenitally missing lateral incisors. Part I: Canine substitution.

UNLABELLED: Dentists often encounter patients with missing or malformed teeth. The maxillary lateral incisor is the second most common congenitally absent tooth. There are three treatment options that exist for replacing missing lateral incisors. They include canine substitution, a tooth-supported restoration, or a single-tooth implant. Selecting the appropriate option depends on the malocclusion, specific space requirements, tooth-size relationship, and size and shape of the canine. The ideal treatment is the most conservative option that satisfies individual esthetic and functional requirements. Often the ideal option is canine substitution. Although the orthodontist positions the canine in the most esthetic and functional location, the restorative dentist often needs to place a porcelain veneer or crown to re-create normal lateral incisor shape and color. This article closely examines patient selection and illustrates the importance of interdisciplinary treatment planning to achieve optimal esthetics. It is the first in a three-part series discussing the three treatment alternatives for replacing missing lateral incisors. CLINICAL SIGNIFICANCE: Patients with congenitally missing lateral incisors often raise difficult treatment planning issues. Therefore, to produce the most predictable esthetic results, it is important to choose the treatment that will best address the initial diagnosis. This article is the first in a three-part series that describes the different treatments available for patients with congenitally missing lateral incisors. This first article focuses on canine substitution as a method of tooth replacement for these missing teeth. The general dentist will learn to evaluate specific patient selection criteria and determine whether canine substitution is an appropriate treatment alternative for replacing missing lateral incisors. The orthodontist will understand how to position the canines to satisfy functional requirements and achieve proper esthetics. Finally, the importance of interdisciplinary team treatment planning is emphasized as a requirement for achieving optimal final esthetics.