Surgical and orthodontic treatment of impacted maxillary canines in cases where lateral incisors are congenitally absent

Abstract

Unilateral or bilateral congenitally missing maxillary lateral incisors are often accompanied by impacted canines. Planning treatment in these cases frequently involves close cooperation among the orthodontist, the oral surgeon, and the general dentist. Whether to open or close the space in the maxillary lateral incisor region depends on many factors, including age and sex of the patient, shape and shading of the canine, mesiodistal position of the canines, symmetry, mesiodistal position of the molars, mandibular arch discrepancies, and profile. Surgical exposure and the subsequent orthodontic positioning of the impacted canine often form part of the treatment. The surgical approach varies according to whether 1 canine is impacted or both. Preservation of the periodontal integrity is emphasized during the positioning of the teeth in the dental arches. The final option is a prosthetic replacement of 1 or 2 lateral incisor crowns, with either dental abutments or implants, the latter being these authors' therapy of choice. Timing of the implants, availability of bone volume, and adequate space for the placement of the lateral incisors are discussed. The article includes 69 color photographs of the procedures discussed in 5 excellently treated cases.