You’re not alone! Did you know, about 8% of Americans are missing at least one tooth, and about 3% are specifically missing lateral incisor. Up to 20% are missing one or more of the 3rdmolars.
What is Partial Anodontia (Hypodontia)?
Answer: The congenital absence of one or more teeth (permanent or deciduous).
What is the best way to replace a missing lateral incisor?
There are many options to restore the missing incisor; the treatment depends on the amount of space, the condition of the underlying bone, and the patient’s preference. Options include a Traditional Bridge, a Maryland Bridge, canine substitution, or a dental implant.
1. Dental implants: When To Do It? Timing Is Everything!
Before having a dental implant placed, there are several considerations you should be aware of. First, age is an important consideration, as the permanent implant cannot be placed too early. If placed too early, the upper and lower jaws will continue to grow in a downward and forward position, but the implant will stay in the same original place. As a result, the edge of the tooth will be uneven. In order to replace it the crown will look too long!! It is important that the majority of your son or daughter’s jaw growth is complete, or near completion, before the implants are placed. Typically jawbone reaches maturity usually around age 18 for girls and later in boys, (late teens to early twenties). Serial radiographs can be evaluated for progression of growth.
In addition, when the lateral incisors do not develop, neither does the bone that normally grows with them. Therefore, there may be insufficient bone volume to house and anchor the implants, which means bone may have to be generated surgically.
2. What is Canine Substitution?
Several considerations need to be kept in choosing the ideal treatment for a young patient and the parents must be involved in this decision.
When upper lateral incisors are missing, there are 2 possible treatments:
- 1. Open the spaces and replace the missing teeth prosthetically, with an implant or bridge.
- 2. Close the spaces by moving the posterior teeth forward. The canines will replace the lateral incisors and the premolars will replace the canines; the teeth will be “modified” or reshaped accordingly.
Dr. Ace is married to an Orthodontist, Dr. Sarah Jovanovski, who is an expert at moving teeth. If cost is an issue, the treatment preferred is to close the space orthodontically. You are using your own teeth to fill in the gap. However the anatomy, or shape of the canine does not match the lateral incisor. In order to better harmonize the smile, the canine can be reshaped or bonded with composite resin, or a ceramic veneer, to mimic the lateral incisor.
3. Prosthetic replacement by a conventional 3-unit bridge or a Maryland Bridge
- No additional surgical intervention.
- No chance of implant rejection/failure.
- Immediately done (don’t have to wait months for bone grafts, implant integration)
- More expensive, the crown will potentially need to be replaced several times
- Modifications to the adjacent teeth are required, unlike when a traditional bridge is used or when the canine must be reshaped to replace the lateral incisor.
With a Maryland Bridge, very little, or sometimes NO reduction to the tooth is required. The treatment is very conservative and effective. The downfall is that Maryland bridges have a tendency to De-bond, with de-bond rate up to 50% after 5-7years.