Title: Management of missing maxillary lateral incisors in hypodontia: Clinical considerations and treatment pathways
Abstract:
Hypodontia is the congenital absence of one or more teeth, affecting both the primary and permanent dentitions (Nunn et al., 2003). Missing maxillary lateral incisors represent the second most common presentation in the acceptable sequence of hypodontia (Poder et al, 2004). The aetiology is complex, follows a polygenic pattern of inheritance, and remains incompletely understood. Management of hypodontia often requires a multidisciplinary team (MDT) approach, involving paediatric dentistry, orthodontics, restorative dentistry, and maxillofacial surgery where appropriate. It is important to understand the clinical features and challenges associated with missing maxillary lateral incisors and outline treatment objectives and pathways following completion of orthodontic treatment. Treatment strategies include space closure with canine substitution, space opening for resin-bonded bridges, and site preparation for implant placement. Canine substitution presents challenges such as bulbosity, increased crown width, a darker colour due to higher phosphoprotein content, and unfavourable gingival margin levels, often requiring elective enameloplasty and aesthetic modification. Resin- bonded bridge option requires careful design selection and carries risks including debonding and secondary caries. Implant-based solutions require precise space management and long-term planning. For each option, clinical considerations, technical challenges, and management strategies are important to understand. Furthermore, the role of the general dental practitioner is in long-term monitoring, maintenance, and coordination of care. Clinical examples and evidence-based approaches will enable clinicians to develop a clearer understanding of multidisciplinary decision-making and practical management strategies for patients with missing maxillary lateral incisors. "The authors acknowledge that this research was undertaken during a two year Dental Foundation Training placement funded by NHS Workforce, Training and Education (WT&E), London Region"
