Ridge Changes with Orthodontic Space Opening 89

The orthodontic management of congenitally missing maxillary lateral incisors has three common treatment approaches: space closure by means of canine substitution, the placement of an endosseous dental implant, and a tooth supported restoration. Replacement of the missing teeth with an endosseous dental implant is a viable option, especially when adjacent teeth are healthy and unrestored ( Kokich, 2004 ). An alveolar ridge with adequate dimensions is a prerequisite for an ideally restored endosseous dental implant in the anterior a esthetic zone. When the height and width of the edentulous ridge is inadequate, grafting procedures may be necessary. It has been suggested that the orthodontic movement of adjacent teeth through the edentulous alveolar ridge can develop adequate alveolar ridge dimensions without resorting to grafting procedures ( Zachrisson, 2003 ; Gunduz et al. , 2004 ; Kokich, 2004 ). Bone is deposited as the teeth move along the ridge, reconstituting any dimensional de ciencies. According to Kokich, if a permanent lateral incisor is congenitally absent, it may be advisable to allow the permanent canine to erupt mesially into the lateral incisor space. The canine can then be orthodontically moved distally to develop a site with proper dimensions able to receive an implant without a graft ( Kokich, 1994 , 2004 ; Alveolar ridge w idth and h eight c hanges a fter o rthodontic s pace