The management of congenitally missing lateral incisors   h rosenberg
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The management of congenitally missing lateral incisors   h rosenberg The management of congenitally missing lateral incisors h rosenberg Presentation Transcript

  • The Management ofCongenitally Missing Lateral Incisors Dr. Harold Rosenberg Humbertown Orthodontics 203-270 The Kingsway, Toronto drhr@humbertownortho.com
  • Congenitally Missing Teeth The interdisciplinary management of hypodontia: orthodontics. Carter et al BDJ 2003; 194(7):361-366.There are several issues that commonly arise in the orthodontic management of patients with hypodontia: 1. Space management 2. Uprighting and aligning teeth 3. Management of deep overbite 4. Retention and stabilityThe decision on whether to open or close spaces depends upon: 1. The age of the patient 2. The severity of the hypodontia 3. The degree of inherent crowding
  • Congenitally Missing Teeth The interdisciplinary management of hypodontia: orthodontics. Carter et al BDJ 2003; 194(7):361-366.There are several issues that commonly arise in the orthodontic management of patients with hypodontia: 1. Space management 2. Uprighting and aligning teeth 3. Management of deep overbite 4. Retention and stabilityThe decision on whether to open or close spaces depends upon: 1. The age of the patient 2. The severity of the hypodontia 3. The degree of inherent crowding View slide
  • Congenitally Missing Mx LateralIncisors- Space Closure vs ProstheticReplacement View slide
  • Congenitally Missing Mx Lateral Incisors- Space Closure vs Prosthetic ReplacementThe congenitally missing upper lateral incisor. A retrospectivestudy of orthodontic space closure versus restorative treatment.Robertsson & Mohlin. EurJOrtho 2000;22:697-7100.RESULTS: Orthodontic space closure producesresults that are well accepted by patients, doesnot impair TMJ function, and encouragesperiodontal health in comparison withprosthetic replacements.
  • Congenitally Missing Mx LateralIncisors- Space Closure vs ProstheticReplacement
  • Congenitally Missing Mx Lateral Incisors- Space Closure vs Prosthetic ReplacementThe congenitally missing maxillary lateral incisor. Part 1: estheticjudgement of treatment options. Armbruster PC, et al. World J of Ortho 2005;6(4):369-75.CONCLUSIONS: Including esthetics of the finishedresult as an advantage or disadvantage for eitherrestoration or canine substitution of the lateralincisors could be misleading to the patient becausejudgment of esthetics of a smile can vary from oneperson to another or from one dental professional toanother.
  • Congenitally Missing Teeth Managing Congenitally Missing Lateral Incisors. Parts I-III. Kokich VO, Kinzer GA. J Esthet Restor Dent 17(1):5-10; 17(2):202-210; 17(4):202-210, 2005.
  • Congenitally Missing Teeth Managing Congenitally Missing Lateral Incisors. Parts I-III. Kokich VO, Kinzer GA. J Esthet Restor Dent 17(1):5-10; 17(2):202-210; 17(4):202-210, 2005. Congenitally Missing Lateral Incisors (20% of all conenitally missing teeth, third most common)
  • Congenitally Missing Teeth Managing Congenitally Missing Lateral Incisors. Parts I-III. Kokich VO, Kinzer GA. J Esthet Restor Dent 17(1):5-10; 17(2):202-210; 17(4):202-210, 2005. Congenitally Missing Lateral Incisors (20% of all conenitally missing teeth, third most common) CanineSubstitution
  • Congenitally Missing Teeth Managing Congenitally Missing Lateral Incisors. Parts I-III. Kokich VO, Kinzer GA. J Esthet Restor Dent 17(1):5-10; 17(2):202-210; 17(4):202-210, 2005. Congenitally Missing Lateral Incisors (20% of all conenitally missing teeth, third most common) Canine ToothSubstitution Supported Restoration
  • Congenitally Missing Teeth Managing Congenitally Missing Lateral Incisors. Parts I-III. Kokich VO, Kinzer GA. J Esthet Restor Dent 17(1):5-10; 17(2):202-210; 17(4):202-210, 2005. Congenitally Missing Lateral Incisors (20% of all conenitally missing teeth, third most common) Canine Single Tooth ToothSubstitution Implant Supported Restoration
  • Congenitally Missing Teeth Managing Congenitally Missing Lateral Incisors. Parts I-III. Kokich VO, Kinzer GA. J Esthet Restor Dent 17(1):5-10; 17(2):202-210; 17(4):202-210, 2005.
  • Congenitally Missing Teeth Managing Congenitally Missing Lateral Incisors. Parts I-III. Kokich VO, Kinzer GA. J Esthet Restor Dent 17(1):5-10; 17(2):202-210; 17(4):202-210, 2005. Congenitally Missing Lateral Incisors
  • Congenitally Missing Teeth Managing Congenitally Missing Lateral Incisors. Parts I-III. Kokich VO, Kinzer GA. J Esthet Restor Dent 17(1):5-10; 17(2):202-210; 17(4):202-210, 2005. Congenitally Missing Lateral Incisors CanineSubstitution ?
  • Congenitally Missing Teeth Managing Congenitally Missing Lateral Incisors. Parts I-III. Kokich VO, Kinzer GA. J Esthet Restor Dent 17(1):5-10; 17(2):202-210; 17(4):202-210, 2005. Congenitally Missing Lateral Incisors Canine ToothSubstitution Supported ? Restoration?
  • Congenitally Missing Teeth Managing Congenitally Missing Lateral Incisors. Parts I-III. Kokich VO, Kinzer GA. J Esthet Restor Dent 17(1):5-10; 17(2):202-210; 17(4):202-210, 2005. Congenitally Missing Lateral Incisors Canine Tooth Single ToothSubstitution Supported Implant? ? Restoration?
  • Congenitally Missing Teeth Managing Congenitally Missing Lateral Incisors. Parts I-III. Kokich VO, Kinzer GA. J Esthet Restor Dent 17(1):5-10; 17(2):202-210; 17(4):202-210, 2005. Congenitally Missing Lateral Incisors Canine Tooth Single ToothSubstitution Supported Implant? ? Restoration?Appropriate option depends on the malocclusion, specific spacerequirements, tooth-size relationship, and size and shape of the canine.The ideal treatment is the most conservative option that satisfies individual esthetic and functional requirements.
  • Congenitally Missing Teeth Managing Congenitally Missing Lateral Incisors. Part I: Canine Substitution. Kokich VO, Kinzer GA. J Esthet Restor Dent 17(2): 202-210, 2005.
  • Congenitally Missing Teeth Managing Congenitally Missing Lateral Incisors. Part I: Canine Substitution. Kokich VO, Kinzer GA. J Esthet Restor Dent 17(2): 202-210, 2005. Congenitally Missing Lateral Incisors
  • Congenitally Missing Teeth Managing Congenitally Missing Lateral Incisors. Part I: Canine Substitution. Kokich VO, Kinzer GA. J Esthet Restor Dent 17(2): 202-210, 2005. Congenitally Missing Lateral Incisors
  • Congenitally Missing Teeth Managing Congenitally Missing Lateral Incisors. Part I: Canine Substitution. Kokich VO, Kinzer GA. J Esthet Restor Dent 17(2): 202-210, 2005. Congenitally Missing Lateral Incisors CanineSubstitution ?
  • Congenitally Missing Teeth Managing Congenitally Missing Lateral Incisors. Part I: Canine Substitution. Kokich VO, Kinzer GA. J Esthet Restor Dent 17(2): 202-210, 2005. Congenitally Missing Lateral Incisors CanineSubstitution ?
  • Congenitally Missing Teeth Managing Congenitally Missing Lateral Incisors. Part I: Canine Substitution. Kokich VO, Kinzer GA. J Esthet Restor Dent 17(2): 202-210, 2005. Congenitally Missing Lateral Incisors CanineSubstitution ?
  • Congenitally Missing Teeth Managing Congenitally Missing Lateral Incisors. Part I: Canine Substitution. Kokich VO, Kinzer GA. J Esthet Restor Dent 17(2): 202-210, 2005. Congenitally Missing Lateral Incisors CanineSubstitution ?
  • Congenitally Missing Teeth Managing Congenitally Missing Lateral Incisors. Part I: Canine Substitution. Kokich VO, Kinzer GA. J Esthet Restor Dent 17(2): 202-210, 2005. Congenitally Missing Lateral Incisors CanineSubstitution ?
  • Congenitally Missing Teeth Managing Congenitally Missing Lateral Incisors. Part I: Canine Substitution. Kokich VO, Kinzer GA. J Esthet Restor Dent 17(1):5-10, 2005.
  • Congenitally Missing Teeth Managing Congenitally Missing Lateral Incisors. Part I: Canine Substitution. Kokich VO, Kinzer GA. J Esthet Restor Dent 17(1):5-10, 2005. Canine Substitution- Dental & Facial Criteria I. Malocclusion Class II with no crowding in the Md arch Class II molars, 1st PM in canine position Class I with sufficient crowding requiring Md extractions •Design final occlusal scheme so that lateral excursive movements are in anterior group function. •Evaluate anterior tooth size relationship  diagnostic wax-up to assess how much reduction is required in the maxillary arch to achieve proper OB & OJ
  • Congenitally Missing Teeth Managing Congenitally Missing Lateral Incisors. Part I: Canine Substitution. Kokich VO, Kinzer GA. J Esthet Restor Dent 17(1):5-10, 2005.
  • Congenitally Missing Teeth Managing Congenitally Missing Lateral Incisors. Part I: Canine Substitution. Kokich VO, Kinzer GA. J Esthet Restor Dent 17(1):5-10, 2005. Canine Substitution- Dental & Facial Criteria II. Profile •A balanced relatively straight profile is ideal •A mildly convex profile may be acceptable
  • Congenitally Missing Teeth Managing Congenitally Missing Lateral Incisors. Part I: Canine Substitution. Kokich VO, Kinzer GA. J Esthet Restor Dent 17(1):5-10, 2005.
  • Congenitally Missing Teeth Managing Congenitally Missing Lateral Incisors. Part I: Canine Substitution. Kokich VO, Kinzer GA. J Esthet Restor Dent 17(1):5-10, 2005. Canine Substitution- Dental & Facial CriteriaIII. Canine Shape & Color •With a wider crown and more convex labial surface, a significant amount of reduction is often required to achieve a normal occlusion & acceptable esthetics. •May result in dentin showing through and a need for restorative intervention •The color of the canine should match the central  if bleaching of canine does not work than a veneer may be indicated •Crown width at the CEJ should be evaluated on a PA as a narrow mesiodistal width produces a more esthetic emergence profile than one with a wide CEJ width.
  • Congenitally Missing Teeth Managing Congenitally Missing Lateral Incisors. Part I: Canine Substitution. Kokich VO, Kinzer GA. J Esthet Restor Dent 17(1):5-10, 2005.
  • Congenitally Missing Teeth Managing Congenitally Missing Lateral Incisors. Part I: Canine Substitution. Kokich VO, Kinzer GA. J Esthet Restor Dent 17(1):5-10, 2005.Canine Substitution- Dental & Facial CriteriaThus, the ideal lateral incisor substitute is a caninethat is: •The same color as the central incisor •Is narrow at the CEJ buccolingually and mesiodistally •Has a relatively flat labial surface •Has a narrow midcrown width buccolingually
  • Congenitally Missing Teeth Managing Congenitally Missing Lateral Incisors. Part I: Canine Substitution. Kokich VO, Kinzer GA. J Esthet Restor Dent 17(1):5-10, 2005.Canine Substitution- Dental & Facial CriteriaThus, the ideal lateral incisor substitute is a caninethat is: •The same color as the central incisor •Is narrow at the CEJ buccolingually and mesiodistally •Has a relatively flat labial surface •Has a narrow midcrown width buccolingually
  • Congenitally Missing Teeth Managing Congenitally Missing Lateral Incisors. Part I: Canine Substitution. Kokich VO, Kinzer GA. J Esthet Restor Dent 17(1):5-10, 2005.Canine Substitution- Dental & Facial CriteriaThus, the ideal lateral incisor substitute is a caninethat is: •The same color as the central incisor •Is narrow at the CEJ buccolingually and mesiodistally •Has a relatively flat labial surface •Has a narrow midcrown width buccolingually
  • Congenitally Missing Teeth Managing Congenitally Missing Lateral Incisors. Part I: Canine Substitution. Kokich VO, Kinzer GA. J Esthet Restor Dent 17(1):5-10, 2005.
  • Congenitally Missing Teeth Managing Congenitally Missing Lateral Incisors. Part I: Canine Substitution. Kokich VO, Kinzer GA. J Esthet Restor Dent 17(1):5-10, 2005. Canine Substitution- Dental & Facial Criteria IV. Lip Level •Excessive gingiva-to-lip distance will reveal •The gingival margin of the canine (should be placed more incisal to the central incisor  may require gingivectomy) •Prominent canine root eminence
  • Congenitally Missing Teeth Managing Congenitally Missing Lateral Incisors. Part I: Canine Substitution. Kokich VO, Kinzer GA. J Esthet Restor Dent 17(1):5-10, 2005. Canine Substitution- Dental & Facial Criteria IV. Lip Level •Excessive gingiva-to-lip distance will reveal •The gingival margin of the canine (should be placed more incisal to the central incisor  may require gingivectomy) •Prominent canine root eminence
  • Congenitally Missing Teeth Managing Congenitally Missing Lateral Incisors. Part I: Canine Substitution. Kokich VO, Kinzer GA. J Esthet Restor Dent 17(1):5-10, 2005.
  • Congenitally Missing Teeth Managing Congenitally Missing Lateral Incisors. Part I: Canine Substitution. Kokich VO, Kinzer GA. J Esthet Restor Dent 17(1):5-10, 2005. Canine Substitution- Treatment •Brackets should be placed according to gingival margin heights  brackets on canines placed at a distance from the gingival margin that will erupt these teeth into the appropriate lateral incisor vertical position. •As canines erupt they may cause interferences and require equilibration during orthodontic alignment. •During finishing reshaping is required for optimal esthetics •A need for restorative treatment to re-create ideal lateral incisor color and contour is often required (bleaching, composite resin, porcelain veneer). •Interdisciplinary treatment planning is necessary to achieve optimal final esthetics
  • Congenitally Missing Teeth Managing Congenitally Missing Lateral Incisors. Part I: Canine Substitution. Kokich VO, Kinzer GA. J Esthet Restor Dent 17(1):5-10, 2005.
  • Congenitally Missing Teeth Managing Congenitally Missing Lateral Incisors. Part I: Canine Substitution. Kokich VO, Kinzer GA. J Esthet Restor Dent 17(1):5-10, 2005. A.Irregular gingival architecture B.Incisor wear affects proper crown width-to-length ratio C.Ortho intrusion necessary to facilitate restorative lengthening of the central incisor D.Provisional composite restorations completed E.Ortho extrusion of canines F.Ideal length of canines as lateral inicsors G.Cuspal equilibration completed H.Composite restoration of mesioincisal corners
  • Congenitally Missing Teeth Managing Congenitally Missing Lateral Incisors. Part II: Tooth supported restorations. Kokich VO, Kinzer GA. J Esthet Restor Dent 17(2):202-210, 2005.
  • Congenitally Missing Teeth Managing Congenitally Missing Lateral Incisors. Part II: Tooth supported restorations. Kokich VO, Kinzer GA. J Esthet Restor Dent 17(2):202-210, 2005. Congenitally Missing Lateral Incisors Tooth Supported Restoration?
  • Congenitally Missing Teeth Managing Congenitally Missing Lateral Incisors. Part II: Tooth supported restorations. Kokich VO, Kinzer GA. J Esthet Restor Dent 17(2):202-210, 2005. Congenitally Missing Lateral Incisors Tooth Supported Restoration?A. Cantilevered Fixed Partial Denture
  • Congenitally Missing Teeth Managing Congenitally Missing Lateral Incisors. Part II: Tooth supported restorations. Kokich VO, Kinzer GA. J Esthet Restor Dent 17(2):202-210, 2005. Congenitally Missing Lateral Incisors Tooth Supported Restoration?A. Cantilevered Fixed Partial Denture B. Resin-Bonded Fixed Partial Denture
  • Congenitally Missing Teeth Managing Congenitally Missing Lateral Incisors. Part II: Tooth supported restorations. Kokich VO, Kinzer GA. J Esthet Restor Dent 17(2):202-210, 2005. Congenitally Missing Lateral Incisors Tooth Supported Restoration?A. Cantilevered Fixed C. Full-Coverage Partial Denture Fixed Partial Denture B. Resin-Bonded Fixed Partial Denture
  • Congenitally Missing Teeth Managing Congenitally Missing Lateral Incisors. Part II: Tooth supported restorations. Kokich VO, Kinzer GA. J Esthet Restor Dent 17(2):202-210, 2005. Congenitally Missing Lateral Incisors Tooth Supported Restoration?A. Cantilevered Fixed C. Full-Coverage Partial Denture Fixed Partial Denture B. Resin-Bonded Fixed Partial Denture
  • Congenitally Missing Teeth Managing Congenitally Missing Lateral Incisors. Part II: Tooth supported restorations. Kokich VO, Kinzer GA. J Esthet Restor Dent 17(2):202-210, 2005. Congenitally Missing Lateral Incisors The ideal treatment is the most conservative (least invasive) option that satisfies individual esthetic and Tooth functional requirements. Supported Restoration?A. Cantilevered Fixed C. Full-Coverage Partial Denture Fixed Partial Denture B. Resin-Bonded Fixed Partial Denture
  • Congenitally Missing Teeth Managing Congenitally Missing Lateral Incisors. Part II: Tooth Supported Restorations. Kokich VO, Kinzer GA. J Esthet Restor Dent. 17(2):76-84, 2005.
  • Congenitally Missing Teeth Managing Congenitally Missing Lateral Incisors. Part II: Tooth Supported Restorations. Kokich VO, Kinzer GA. J Esthet Restor Dent. 17(2):76-84, 2005. How much space is necessary for the missing lateral incisor?
  • Congenitally Missing Teeth Managing Congenitally Missing Lateral Incisors. Part II: Tooth Supported Restorations. Kokich VO, Kinzer GA. J Esthet Restor Dent. 17(2):76-84, 2005. How much space is necessary for the missing lateral incisor? 1. Golden proportion • the perceived width of the anterior teeth as viewed from the direct anterior should have a ratio of 1:0.618 with the tooth adjacent to it. (ex. If central 8mm lateral 5mm) • Since proportion is derived from “perceived” size of the teeth from the frontal view there is no relation to the actual measured widths
  • Congenitally Missing Teeth Managing Congenitally Missing Lateral Incisors. Part II: Tooth Supported Restorations. Kokich VO, Kinzer GA. J Esthet Restor Dent. 17(2):76-84, 2005. How much space is necessary for the missing lateral incisor? 1. Golden proportion • the perceived width of the anterior teeth as viewed from the direct anterior should have a ratio of 1:0.618 with the tooth adjacent to it. (ex. If central 8mm lateral 5mm) • Since proportion is derived from “perceived” size of the teeth from the frontal view there is no relation to the actual measured widths 2. Contralateral lateral incisor • Not suited for patients with missing or peg shaped contralateral incisor.
  • Congenitally Missing Teeth Managing Congenitally Missing Lateral Incisors. Part II: Tooth Supported Restorations. Kokich VO, Kinzer GA. J Esthet Restor Dent. 17(2):76-84, 2005. 36.6 mm = 0.78 33.8 mm + X X = 13 mm/2 = 6.5 mm for each lateral incisor
  • Congenitally Missing Teeth Managing Congenitally Missing Lateral Incisors. Part II: Tooth Supported Restorations. Kokich VO, Kinzer GA. J Esthet Restor Dent. 17(2):76-84, 2005. How much space is necessary for the missing lateral incisor? 3. Bolton Analysis • Sum of M-D widths of Mandibular anterior teeth/ Sum of M-D widths of Maxillary teeth = 0.78 when an ideal occlusal relationship is achieved. • Example: Sum of 6 Md anterior teeth is 36.5 mm, Sum of 4 Mx anterior teeth is 33.8. To calculate width of lateral incisor: 36.6 mm = 0.78 33.8 mm + X X = 13 mm/2 = 6.5 mm for each lateral incisor
  • Congenitally Missing Teeth Managing Congenitally Missing Lateral Incisors. Part II: Tooth Supported Restorations. Kokich VO, Kinzer GA. J Esthet Restor Dent. 17(2):76-84, 2005.
  • Congenitally Missing Teeth Managing Congenitally Missing Lateral Incisors. Part II: Tooth Supported Restorations. Kokich VO, Kinzer GA. J Esthet Restor Dent. 17(2):76-84, 2005. How much space is necessary for the missing lateral incisor? 4. Diagnostic wax-up. • The most predictable guide for determining ideal spacing • The canines should be places in position that will allow proper anterior disclusion, and the central incisors incisors should be positioned to provide optimal esthetics, • Remaining space (usually b/w 5-7mm) used for the lateral incisor.
  • Congenitally Missing Teeth Managing Congenitally Missing Lateral Incisors. Part II: Tooth Supported Restorations. Kokich VO, Kinzer GA. J Esthet Restor Dent. 17(2):76-84, 2005.
  • Congenitally Missing Teeth Managing Congenitally Missing Lateral Incisors. Part II: Tooth Supported Restorations. Kokich VO, Kinzer GA. J Esthet Restor Dent. 17(2):76-84, 2005. A. Resin-Bonded Fixed Partial Denture “Maryland Bridge”- Most Conservative • Success rate varies widely from a 54% failure rate over 11 months to a 10% failure rate over 11 years, with debonding the most common cause of failure (Williams et al J Prosthet Dent 1989, 61:436-441; Priest Int J Prosthodont 1996;9:38-45). • Specific criteria must be addressed to ensure optimal esthetics and long-term predictability: 1. Position of abutment teeth 2. Mobility of abutment teeth 3. Thickness of abutment teeth Anne Arundel County, MD 4. Translucency of abutment teeth 5. Overall occlusion
  • Congenitally Missing Teeth Managing Congenitally Missing Lateral Incisors. Part II: Tooth Supported Restorations. Kokich VO, Kinzer GA. J Esthet Restor Dent. 17(2):76-84, 2005.
  • Congenitally Missing Teeth Managing Congenitally Missing Lateral Incisors. Part II: Tooth Supported Restorations. Kokich VO, Kinzer GA. J Esthet Restor Dent. 17(2):76-84, 2005. A. Resin-Bonded Fixed Partial Denture- 1. Position of Abutment teeth • Resin-bonded fixed partial dentures placed in a deep OB relationship have been shown to have a higher incidence of failure (Creugers NH et al. J Dent Res 1992; 71:1822-1825). • As the OB increases either the surface area available for bonding the retainer must decrease or the tooth must be prepared and the occlusion placed on the retainer. • Ideal anterior relationship = SHALLOW OVERBITE
  • Congenitally Missing Teeth Managing Congenitally Missing Lateral Incisors. Part II: Tooth Supported Restorations. Kokich VO, Kinzer GA. J Esthet Restor Dent. 17(2):76-84, 2005.
  • Congenitally Missing Teeth Managing Congenitally Missing Lateral Incisors. Part II: Tooth Supported Restorations. Kokich VO, Kinzer GA. J Esthet Restor Dent. 17(2):76-84, 2005.A. Resin-Bonded Fixed Partial Denture- 1. Position of Abutment teeth • Occlusal forces on proclined incisors create a more tensile type of force at the bond interface • Wheras the same forces on teeth that are upright generate a more shear type of force at the bond interface. • An object loaded with a shear force can withstand 40% more load prior to failure compared with the same object loaded with a tensile force (theoretic physics principles) Tensile Shear
  • Congenitally Missing Teeth Managing Congenitally Missing Lateral Incisors. Part II: Tooth Supported Restorations. Kokich VO, Kinzer GA. J Esthet Restor Dent. 17(2):76-84, 2005.
  • Congenitally Missing Teeth Managing Congenitally Missing Lateral Incisors. Part II: Tooth Supported Restorations. Kokich VO, Kinzer GA. J Esthet Restor Dent. 17(2):76-84, 2005. A. Resin-Bonded Fixed Partial Denture- 2. Mobility of Abutment Teeth • Mobility is a contraindication for resin-bonded fixed partial dentures owing to the stress that is placed on the bond interface when the rigidity of the retainer works to keep the abutment teeth from moving under load. • Although each tooth moves in the B-L direction they have different vectors because of their position in the arch. • Generally, it is the least mobile of the two abutments that debonds.
  • Congenitally Missing Teeth Managing Congenitally Missing Lateral Incisors. Part II: Tooth Supported Restorations. Kokich VO, Kinzer GA. J Esthet Restor Dent. 17(2):76-84, 2005.
  • Congenitally Missing Teeth Managing Congenitally Missing Lateral Incisors. Part II: Tooth Supported Restorations. Kokich VO, Kinzer GA. J Esthet Restor Dent. 17(2):76-84, 2005. A. Resin-Bonded Fixed Partial Denture- 3,4. Thickness and translucency of abutment teeth • When retainer extensions are carried too coronal, thin teeth or teeth with a high degree of translucency in the incisal 1/3 can appear grey due to show through of the metal retainer. • Coronal extension of retainer is also influenced by the amount of overbite. Greying of incisal less of an issue with cerec maryland bridges?
  • Congenitally Missing Teeth Managing Congenitally Missing Lateral Incisors. Part II: Tooth Supported Restorations. Kokich VO, Kinzer GA. J Esthet Restor Dent. 17(2):76-84, 2005.
  • Congenitally Missing Teeth Managing Congenitally Missing Lateral Incisors. Part II: Tooth Supported Restorations. Kokich VO, Kinzer GA. J Esthet Restor Dent. 17(2):76-84, 2005. A. Resin-Bonded Fixed Partial Denture- 5. Occlusal Parafunction • RBFPD contraindicated in patients with occlusal parafunction. The ideal Candidate for a RBFPD has: • Non-mobile abutment teeth • Moderately thick abutment teeth • Have translucency localized in incisal 1/3 • No parafuntion • Shallow Overbite • Large interincisal angle (upright incisors)
  • Congenitally Missing Teeth Managing Congenitally Missing Lateral Incisors. Part II: Tooth Supported Restorations. Kokich VO, Kinzer GA. J Esthet Restor Dent. 17(2):76-84, 2005.
  • Congenitally Missing Teeth Managing Congenitally Missing Lateral Incisors. Part II: Tooth Supported Restorations. Kokich VO, Kinzer GA. J Esthet Restor Dent. 17(2):76-84, 2005. B. Cantilevered Fixed Partial Denture –Second most conservative • Canine is an ideal abutment given its root length and crown dimensions. • Retention and resistance of a partial-coverage preparation requires the use of pins, thus pulpal size and location within the tooth must be evaluated. • If the canine abutment requires a change in the facial contour to enhance esthetics, a conventional full- coverage preparation can be done to support the cantilevered pontic.
  • Congenitally Missing Teeth Managing Congenitally Missing Lateral Incisors. Part II: Tooth Supported Restorations. Kokich VO, Kinzer GA. J Esthet Restor Dent. 17(2):76-84, 2005.
  • Congenitally Missing Teeth Managing Congenitally Missing Lateral Incisors. Part II: Tooth Supported Restorations. Kokich VO, Kinzer GA. J Esthet Restor Dent. 17(2):76-84, 2005. B. Cantilevered Fixed Partial Denture –Second most conservative • The KEY to the long term success of the cantilevered fixed partial denture is managing the occlusion on the pontic (Decock et al. 1996; Int J Prostho 9:331-340; Hochman et al.1987; J Prosth Dent 58:542-545) • Failure to remove all contacts in excursive movements from the cantilever can lead to: • loosening of the restoration • Migration of the abutment • Fracture
  • Congenitally Missing Teeth Managing Congenitally Missing Lateral Incisors. Part II: Tooth Supported Restorations. Kokich VO, Kinzer GA. J Esthet Restor Dent. 17(2):76-84, 2005.
  • Congenitally Missing Teeth Managing Congenitally Missing Lateral Incisors. Part II: Tooth Supported Restorations. Kokich VO, Kinzer GA. J Esthet Restor Dent. 17(2):76-84, 2005. C. Conventional Full-Coverage Fixed Partial Denture- Least Conservative • Treatment of choice when replacing an existing fixed partial denture or when the adjacent teeth require restoration for structural reasons. • Added benefit of being able to control the occlusion and docclusal forces. • Not the ideal treatment for replacement of congenitally missing laterals in young patients.
  • Congenitally Missing Teeth Managing Congenitally Missing Lateral Incisors. Part II: Tooth Supported Restorations. Kokich VO, Kinzer GA. J Esthet Restor Dent. 17(2):76-84, 2005. C. Conventional Full-Coverage Fixed Partial Denture- Least Conservative • Treatment of choice when replacing an existing fixed partial denture or when the adjacent teeth require restoration for structural reasons. • Added benefit of being able to control the occlusion and docclusal forces. • Not the ideal treatment for replacement of congenitally missing laterals in young patients.
  • Congenitally Missing Teeth Managing Congenitally Missing Lateral Incisors. Part II: Tooth Supported Restorations. Kokich VO, Kinzer GA. J Esthet Restor Dent. 17(2):76-84, 2005. C. Conventional Full-Coverage Fixed Partial Denture- Least Conservative • Treatment of choice when replacing an existing fixed partial denture or when the adjacent teeth require restoration for structural reasons. • Added benefit of being able to control the occlusion and docclusal forces. • Not the ideal treatment for replacement of congenitally missing laterals in young patients.
  • Congenitally Missing Teeth Managing Congenitally Missing Lateral Incisors. Part II: Tooth Supported Restorations. Kokich VO, Kinzer GA. J Esthet Restor Dent. 17(2):76-84, 2005.
  • Congenitally Missing Teeth Managing Congenitally Missing Lateral Incisors. Part II: Tooth Supported Restorations. Kokich VO, Kinzer GA. J Esthet Restor Dent. 17(2):76-84, 2005. C. Conventional Full-Coverage Fixed Partial Denture- Least Conservative • Important to evaluate inclination and angulation of teeth and have abutments aligned along a common pathway. • When looking at the patient’s teeth from a frontal perspective, it is imperative that the long axis of the central incisor and the labial surface of the canine are parallel.
  • Congenitally Missing Teeth Managing Congenitally Missing Lateral Incisors. Part II: Tooth Supported Restorations. Kokich VO, Kinzer GA. J Esthet Restor Dent. 17(2):76-84, 2005.
  • Congenitally Missing Teeth Managing Congenitally Missing Lateral Incisors. Part II: Tooth Supported Restorations. Kokich VO, Kinzer GA. J Esthet Restor Dent. 17(2):76-84, 2005. C. Conventional Full-Coverage Fixed Partial Denture- Least Conservative • When evaluating at the patient’s teeth from a lateral perspective, the long axis of the canine and the labial surface of the central incisor must be parallel.
  • Congenitally Missing Teeth Managing Congenitally Missing Lateral Incisors. Part III: Single Tooth Implants . Kokich VO, Kinzer GA. J Esthet Restor Dent 17(4): 202-210, 2005.
  • Congenitally Missing Teeth Managing Congenitally Missing Lateral Incisors. Part III: Single Tooth Implants . Kokich VO, Kinzer GA. J Esthet Restor Dent 17(4): 202-210, 2005. Congenitally Missing Lateral Incisors Single Tooth Implant?
  • Congenitally Missing Teeth Managing Congenitally Missing Lateral Incisors. Part III: Single Tooth Implants . Kokich VO, Kinzer GA. J Esthet Restor Dent 17(4): 202-210, 2005. Congenitally Missing Lateral Incisors Single Tooth Implant?
  • Congenitally Missing Teeth Managing Congenitally Missing Lateral Incisors. Part III: Single Tooth Implants . Kokich VO, Kinzer GA. J Esthet Restor Dent 17(4): 202-210, 2005. Congenitally Missing Lateral Incisors Single Tooth Implant?
  • Congenitally Missing Teeth Managing Congenitally Missing Lateral Incisors. Part III: Single Tooth Implants . Kokich VO, Kinzer GA. J Esthet Restor Dent 17(4): 202-210, 2005. Congenitally Missing Lateral Incisors The ideal treatment is the most conservative (least invasive) option that satisfies individual esthetic and Single Tooth functional requirements. Implant?
  • Congenitally Missing Teeth Managing Congenitally Missing Lateral Incisors. Part III: Single Tooth Implants. Kokich VO, Kinzer GA. J Esthet Restor Dent. 17(4):202-210, 2005.
  • Congenitally Missing Teeth Managing Congenitally Missing Lateral Incisors. Part III: Single Tooth Implants. Kokich VO, Kinzer GA. J Esthet Restor Dent. 17(4):202-210, 2005.Single Tooth ImplantsImplant Site Development• When the permanent canine is orthodontically moved distally, an increased buccolingual alveolar width is established and it remains stable over time (Kokich 2004, Int J Oral Maxillofac Surg 62:48-56.; Ostler MS 1994, J Prosthet Dent 71:144-149.)• If the crown of the permanent canine is apical to the primary canine root, it may be necessary to selectively extract the primary lateral incisor to encourage the permanent canine to erupt adjacent to the central incisor.
  • Congenitally Missing Teeth Managing Congenitally Missing Lateral Incisors. Part III: Single Tooth Implants. Kokich VO, Kinzer GA. J Esthet Restor Dent. 17(4):202-210, 2005.
  • Congenitally Missing Teeth Managing Congenitally Missing Lateral Incisors. Part III: Single Tooth Implants. Kokich VO, Kinzer GA. J Esthet Restor Dent. 17(4):202-210, 2005.Single Tooth ImplantsImplant Site Development• To have adequate room for the development of the papillae 1.5-2 mm of space is recommended between the head of the implant and the adjacent teeth (i.e. if space is 7mm than a 3.75mm diameter implant can be placed)• To place an implant the MINIMUM interradicular distance is generally 5-5.5mm (small diameter implant with 0.75 mm of bone between the adjacent roots)
  • Congenitally Missing Teeth Managing Congenitally Missing Lateral Incisors. Part III: Single Tooth Implants. Kokich VO, Kinzer GA. J Esthet Restor Dent. 17(4):202-210, 2005.Single Tooth ImplantsImplant Site Development• To have adequate room for the development of the papillae 1.5-2 mm of space is recommended between the head of the implant and the adjacent teeth (i.e. if space is 7mm than a 3.75mm diameter implant can be placed)• To place an implant the MINIMUM interradicular distance is generally 5-5.5mm (small diameter implant with 0.75 mm of bone between the adjacent roots) When space is opened the crowns of the central incisor and canine are tipped apart; however, the roots of these tooth do not move as quickly.
  • Congenitally Missing Teeth Managing Congenitally Missing Lateral Incisors. Part III: Single Tooth Implants. Kokich VO, Kinzer GA. J Esthet Restor Dent. 17(4):202-210, 2005.
  • Congenitally Missing Teeth Managing Congenitally Missing Lateral Incisors. Part III: Single Tooth Implants. Kokich VO, Kinzer GA. J Esthet Restor Dent. 17(4):202-210, 2005. Single Tooth Implants Implant Site Development • It is important to take a PA radiograph of the edentulous are prior to removing orthodontic appliances to confirm the ideal root position and adequate spacing for future implant placement (Spear 1997, Semin Orthod 3:45-72).
  • Congenitally Missing Teeth Managing Congenitally Missing Lateral Incisors. Part III: Single Tooth Implants. Kokich VO, Kinzer GA. J Esthet Restor Dent. 17(4):202-210, 2005.
  • Congenitally Missing Teeth Managing Congenitally Missing Lateral Incisors. Part III: Single Tooth Implants. Kokich VO, Kinzer GA. J Esthet Restor Dent. 17(4):202-210, 2005.Single Tooth ImplantsImplant Site Development• In patients requiring proclination of the maxillary incisors (Class III skeletal tendency) it may be impossible to achieve acceptable interradicular spacing using orthodontics even though the coronal spacing may be ideal.• As crowns are tipped labially their roots tend to converge toward each other “wagon-wheel” effect.
  • Congenitally Missing Teeth Managing Congenitally Missing Lateral Incisors. Part III: Single Tooth Implants. Kokich VO, Kinzer GA. J Esthet Restor Dent. 17(4):202-210, 2005.
  • Congenitally Missing Teeth Managing Congenitally Missing Lateral Incisors. Part III: Single Tooth Implants. Kokich VO, Kinzer GA. J Esthet Restor Dent. 17(4):202-210, 2005.Single Tooth ImplantsImplant Site Development• Because implants can not erupt, if an implant is placed before a patient has completed facial growth significant occlusal, periodontal, and restorative problems may be created.• Best to monitor facial growth by evaluating serial cephs taken 6 months to 1 year apart (superimpositions).
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  • Missing Teeth Replacement of missing teeth during and after orthodontic treatment Pontic toothattached to bracket
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  • The Management ofCongenitally Missing Lateral Incisors Dr. Harold Rosenberg Humbertown Orthodontics 203-270 The Kingsway, Toronto drhr@humbertownortho.com