Canines substitution for congenitally missing maxillary lateral incisors– An interdisciplinary case report

Orthodontic treatment for patients with unilateral or bilateral congenitally missing lateral incisors is a challenge. Comprehensive treatment planning is required to achieve a satisfactory result, keeping in mind the aesthetics, function and periodontal stability. An interdisciplinary treatment approach is beneficial and involves orthodontic closure of the space with maxillary canine substitution or space opening for single-tooth implants, bridges and tooth-supported restorations. This case report presents a 18 year old male patient with Class II Division 1 malocclusion who reported with an over-retained maxillary deciduous left lateral incisor, missing permanent maxillary lateral incisors bilaterally, generalized upper anterior spacing and bilateral end-on molar relation with increased overjet and overbite. The patient was treated by extraction of deciduous lateral incisor in the maxillary arch and second premolars in the mandibular arch. Congenitally missing maxillary lateral incisors were substituted with canines bilaterally and the maxillary premolars were substituted as canines with an interdisciplinary approach. A remarkable improvement in the facial profile, smile esthetics and a favourable functional Class I occlusion with normal overjet and overbite was achieved.