This case report describes the orthodontic treatment of a woman, aged 15 years, with permanent dentition, brachyfacial typology, with congenitally missing maxillary lateral incisors. Multibracket straightwire fixed appliance was used to open the space for dental implant placement, and treat the impaired occlusion. The missing lateral incisors were substituted with oral implants. 1. Introduction The management of missing lateral incisor requires an integrated multidisciplinary approach [1]. Generally the choice between space opening with tooth replacement and space closure with canine substitution relies on several parameters to be considered before treatment planning. Commonly the choice is related to occlusal relationship (i.e., overjet and overbite, molar relationship), facial typology and profile, arch length, and tooth size discrepancies. The morphology of the canine, in terms of size and shape, and its colour [2] also may address different treatment strategies. Finally, patient expectation and compliance can influence the treatment planning. In case of unilateral tooth agenesis, space opening is often recommended to improve the aesthetics of patients and preserve smile symmetry. On the contrary, in case of bilateral agenesis, space closure and space opening could be both performed with respect to the issues previously reported [3–6]. Space opening is advised in low-angle subjects, whilst in high-angle individuals space closure should be preferred to preserve arch anchorage and avoid clock-wise rotation of the lower jaw. Retruded profiles should be better treated with space opening and tooth substitution, in order to improve labial sagittal relationships. This treatment strategy should be avoided in subjects with bimaxillary dental protrusion, in which it could result in worsening of the profile. Molar relationship should be also considered. Molar class I or class III tendency should be better treated with space opening to preserve ideal occlusal anterior and posterior relationship (i.e., canine and molar relationship) and establish a solid angle class I. In case of full cusp or partial molar class II, space closure should be preferred to facilitate orthodontic biomechanics and reduce treatment duration. A stable molar class II and canine class I are then obtained. However, in case of arch length discrepancies extractions in the lower arch should be considered, thus obtaining a molar and canine class I. Anterior relationship, that is, overjet and overbite, must be taken into account in terms of facilitation of biomechanics. Reduced overjet and
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