Congenitally Missing Laterals

 The following case was a very interesting one with a few hurdles and difficult choices to make. This female teenage patient presented to the office with congenitally missing lateral incisors, meaning she was born without these teeth. Her canines had drifted toward the midline to fill the spaces, so the treatment plan took some time and serious consideration to develop. There are many ways to approach this issue, but Dr. Saylor had 2 plans of action in mind:

1. We could move the canines back into natural,optimally functional position with orthodontics and “build” new lateral incisors on top of implants. Moving these teeth towards the posterior would leave a thin ridge of bone where the laterals needed to be implanted, so a periodontist would perform a bone augmentation procedure to have a foundation in which to place titanium dental implants. (Longer, more involved treatment.)

2.  We could pull everything forward with braces to close the spaces and recontour the canines to look like the missing lateral incisors. (Easier of the two plans.)

-Dr. Saylor collectively decided along with the patient, an orthodontist and a periodontist to go with Treament Plan #1.                                                                                                             -Reason being: This course of treatment was definitely the best for the patient in the long run. The canine teeth are the sentries of the masticatory process. That is, the canines are the teeth that provide guidance for the function of the jaws in the chewing motion. If the canines are moved or have drifted out of position, the function may be compromised and cause the temperomandibular joint (TMJ) to become stressed and develop lifelong issues.

  The picture below is the patient after bone augmentation surgery and orthodontics.

 The next photo is the patient after having the dental implants placed. The implant is left to integrate into the bone for 90-120 days and then the abutment screw is placed. An impression is taken of these abutments so that custom implant crowns can be fabricated. This picture looks a little scary, but illustrates quite a scientific advancement for the dental field.

  The following photo showcases the multi-purpose functions of today’s composite resin. Instead of a traditional temporary crown or veneer that is made out of acrylic from an impression of the original tooth structure, Dr. Saylor had to sculpt temporary crowns to cover the abutment screws, as we had no impression of the original missing teeth! These temporaries look pretty good and give us an idea of how to shape and prescribe the laboratory fabrication specifications. They are not nearly as perfect as the porcelain implant crowns will be, but are definitely easier to look at than the preceding photo!

  The photo below is of the porcelain crowns in place. One of the most difficult challenges to overcome when creating teeth for a patient is matching the angulation or “flare” of the natural teeth. What most people do not realize is that the shape, size, and angle of protrusion of the teeth has a huge impact on the “wideness” of the smile and also the formation and fullness of the lips. Most patients who are missing front teeth congenitally cannot pinpoint exactly why they are displeased with their smile. Usually, it’s because the smile is not a bright, wide smile and has the appearance of a child’s smile in an adult face. This case also presented a challenge to the dental team because the patient began treatment as a teenager and still had some physical maturing to do. Dr. Saylor had to account for this factor and try to foresee the end results in an adult face and frame.  The patient was extremely pleased with the results and has a beautiful, natural, and healthy-looking smile!

Yet another happy patient of Dr. Saylor’s!

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