3 Absent upper lateral incisors
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?
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.
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.
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.
The intraoral views are shown in Figures 3.1 and 3.2. What do these show?
Hypodontia (affects ~2% of Caucasians) – also associated with cleft lip and palate, Down syndrome and ectodermal dysplasia