Congenitally missing maxillary lateral incisors: restorative replacement. Counterpoint.

A As dentists, we are often faced with the question: to close or not to close? Since maxillary lateral incisors are often congenitally missing, replacement of these teeth raises several important treatment planning concerns. Therefore, it is beneficial to use an interdisciplinary treatment approach to obtain the most predictable outcome. There are multiple treatment options for the replacement of congenitally missing lateral incisors, including canine substitution, single-tooth implants, and tooth-supported restorations. Drs Zachrisson, Rosa, and Toreskog beautifully illustrated the benefits of canine substitution by presenting the advantages and disadvantages of space closure as well as the functional and esthetic limitations that accompany this treatment choice. Like our European colleagues, our team agrees with the underlying principle to develop treatment plans that are both conservative and functional while maintaining excellent esthetics. However, the esthetic and functional success of canine substitution ultimately depends on variables such as malocclusion, crowding, profile, crown shape and color, and smiling lip level. Also, the amount of crown reduction that is often required to appropriately position these teeth esthetically and functionally in 3 planes of space can be excessive. Therefore, the optimal canine substitution patient is one who has small canines with crowns that match the shade of the central incisors. Ideally, he or she should also have a nice profile, a Class II dental relationship, and no crowding in the mandibular arch. However, many patients do not meet these criteria, and multiple veneers often need to be placed on the anterior teeth to overcome the