Space for missing maxillary lateral incisors--orthodontic perceptions

Historically there has been a long-standing debate regarding the orthodontic management of dentitions with missing maxillary lateral incisors. Whether to provide space for prosthetic replacements or to close space utilizing the canines as substitute lateral incisors are the options of treatment planning for an individual. This presentation is directed at the orthodontic management of those patients who were orthodontically treated in the past by providing space for replacement lateral incisors and now at dental maturity or even later, seek a prosthetic replacement in the form of an osseointegrated fixture. In many instances there will be inadequate interradicular bone space and yet at the time of debanding adequate space often was present and now some years hence the patient is faced with orthodontic re-treatment to provide that space again. Whilst that is a challenge in itself, there is a further apparent problem to be met for those younger patients requiring space opening mechanics in deciding upon and implementing at the debanding phase, the form of retention that will hold the teeth and the roots firmly in position until the time is right for an osseointegrated fixture to be placed and treatment finalized.