Substitution of a transposed premolar for a congenitally absent lateral incisor

The purpose of this report is to review the orthodontic treatment of a patient with bilateral transposition of maxillary canines and first premolars in addition to congenital absence of a maxillary lateral incisor. This unique combination of factors led to substitution of the maxillary left first premolar for the left lateral incisor. The occlusal fit, gingival form, and esthetic appearance of premolar/lateral incisor substitution are discussed.