congenital missing lateral incisors
TRANSCRIPT
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
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