Managing Congenitally Missing Lateral Incisors Part 1: Canine Substitution

tally missing maxillary lateral incisors raises several important issues: Amount of space? Patient age? Type of malocclusion? Condition of the adjacent teeth? There are three treatment options that exist for replacing missing lateral incisors. These options include: canine substitution, a tooth-supported restoration, and a single-tooth implant. There are also specific criteria that must be addressed when choosing the appropriate treatment option. The primary consideration among all treatment plans should be conservation. Generally, the treatment of choice should be the least invasive option that satisfies the expected esthetic and functional objectives. The orthodontist plays a key role in achieving specific space requirements by positioning teeth in an ideal restorative position. For example, canine substitution can be an excellent, esthetic treatment option for replacing missing laterals. However, if it is used in the wrong patient, the final result may be less than ideal. Ultimately, an interdisciplinary approach is the most predictable way to achieve optimal final esthetics. SELECTING THE APPROPRIATE PATIENT There are specific dental and facial criteria that must be evaluated before choosing canine substitution as the treatment of choice for replacing a missing maxillary lateral incisor. They include malocclusion and amount of crowding, profile, canine shape and color, and lip level (Figure 1A through Figure 1C).1,2 If these selection criteria are fulfilled, the patient can expect a functional and esthetic final result.3