Replacing the Unilateral Missing Maxillary Lateral Incisor: An Objective and Subjective Comparison of...

Management of missing anterior teeth can pose significant challenges for the orthodontist, as the maxillary incisors are key to esthetic orthodontic treatment planning. Two treatment modalities for patients that are unilaterally missing a maxillary lateral incisor that offer definitive functional and esthetic natural-tooth replacements for patients, regardless of age, are orthodontic canine substitution (OCS) and autotransplantation (AT) of a lower incisor. Using validated indices and an electronic questionnaire, the purpose of the study was to assess, objectively and subjectively, whether AT of a lower incisor or unilateral OCS offers patients who present with a unilateral missing maxillary lateral incisor a better esthetic result.

An orthodontist, periodontist, restorative dentist, and prosthodontist evaluated intraoral frontal images of 55 patients who were missing a single maxillary lateral incisor and were treated with unilateral OCS (25) or AT of a lower incisor (30) using the Pink and White Esthetic Indices. In addition, the specialists evaluated 30 finished orthodontic cases with no missing teeth as controls. An electronic survey was distributed to orthodontists, general dentists, and laypeople to gauge subjective opinions on the esthetic results of OCS versus AT.

Lower incisor autotransplantation and unilateral orthodontic canine substitution had statistically significant lower esthetic scores than cases without missing teeth. The scores of AT and OCS were not significantly different from one another. Electronic survey data showed that dental providers find finished orthodontic cases the most esthetic, followed by lower incisor AT and unilateral OCS. Laypeople find unilateral OCS significantly more esthetic than both control and AT cases.

Compared to unilateral OCS, lower incisor AT offers comparable esthetic outcomes and should be considered in cases of unilateral missing maxillary lateral incisors.

This study demonstrated that orthodontic space closure and dental autotransplantation can be acceptable treatment solutions for growing patients with a unilateral missing maxillary lateral incisor. Esthetic outcomes in the maxillary anterior region can impact the psychological status of a patient during an important developmental stage.