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Title Canine Substitution and Prosthetic Replacement for Patients with Missing Permanent Maxillary Lateral Incisors Provide Satisfactory Long-Term Results
Clinical Question For patients with congenitally missing lateral incisors, is orthodontic space closure with canine substitution or prosthodontic replacement more likely to provide long-term esthetic and functional success?
Clinical Bottom Line Both orthodontic space closure and prosthodontic replacement are effective treatment options. A definitive conclusion on superiority of one treatment over the other in regard to long-term esthetic and functional outcome cannot be determined. However, treatment with orthodontic space closure presents significantly less long-term risk for complications.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 27476355Silveira/20169 case control studiesSystematic review of non-randomized trials
Key resultsThe esthetics of orthodontic space closure were more favorable than tooth-supported and implant-support dental prostheses. Periodontal indexes were the worst for tooth-supported prostheses. Presence or absence of a canine rise had no relationship to occlusal function or to signs/symptoms of TMD.
#2) 27585769Schneider/20169 post-treatment intraoral frontal photographs presented to 287 observersComparative study
Key resultsNine post-treatment intraoral frontal photographs were presented to 87 orthodontists, 100 general dentists, 100 laypersons (three photos with canine substitution; three with implants; three with no missing teeth). Dental professionals ranked the esthetics of implants and canine substitution as equally pleasing, while laypersons preferred space closure with canine substitution. Due to variations in esthetic perceptions/preferences and the absence of randomized controlled trials (RCTs) for long-term functional and esthetic stability of treatment modalities, "dental professionals should refrain from imposing their esthetic preferences on patients."
#3) 27314109 Kiliaridis/201612 articles (5 that compared therapeutic options directly)Systematic review of non-randomized trials
Key resultsBoth orthodontic space closure with canine substitution and prosthodontic intervention (implant placement, fixed prosthesis) are effective options. The authors were unable to conclude if one treatment option was superior over the other regarding esthetic, functional, and biological outcomes due to the lack of RCTs, prospective, or retrospective studies comparing the two. Space closure, however, appears to be advantageous based on periodontal health, esthetics, early completion of definitive treatment, and longevity.
#4) 27476355Rosa/201658 patients (26 with agenesis treated with space closure, 32 controls no missing teeth and no need for extractions) Retrospective cohort study
Key resultsIntrusion of the first premolar and extrusion of the canine for orthodontic space closure does not increase the risk for periodontal deterioration or TMD - patients are periodontally healthy after 10 years, with no significant difference in occlusal function.
Evidence Search maxillary lateral incisor agenesis AND orthodontics
Comments on
The Evidence
Further studies need to be performed in order to provide a more definitive answer regarding the superiority of treatment alternatives. In Rosa/2016, all 58 patients included in the study were treated by the same orthodontist. The authors report pursuing an upcoming study with patients whom underwent implant placement and are seen by the same orthodontic provider. Silveira/2016 cited the lack of comparative prospective studies, bias within the available studies, and difficulties evaluating comparisons of both treatment options directly and indirectly. The 2016 systematic review by Kiliaridis addresses the difficulty of drawing definitive conclusions on the topic due to the absence of randomized controlled trials, and few prospective and retrospective studies available. Schneider/2016 similarly remarked on the lack of RCTs.
Applicability This evidence aids in discussion of treatment options for patients with congenitally missing permanent maxillary lateral incisors. For patients in whom implants are not an option for medical or financial reasons, current evidence demonstrates that orthodontic space closure achieves satisfactory esthetic and functional long-term results.
Specialty/Discipline (General Dentistry) (Orthodontics) (Pediatric Dentistry)
Keywords canine substitution, maxillary lateral incisor agenesis, orthodontic space closure
ID# 3371
Date of submission: 03/18/2019spacer
E-mail amber.clark@childrenscolorado.org
Author Amber Clark
Co-author(s) e-mail
Faculty mentor/Co-author Chaitanya Puranik
Faculty mentor/Co-author e-mail chaitanya.puranik@childrenscolorado.org
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