Missing anterior teeth: orthodontic closure and transplantation as viable options to conventional replacements

Traditional replacement options for missing maxillary incisors include implants and partial dentures. Although less well known among endodontists and general dentists, orthodontic space closure and autotransplantation of developing premolars may, however, constitute relevant alternatives. The challenge in treating patients with missing maxillary incisors and concomitant malocclusion is how to achieve the best esthetic and functional results, particularly in the long term (1). Although data for survival of single tooth implants is favorable, over time there may be significant problems associated with their use in the esthetic zone, such as infraocclusion (2, 3), gingival retraction with root exposure, and darkening of the overlying gingiva due to resorption of the buccal bone plate (4). Autotransplantation of teeth and orthodontic space closure represent viable biological approaches for replacement of incisors because of the permanence of the result, particularly in growing individuals. Treatment decisions for young people with missing incisors should be based on a comprehensive assessment that includes several factors (1), and the ultimate treatment plan should be dictated by the diagnosis and not by a preferred methodology. From 2000 to 2003, the authors published a series of articles in the American Journal of Orthodontics and Dentofacial Orthopedics on the outcome of tooth transplantation, and of orthodontic space closure in the management of missing teeth (5–9). It is clear from the debate that followed (3, 10–16) that there are conflicting opinions, pointing to a need for further information and research in this area. The purpose of this article is to summarize the authors’ experience over the past 40 years with transplantation and orthodontic space closure in the treatment of missing incisors. There are two main reasons for missing incisors in young people: traumatic injuries and congenital absences. Because the nature of the problems differs in these two situations, the management with regards to the two types of missing teeth will be discussed separately.