Congenital missing lateral incisors

1. To close or to open the space of
congenital missing lateral incisors
Prof.Dr.Maher Abdul Salam
Fouda

2. GOOD MORNING

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

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

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

6. Congenital missing permanent upper laterals and lower
centrals

7. Congenital missing permanent upper laterals and lower
central incisor

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

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

10. 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

11. 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

12. Congenital missing maxillary lateral incisors in
the permanent dentition

14. 1) Orthodontic closing the space
2) Orthodontic opening the space
3) No treatment
Treatment options of congenital missing
lateral incisors

15. Space closure with canine substitution

16. Orthodontic - prosthodontic
(opening the space )
Second option to replace missing
lateral incisors

17. Opening the space of Congenitally Missing Maxillary Lateral Incisors

18. Initial panoramic radiograph
Space opening of Congenitally Missing Maxillary Lateral Incisors
Panoramic radiograph post orthodontics

19. 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

20. Hawley retainer with artificial lateral
incisors
Bonded retainer
Retention after space opening

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

22. ‫قسم‬‫األسنان‬ ‫تقويم‬–‫المنصورة‬ ‫جامعة‬

24. HOW TO CORRECT THE MIDLINE DEVIATION
FACIAL MID LINE
SHIFTED MIDLINE

25. HOW TO CORRECT THE MIDLINE DEVIATION
FACIAL MID LINE
POWER CHAIN LIAGATURE WIRE

26. HOW TO CORRECT THE MIDLINE DEVIATION
FACIAL MID LINE
OPEN COIL SPRING

27. HOW TO CORRECT THE MIDLINE DEVIATION
Corrected midline shift and open space for
congenital missing lateral incisors

28. Mechanics of space opening :
Open space of the lateral incisors and prosthetic
replacement of lateral incisors

29. Mechanics of space opening :
Open space of the lateral incisors and prosthetic
replacement of lateral incisors

30. Choose the proper arch form for the
case under treatment
TAPERED ARCH FORM
SEQUARE ARCH FORM
OVOID ARCH FORM

31. 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

32. 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.

33. Activation of the open coil spring

34. 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

35. Coil spring causes rotation of the centrals and canines.
Tying them with O rings will not prevent rotation
O rings for arch wire
ligation

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

38. The anti-rotation tie

39. The anti-rotation tie

40. Rotation wedgeRotation wedge

41. Rotation wedge

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

43. Improper angulation of the
roots of the central incisors
proper angulation of the roots
of the central incisors

44. Improper angulations of the roots of the centrals after
space opening

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

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

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

49. 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

50. 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

51. 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

52. CASE REPORT

53. Orthodontic space opening of congenital missing
laterals

54. Upper and lower teeth before space opening

55. Fixed appliance for opening the space

56. Fixed appliance for space opening

57. Final space opening

58. ANY
QUESTIONS