To close or to open the space of congenital missing lateral incisors

Prof.Dr.Maher Abdul Salam Fouda

GOOD MORNING

Orthodontic space opening of congenital missing maxillary lateral incisors for replacement of implant supported restoration

Mixed dentition stage, congenital missing permanent laterals and retained right deciduous lateral and deciduous canines

Mixed dentition stage, congenital missing permanent laterals and retained right deciduous lateral and deciduous canines

Congenital missing permanent upper laterals and lower centrals

Congenital missing permanent upper laterals and lower central incisor

Congenital missing maxillary lateral incisors; the deciduous canines , the right supernumerary tooth and the left deciduous lateral incisors still there.

Early detection

Congenital missing upper lateral incisors and lower right second premolar in early mixed dentition with retained deciduous laterals and canines.

If the crown of the permanent canine is erupting apical to the primary canine root as it normally does, extract the primary lateral incisors to encourage the permanent canine to erupt adjacent to the central incisor and insert palatal arch on the second deciduous molars to avoid arch length shortening.

Early detection

As the permanent canine erupt adjacent to the central incisors, it s large bucco-lingual width ′begin to develop the alveolar ridge in the edentulous area.

The canine is moved distally leaving behind an adequate bucco-lingual width for implant placement.

Early detection

Congenital missing maxillary lateral incisors in the permanent dentition

1)Orthodontic closing the space2)Orthodontic opening the space3)No treatment

Treatment options of congenital missing lateral incisors

Space closure with canine substitution

Orthodontic - prosthodontic (opening the space )

Second option to replace missing lateral incisors

Opening the space of Congenitally Missing Maxillary Lateral Incisors

Initial panoramic radiograph

Space opening of Congenitally Missing Maxillary Lateral Incisors

Panoramic radiograph post orthodontics

Particularly in adolescents the patients need long-term retention of the spaces with temporary retainers until the growth is complete If implant supported restoration is planned.

Four-wire version of the resin-bonded bridge

Three-wire design for single tooth replacement of a missing right lateral incisor

Hawley retainer with artificial lateral incisors

Bonded retainer

Retention after space opening

Orthodontic space opening of congenital missing lateral incisors with the replacement by implants

األسنان قسم – تقويمالمنصورة جامعة

Orthodontic hints for space opening

HOW TO CORRECT THE MIDLINE DEVIATION

FACIAL MID LINE

SHIFTED MIDLINE

HOW TO CORRECT THE MIDLINE DEVIATION

FACIAL MID LINE

POWER CHAIN LIAGATURE WIRE

HOW TO CORRECT THE MIDLINE DEVIATION

FACIAL MID LINE

OPEN COIL SPRING

HOW TO CORRECT THE MIDLINE DEVIATION

Corrected midline shift and open space for congenital missing lateral incisors

Mechanics of space opening :

Open space of the lateral incisors and prosthetic replacement of lateral incisors

Mechanics of space opening :

Open space of the lateral incisors and prosthetic replacement of lateral incisors

Choose the proper arch form for the case under treatment

TAPERED ARCH FORM

SEQUARE ARCH FORM

OVOID ARCH FORM

Align the teeth first with NITI wire 0.012 inch, 0.014 inch, 0.016 inch and S.S 0.016 x0.022 inch. The space is opened on stainless steel rectangular arch wire 0.016 x 0.022 inch

Start space opening using open coil springs that open and maintain spaces with constant, gentle force. From start to finish this spring delivers constant, unvarying force for predictable results-even when spring compression is changed the force stays the same.

Activation of the open coil spring

The open coil spring will close the diastema and retract the canines on rectangular stainless steel wire 0.016x0.022 inch and better 0.019x0.025 inch S.S

Coil spring causes rotation of the centrals and canines. Tying them with O rings will not prevent rotation

O rings for arch wire ligation

Ligate the centrals and canines with anti - rotation 0.009 inch soft stainless steel ligatures

The anti-rotation tie

The anti-rotation tie

Rotation wedgeRotation wedge

Rotation wedge

The open coil springs tend to protrude the central incisors hence you should cinch back the arch wire

Improper angulation of the roots of the central incisors

proper angulation of the roots of the central incisors

Improper angulations of the roots of the centrals after space opening

Proper angulation of the roots of the central incisors after space opening

To prevent improper angulations of the roots of the centrals bond the brackets on the centrals correctly

Opening the space to 6 mm (ideal state) to 5mm at the minimum

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The uprighting of roots may be performed by four approaches:

1. Bending the wire:

It is better to use square beta-titanium wire, e.g. CNA or TMA. We use L-bend which results in uprighting and intrusion, or Z-bend for uprighting only

Uprighting - Z-bend on the canine and L-bend on the central incisor

2. Preactivated bend in T-loop arch or uprighting bend in T-loop arch.

Opening the space for lateral incisors and uprighting the roots by means of T-loop arch

3. Partial arches, cantilever or box loop

Uprighting of roots with box loops

4. Bonding the brackets - angulated placement of brackets on labial surfaces of canine and central incisor.

OPG taken prior to removal of fixed appliance in order to examine the position of roots.

Parallelism of roots is controlled with OPG during treatment

CASE REPORT

Orthodontic space opening of congenital missing laterals

Upper and lower teeth before space opening

Fixed appliance for opening the space

Fixed appliance for space opening

Final space opening

ANY QUESTIONS