3: Absent upper lateral incisors

3 Absent upper lateral incisors

Summary

Sarah, aged 12 years, presents with spacing of her upper anterior teeth (Fig. 3.1). What are the possible causes and how may it be treated?

image

Fig. 3.1 Anterior occlusion at presentation.

History

Complaint

Sarah does not like the gaps between her upper front teeth. She has just moved to a new school and feels self-conscious about the appearance of her teeth.

History of complaint

All primary teeth were present and were lost normally. When her upper permanent front teeth erupted, there was considerable spacing between them and this has not altered much since then. The permanent teeth erupted at a normal age and none have been extracted or avulsed.

Medical history

Sarah is fit and well.

Dental history

Sarah attends her general dental practitioner regularly but has had no intervention other than placement of fissure sealants to her first permanent molars.

Family history

Sarah’s mother also has a small space between her upper front teeth due to one missing tooth (image).

Social history

Sarah is a keen clarinet player and not motivated to wearing a fixed appliance.

image How will her instrument playing impact on orthodontic treatment?

Wearing an orthodontic appliance will temporarily affect her musical performance but with practice and motivation, most wind instrument players adjust. With a woodwind instrument such as a clarinet, it is likely that Sarah will adjust very quickly to wearing an orthodontic appliance and for playing to return to normal within a few weeks. It would, however, be advisable to avoid fitting an appliance close to dates of music exams, auditions or performances. Any orthodontic appliance, particularly fixed appliances, may rub the inside of the lips and cheeks when fitted but wax may be applied to minimize this. As Sarah is not keen for a fixed appliance and provided treatment is possible with a removable appliance, this could be removed while playing. In advance of any orthodontic treatment, it would be useful for the orthodontist to ascertain how many hours Sarah practises per day as leaving the appliance out for long periods is likely to influence treatment outcome.

Examination

Extraoral

Sarah has a Class I skeletal pattern with average FMPA; there is no facial asymmetry. Her lips are competent with the lower lip covering the incisal third of the upper incisors. The temporomandibular joints are symptom-free.

image What else should you check for?

• Thinning of the hair.
• Absence of palmar sweat glands.

These signs are present in anhidrotic ectodermal dysplasia, which is associated with marked hypodontia (see Chapter 36). Neither was evident in Sarah’s case.

Intraoral

image The intraoral views are shown in Figures 3.1 and 3.2. What do these show?

The soft tissues appear healthy and overall oral hygiene seems good, although there are small plaque deposits labially on the lower incisors. All teeth are of good quality and no caries is evident.

The following teeth are present:

image

Fig. 3.2 (A) Lower occlusal view.

image

Fig. 3.2 (B) Upper occlusal view.

image

Fig. 3.2 (C) Right buccal occlusion.

image

Fig. 3.2 (D) Left buccal occlusion.

image

There is a retained fragment of image.
There is mild imbrication of the lower incisors; the upper arch is spaced.
The incisor relationship is Class I with a complete overbite.
The lower centreline is shifted slightly to the left.
The buccal segment relationship is half unit Class II bilaterally.

image What other clinic assessment would you undertake?

The labial and palatal mucosae in the 2 area should be palpated for the presence of an unerupted tooth or any pathology.

image What are the possible causes of the upper labial segment spacing?

These are listed in Table 3.1.

Table 3.1 Possible causes of the upper labial segment spacing

Cause Aetiology
Absence of image
Hypodontia (affects ~2% of Caucasians) – also associated with cleft lip and palate, Down syndrome and ectodermal dysplasia
Avulsion
Extraction

Failure of/delayed eruption of 2’s
Crowding
Ectopic position
Supernumerary tooth
Scar tissue
Dilaceration
Cyst/tumour

image What is the most likely cause in this case?

Congenital absence of image is most likely. This is more common in females than males. The genetic linkage is indicated by Sarah’s mother, who has absence of image

Share this:

Related posts:

  1. 27: Facial swelling and dental abscess
  2. 39: Gingival bleeding and enlargement
  3. 22: Nursing and early childhood caries
  4. 12: Increased overbite
  5. 30: The fractured permanent incisor root
  6. 38: Dentinogenesis imperfecta

Stay updated, free dental videos. Join our Telegram channel
Tags:
Jan 2, 2015 | Posted by in Orthodontics | Comments Off on 3: Absent upper lateral incisors

VIDEdental - Online dental courses
Get VIDEdental app for watching clinical videos