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Managing the Patient with Missing or Malformed Maxillary Central Incisors Managing the Patient with Missing or Malformed Maxillary Central Incisors

Author(s):

Vincent G. Kokich, Sr., DDS, MSD;Katherine E. Crabill

Date Added:

4/1/2006


Summary:

Occasionally, orthodontists and general dentists encounter a patient who has traumatically avulsed a maxillary central incisor1 or a patient with a geminated or fused maxillary central incisor that must be removed. In either situation, a decision must be made about the eventual restoration of the anterior edentulous space. Several options exist for replacing a missing maxillary central incisor. If the tooth has been avulsed, the simplest long-term solution is to replant it. However, the success of reimplantation depends on the status of the tooth root, the ability to perform endodontics, and the length of time that the tooth is out of the alveolar socket. If reimplantation is not possible, autotransplantation might be an option. However, the patient must have an arch-length deficiency, so that a premolar from a posterior quadrant can be transplanted to the edentulous site. A third solution is to maintain the edentulous space during childhood and adolescence, and to place a bridge or implant during adulthood. A fourth possible solution is to close the edentulous space and substitute the ipsilateral lateral incisor for the central incisor. The choice of the appropriate solution for the missing maxillary central incisor depends on the specific characteristics of each situation.

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