Membership information 1800 444 542
Dentolegal advice 1800 444 542

The dilemma of missing maxillary lateral incisors

10 January 2017
Clinical Case

E, a 12-year-old patient, presents for a dental check-up at your practice; she and her mother are worried about her ‘gappy smile’. They want some advice about orthodontics and what might be the best treatment option. 

You determine from the panoramic radiograph that the maxillary permanent lateral incisors are congenitally missing. E is involved in performing arts and has high aspirations to pursue it as a career.

Your undergraduate training has provided you with the ability to put together an orthodontic problem list, which consists of the following information:

  • congenitally missing maxillary lateral incisors
  • excess space in the maxillary arch
  • slightly increased anterior overjet (4mm) and overbite (3mm)
  • half-unit class II posterior dental malocclusion
  • increased gingival display upon smiling (3mm of gingival display).
What other diagnostic records might be required to supplement your current knowledge of E’s case? What advice can you offer to E and her mother about her cosmetic concerns? Do you feel comfortable discussing the potential treatment options with respect to risks, costs and benefits in the short, medium and long-term?

Overview 

Congenitally missing maxillary lateral incisor cases are relatively common and are often associated with both short and long-term clinical dilemmas. Numerous factors must be carefully considered in the diagnostic and treatment planning process. It is imperative that every relevant treatment option is evaluated from a cost-benefit perspective, and thoroughly discussed with the patient as part of the informed consent process. 
 
The respective advantages and disadvantages of both orthodontic space closure and the prosthetic replacement for missing lateral incisors must be clearly outlined to prospective patients. Restorative dental implants were once perceived to be the panacea for replacement of missing or severely compromised teeth. However, ongoing research and clinical experience has highlighted significant issues with restorative implants, particularly when planned for the critical aesthetic zone of an adolescent or young adult patient.
 
Patient expectations and demands are increasing, which places the onus on clinicians to provide pleasing aesthetics and a reliable, functional outcome within a reasonable timeframe. In addition to this, particular attention must be paid to the likely ongoing maintenance and expected longevity of the treatment.


These case studies are based on real events and provided here as guidance. They do not constitute legal advice but are published to help members better understand how they might deal with certain situations. This is just one of the many benefits Dental Protection members enjoy as part of their subscription. 
For more detailed advice on any issues, contact us

© 2010-2024 The Medical Protection Society Limited

DPL Australia Pty Ltd (“DPLA”) is registered in Australia with ABN 24 092 695 933. DPLA is part of the Medical Protection Society Limited (“MPS”) group of companies. MPS is registered in England (No. 00036142) with its registered office at Level 19, The Shard, 32 London Bridge Street, London, SE1 9SG. All the benefits of MPS membership are discretionary, as set out in the Memorandum and Articles of Association.

“Dental Protection member” in Australia means a non-indemnity dental member of MPS. Dental Protection members may hold membership independently or in conjunction with membership of the Australian Dental Association (W.A. Branch) Inc. (“ADAWA”).

Dental Protection members who hold membership independently need to apply for, and where applicable maintain, an individual Dental Indemnity Policy underwritten by MDA National Insurance Pty Ltd (“MDA”), ABN 56 058 271 417, AFS

Licence No. 238073. DPLA is a Corporate Authorised Representative of MDA with CAR No. 326134. For such Dental Protection members, by agreement with MDA, DPLA provides point-of-contact member services, case management and colleague-to-colleague support.

Dental Protection members who are also ADAWA members need to apply for, and where applicable maintain, an individual Dental Indemnity Policy underwritten by MDA, which is available in accordance with the provisions of ADAWA membership.

None of ADAWA, DPLA and MPS are insurance companies. Dental Protection® is a registered trademark of MPS.

Before making a decision to buy or hold any products issued by MDANI, please consider your personal circumstances and the Important Information, Policy Wording and any supplementary documentation available by contacting DPLA on 1800 444 542 or via email.

For information on MPS and DPLA’s use of your personal data and your rights, please see our Privacy Notice.