Managing the patient with missing or malformed maxillary central incisors.

2). O ccas ional ly , orthodontists and genera l dentists encounter a patient who has traumatically avulsed a maxillary central incisor or a pa tient with a geminated or fused maxillary central incisor that must be removed. In either situa tion, a decision must be made about the eventual restoration of the anterior edentulous space. Several options exist for replacing a missing maxillary central incisor. If the tooth has been avulsed, the simplest long-term solution is to replant it. However, the success of reimplantation depends on the status of the tooth root, 4 the ability to perform endodo tics, and the length of time that the tooth is out alveolar socket. 5 If reimplantation is not possib autotransplantation might be an option. 6 However, the patient must have an arch-length deficiency, so that a premolar from a posterior quadrant can be transplanted to the edentulous site. A third solution is to maintain the edentulous space during childhood and adolescence, and to place a bridge or implant during adulthood. A fourth possible solution is to close the edentulous space and substitute the ipsilateral lateral incisor for the central incisor. 7 The choice of the appropriate soluti for the missing maxillary central incisor depends on the specific characteristics of each situation.