Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Clinical
  • Published:

Camouflaging the permanent maxillary canine to substitute an absent lateral incisor - part 2: challenges and solutions

British Dental Journal volume 232, pages 84–91 (2022)Cite this article

Abstract

The developmental absence of permanent maxillary lateral incisors is a common developmental anomaly and presents clinical challenges. The maxillary lateral incisor is the second most common developmentally absent tooth after the mandibular second premolar, therefore can present frequently in practice. Patients with hypodontia of the maxillary lateral incisor present clinical challenges in relation to function and aesthetics. In part one of this two-part series, we focused on the assessment, diagnosis and management. In this part, we will discuss some of the frequently encountered challenges in canine camouflage cases and possible solutions.

Key points

  • Appropriate multidisciplinary management including involvement of the patient's GDP is of paramount importance in order to achieve the best aesthetics, function and durability of the final result when camouflaging the maxillary canine.

  • Certain canine substitution cases can present a specific set of challenges to the restorative specialist and orthodontist. The aim of this article, therefore, is to help clinicians tackle some of these challenges and obstacles.

  • This paper details the cruciality of the multidisciplinary treatment approach to achieve optimal results and to overcome the frequently encountered challenges.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12
Fig. 13
Fig. 14
Fig. 15
Fig. 16
Fig. 17
Fig. 18
Fig. 19
Fig. 20

Similar content being viewed by others

References

  1. Ludwig B, Zachrisson B U, Rosa M. Non-compliance space closure in patients with missing lateral incisors. J Clin Orthod 2013; 47: 180-187.

  2. Rosa M, Lucchi P, Ferrari S, Zachrisson B U, Caprioglio A. Congenitally missing maxillary lateral incisors: long-term periodontal and functional evaluation after orthodontic space closure with first premolar intrusion and canine extrusion. Orthod Fr 2017; 88: 319-332.

  3. Rosa M, Lucchi P, Ferrari S, Zachrisson B U, Caprioglio A. Congenitally missing maxillary lateral incisors: Long-term periodontal and functional evaluation after orthodontic space closure with first premolar intrusion and canine extrusion. Am J Orthod Dentofacial Orthop 2016; 149: 339-348.

  4. Rosa M, Olimpo A, Fastuca R, Caprioglio A. Perceptions of dental professionals and laypeople to altered dental esthetics in cases with congenitally missing maxillary lateral incisors. Prog Orthod 2013; 14: 34.

  5. Rosa M, Zachrisson B U. The space-closure alternative for missing maxillary lateral incisors: an update. J Clin Orthod 2010; 44: 540-549.

  6. Rosa M, Zachrisson B U. Integrating space closure and esthetic dentistry in patients with missing maxillary lateral incisors. J Clin Orthod 2007; 41: 563-573.

  7. Rosa M, Zachrisson B U. Integrating esthetic dentistry and space closure in patients with missing maxillary lateral incisors. J Clin Orthod 2001; 35: 221-234.

  8. Zachrisson B U. Improving the esthetic outcome of canine substitution for missing maxillary lateral incisors. World J Orthod 2007; 8: 72-79.

  9. Zachrisson B U. Planning esthetic treatment after avulsion of maxillary incisors. J Am Dent Assoc 2008; 139: 1484-1490.

  10. Zachrisson B U, Rosa M, Toreskog S. Congenitally missing maxillary lateral incisors: canine substitution. Point. Am J Orthod Dentofacial Orthop 2011; DOI: 10.1016/j.ajodo.2011.02.003.

  11. Kokich Jr V O., Kinzer G A. Managing congenitally missing lateral incisors. Part I: Canine substitution. J Esthet Restor Dent 2005; 17: 5-10.

  12. Bolton W A. Disharmony In Tooth Size And Its Relation To The Analysis And Treatment Of Malocclusion. Angle Orthod 1958; 28: 113-130.

  13. Othman S A, Harradine N W T. Tooth-size discrepancy and Bolton's ratios: a literature review. J Orthod 2006; 33: 45-51.

  14. Chu S J. A biometric approach to predictable treatment of clinical crown discrepancies. Pract Proced Aesthet Dent 2007; 19: 401-409.

  15. Chu S J, Hochman M N. A biometric approach to aesthetic crown lengthening: part I - midfacial considerations. Pract Proced Aesthet Dent 2008; 20: 17-24.

  16. Chu S J, Hochman M N, Fletcher P. A biometric approach to aesthetic crown lengthening: part II - interdental considerations. Pract Proced Aesthet Dent 2008; 20: 529-536.

  17. Vellini-Ferreira F, Cotrim-Ferreira F A, Ribeiro J A, Ferreira-Santos C I. Mapping of proximal enamel thickness in permanent teeth. Braz J Oral Sci 2012; 11: 481-485.

  18. Thordarson A, Zachrisson B U, Mjör I A. Remodeling of canines to the shape of lateral incisors by grinding: a long-term clinical and radiographic evaluation. Am J Orthod Dentofacial Orthop 1991; 100: 123-132.

  19. McNeill R W, Joondeph D R. Congenitally absent maxillary lateral incisors: treatment planning considerations. Angle Orthod 1973; 43: 24-29.

  20. Nordquist G G, McNeill R W. Orthodontic vs. restorative treatment of the congenitally absent lateral incisor - long term periodontal and occlusal evaluation. J Periodontol 1975; 46: 139-143.

  21. Abduo J, Tennant M. Impact of lateral occlusion schemes: A systematic review. J Prosthet Dent 2015; 114: 193-204.

  22. Thornton L J. Anterior guidance: group function/canine guidance. A literature review. J Prosthet Dent 1990; 64: 479-482.

  23. Balshi T J. Osseointegration and orthodontics: modern treatment for congenitally missing teeth. Int J Periodontics Restorative Dent 1993; 13: 494-505.

  24. Jahanbin A, Basafa M, Alizadeh Y. Evaluation of the Divine Proportion in the facial profile of young females. Indian J Dent Res 2008; 19: 292-296.

  25. Ricketts R M. The biologic significance of the divine proportion and Fibonacci series. Am J Orthod 1982; 81: 351-370.

  26. Gahan M J, Lewis B R K, Moore D, Hodge T M. The orthodontic-restorative interface: 1. Patient assessment. Dent Update 2010; DOI: 10.12968/denu.2010.37.2.74.

  27. Alkadhimi A, Razaghi N, Elder A, DiBiase A. Camouflaging the permanent maxillary canine to substitute an absent lateral incisor - part 1: assessment and management. Br Dent J 2022; 232: 20-26.

  28. Robertsson S, Mohlin B. The congenitally missing upper lateral incisor. A retrospective study of orthodontic space closure versus restorative treatment. Eur J Orthod 2000; 22: 697-710.

  29. Schneider U, Moser L, Fornasetti M, Piattella M, Siciliani G. Esthetic evaluation of implants vs canine substitution in patients with congenitally missing maxillary lateral incisors: Are there any new insights? Am J Orthod Dentofacial Orthop 2016; 150: 416-424.

  30. Armbruster P C, Gardiner D M, Whitley Jr J B, Flerra J. The congenitally missing maxillary lateral incisor. Part 2: assessing dentists' preferences for treatment. World J Orthod 2005; 6: 376-381.

  31. Qadri S, Parkin N A, Benson P E. Space closing versus space opening for bilateral missing upper laterals - aesthetic judgements of laypeople: a web-based survey. J Orthod 2016; 43: 137-146.

  32. De-Marchi L M, Pini N I P, Ramos A L, Pascotto R C. Smile attractiveness of patients treated for congenitally missing maxillary lateral incisors as rated by dentists, laypersons and the patients themselves. J Prosthet Dent 2014; 112: 540-546.

  33. Jamilian A, Perillo L, Rosa M. Missing upper incisors: a retrospective study of orthodontic space closure versus implant. Prog Orthod 2015; 16: 2.

  34. Armbruster P C, Gardiner D M, Whitley Jr J B, Flerra J. The congenitally missing maxillary lateral incisor. Part 1: esthetic judgement of treatment options. World J Orthod 2005; 6: 369-375.

Download references

Author information

Authors and Affiliations

  1. Senior Registrar in Orthodontics, The Royal London Hospital Barts Health NHS Trust and East Kent Hospitals University NHS Trust, London, UK

    Aslam Alkadhimi

  2. Specialist Registrar in Restorative Dentistry, The Royal London Hospital Barts Health NHS Trust, London, UK

    Nahal Razaghi

  3. Consultant in Restorative Dentistry, East Kent Hospitals University NHS Trust, Kent, UK

    Andrew Elder

  4. Consultant Orthodontist, East Kent Hospitals University NHS Trust, Kent, UK

    Andrew T. DiBiase

Authors
  1. Aslam Alkadhimi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nahal Razaghi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Andrew Elder
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Andrew T. DiBiase
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Aslam Alkadhimi contributed to conceptualisation, literature search, original draft preparation, drafting and critically revising the manuscript; Nahal Razaghi contributed to literature search, original draft preparation, drafting and critically revising the manuscript; Andrew Elder contributed to supervision, original draft preparation, structuring and critically revising the manuscript and Andrew T DiBiase contributed to supervision, draft editing and critically revising the manuscript.

Corresponding author

Correspondence to Aslam Alkadhimi.

Ethics declarations

The authors declare that there are no competing interests. Ethical approval was not required. Appropriate consents were obtained.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Alkadhimi, A., Razaghi, N., Elder, A. et al. Camouflaging the permanent maxillary canine to substitute an absent lateral incisor - part 2: challenges and solutions. Br Dent J 232, 84–91 (2022). https://doi.org/10.1038/s41415-022-3871-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41415-022-3871-0

This article is cited by

Search

Advanced search

Quick links