There are conditions that sometimes force creative decision-making to establish an aesthetic and functional dental occlusion.
I’m referring here to congenital absence of lateral incisors, traumatic loss of an upper central incisor (or two), or mutilated dentition with at least one missing canine.
Case 1: Congenital absence of upper left lateral incisor, upper right lateral incisor shaped like a grain of rice (microdent).
Treatment: Substitution of canines for laterals.
Case 2: Congenital absence of 2 lower central incisors.
Treatment: Extraction of 2 upper premolars, lower lactate incisor and substitution of lower central incisors by laterals.
Case 3: Coronal fracture of the left upper central incisor in a car accident. The patient was entitled to replacement of the fractured incisor, but it was impossible to replace the fractured incisor without orthodontic treatment. We agreed with the insurer to perform an orthodontic treatment that would avoid prosthetic replacement of the fractured tooth.
I therefore proceeded to extract the fractured tooth and 3 other premolars. The aim was to replace the central with the lateral incisor and the lateral with the canine, and to veneer the lateral incisor. In the end, the patient had a composite veneer made (to the cheapest bidder…) and did not want any gingival correction.
Case 4: Traumatic avulsion of central incisors. The patient was wearing a removable denture and wanted a permanent solution. I chose to extract 2 lower premolars and converge the lateral incisors in the edentulous space to substitute the central ones. The plan was to veneer the lateral incisors with a minimum of 2 veneers (ideally 6 veneers), but for financial reasons the patient didn’t go ahead with the treatment with his dentist. Nevertheless, he no longer needs dentures and finds the aesthetics of his incisors better than the dentures he had.
Case 5: A 66-year-old patient underwent bimaxillary advancement orthognathic surgery for sleep apnea. The surgeon operated without requiring prior orthodontic treatment. The lady seeks orthodontic treatment because her posterior teeth are not touching. She only closes on the lower incisors. I extracted a lower incisor (41) to achieve a functional bite.