This article is based on an original article in Swedish which can be found here

BACKGROUND

The most common cause of the absence of maxillary lateral incisors is agenesis, meaning congenital absence of the tooth bud. The prevalence is 1.5-2% in the Scandinavian population. Maxillary lateral incisors may also sometimes need to be extracted due to root resorption or trauma. In normal occlusal development, the maxillary lateral incisors erupt at 8-9 years of age. If primary maxillary lateral incisors persist and the permanent incisors have not erupted, the diagnosis can be easily made with a radiographic examination.

After the diagnosis is established, it is important to ensure the eruption of the permanent canine and that there are no missing tooth buds elsewhere in the dentition. The incidence of ectopically displaced canines and other missing tooth buds is greater if the maxillary lateral is absent. Furthermore, it may be appropriate to extract the primary lateral incisor and possibly the primary canine at 9-10 years of age if these do not resorb adequately. This is to allow for complication-free eruption of the canine in the place of the lateral without persistent primary teeth. In the untreated permanent dentition, one often sees spacing in the maxillary anterior region and that the canine has erupted in a rotated position in the place of the lateral.

INDICATION FOR TREATMENT

Psychosocial dissatisfaction due to affected aesthetics.

TREATMENT

There are two treatment strategies: orthodontic space closure or space-maintaining measures. If one wants to preserve space, the treatment options are tooth-supported fixed prosthetics, resin-bonded fixed dental prosthesis, implant-supported crown, or autotransplantation. The most common treatment choices are orthodontic space closure or implant-supported crown. For many patients, several treatment options are possible.