Management of Congenitally Missing Bilateral Lateral Incisors with Fixed Orthodontic Treatment, Ridge Augmentation and Two Stage Implant Therapy: Multidisciplinary Approach

Management of Congenitally Missing Bilateral Lateral Incisors with Fixed Orthodontic
Treatment, Ridge Augmentation and Two Stage Implant Therapy: Multidisciplinary
Approach – A Case Report
Dr.Abu-Hussein Muhamad
DDS,MScD,MSc,MDentSci(PaedDent)

ABSTRACT
• Aim: Placing dental implants in the esthetic zone is considered to be the ultimate
challenge for many dentists. Insufficient bone is a common problem for implant
placement, especially in the upper anterior jaw. A multidisciplinary approach
towards the replacement of congenitally missing lateral incisors was planned.
• Case Report: Orthodontic treatment was done to create adequate space to place
implant in relation to upper right and left lateral incisors. Insufficient ridge width
was confirmed by a computerized tomography scan in relation to 22 region, which
was augmented at the time of implant placement. Two stage implant was placed
in relation to upper right and left lateral incisors. Permanent restoration was
placed after 4 months. Conclusion: This case report describes esthetic and
functional outcomes obtained by the multidisciplinary approach for the
restoration of congenitally missing maxillary left and right lateral incisor areas. Key
Words: Dental Implants, Orthodontics, Ridge Augmentation.
•

INTRODUCTION
• Currently dentists are facing a growing aesthetic
demand from patients. This often requires an
interdisciplinary approach to assess, diagnose and
treating existing problems through a combination of
orthodontic, periodontal, surgical and prosthodontic
treatments . In many cases obtaining favorable results in
aesthetic restorations depends on the position of the
teeth, the clinical dimensions of the crowns, the gingival
architecture. Communication between disciplines is
essential to achieving improved aesthetic results

The treatment plan was
•  Initial therapy (SRP)
•  Orthodontic therapy for alignment and
achieve-ment of sufficient space
•  Surgery: ridge augmentation and implant
place-ment
•  Prosthesis
•  SPT (supportive periodontal therapy)

Congenitally Missing Lateral Incisors
• There are several issues that commonly arise
in the orthodontic management of patients
with hypodontia:
• 1. Space management
• 2. Uprighting and aligning teeth
• 3. Management of deep overbite
• 4. Retention and stability

Phase 1: Planning
• All dental professionals involved in the treatment
(orthodontist, periodontist, master ceramist, and
operative dentist) evaluated the clinical case individually
to decide which noninvasive procedures were indicated.
Next, the four professionals discussed the prognosis and
limitations of the case. The master ceramist performed a
diagnostic wax-up to provide a model of the
multidisciplinary treatment. After patient approval, the
conservative treatment was then split into three
restorative phase orthodontic, surgical, and restorative

Phase 2: Orthodontics
• Dental implants have become a common method for restoring
missing teeth. However, especially upper lateral incisor
implants are esthetically challenging. The orthodontic
improvement of the procedure and the final attendance result
of these patients can be accomplished best by positioning
the remaining natural dentition in the anatomically correct
location. This treatment should be closely coordinated with
the implant placement and the restorative team . In cases of
extensive dento-alveolar and skeletal malformations,
occlusion and facial proportions additionally must be
improved by orthognatic surgery and sometimes even by
esthetic plastic surgery

Phase 3: Surgical;
•
• A more recent option for treating congenitally missing lateral
incisors, and one that currently is recommended often, is the
single-tooth implant. Over the past several years, the predictability
and longterm success rates of implants have made them an
obvious restorative choice,5 especially when teeth adjacent to the
space are healthy, of normal size and shape, and unrestored.
Furthermore, placement of an implant may provide a functional
stimulus to help preserve bone and prevent resorption. However,
when choosing the single-tooth implant as a restorative option,
several factors must be taken into account such as growth
considerations, space requirements, and site development

Phase III: Restorative
• The restorative phase was initiated 8weeks after implant
placement. After the resin-bonded bridges were
removed, an incision was made lingual to the implants
and the tissue released to the facial. The implant cover
screws were removed, and standard analog abutments
were tried in using an Essex retainer to evaluate space. A
1.5-mm to 4-mm straight standard abutment was
chosen for each implant. Bis-acryl provisionals were
made and cemented with a temporary crown-and-bridge
cement. The tissue was approximated around the
provisional and sutured .

DISCUSSION
• Minimally invasive dentistry aims to preserve healthy oral
structures, respecting the original tissues whereas simplifying
clinical steps in order to achieve the treatment goals in a
predictable way.[1`] As clinical conditions are different, there
is not a common guide to achieve these objectives for every
case. However, a multidisciplinary analysis usually leads to an
appropriate cas resolution.[16,17,18]Treatment modalities
which comply the original characteristics of soft and hard
tissues, like flapless extraction4 followed by immediate
implant placement and immediate provisional restoration are
in accordance with the aforementioned statements of
minimally invasive dentistry

Conclusions
• This presentation report describes aesthetic and
functional outcomes obtained by the
multidisciplinary approach for the restoration of
congenitally missing maxillary left and right lateral
incisor areas and fabrication of two single crowns.
In congenitally missing situations, in absence of any
pathologic symptoms or negative radiologic
findings, such a kind of treatment suggest a
successful and a satisfactory result in short-term
evaluation.

References
• Abu-Hussein M., Abdulgani A., Watted N .Zahalka M.(2015); Congenitally Missing Lateral Incisor with Orthodontics, Bone Grafting and Single-Tooth Implant: A Case
Report. Journal of Dental and Medical Sciences , 14(4),124-130 DOI: 10.9790/08531446124130
• Abu-Hussein M , Chlorokostas G , Watted N , Abdulgani A , Jabareen A, (2016),;Pre-Prosthetic Orthodontic Implant for Management of Congenitally Unerupted
Lateral Incisors – A Case Report Journal of Dental and Medical Sciences 2 .Vol 15 (2 ) , 99-104 DOI: 10.9790/0853-152899104
• Abu-Hussein M., Watted N., Yehia M., Proff P., Iraqi F.(2015) ; Clinical Genetic Basis of Tooth Agenesis, Journal of Dental and Medical Sciences ,14(12),68-77 DOI:
10.9790/0853-141236877
• Muhamad Abu-Hussein, Nezar Watted, Ali Watted, Yosef Abu-Hussein, Mohammad Yehia, Obaida Awadi, Abdulgani Azzaldeen.(2015); Prevalence of Tooth
Agenesis in Orthodontic Patients at Arab Population in Israel. International Journal of Public Health Research.Vol. 3, No. 3, 2015, pp. 77-82
• Muhamad Abu-Hussein, Nezar Watted, Abdulgani Azzaldeen, Mohammad Yehia, Obaida Awadi, Yosef Abu-Hussein.(2015); Prevalence of Missing Lateral Incisor
Agenesis in an Orthodontic Arabs Population in Israel (Arab48). International Journal of Public Health Research. Vol. 3, No. 3, 101-107.
• Abu-Hussein Muhamad , Abdulgani Azzaldeen; The Concept of the Golden Proportion in Dentistry. Journal of Dental and Medical Sciences2021 ;. 20, . 10 ,37-45
• Abusalih A, Ismail H, Abdulgani A, Chlorokostas G, AbuHussein M (2016) Interdisciplinary Management of Congenitally Agenesis Maxillary Lateral Incisors:
Orthodontic/Prosthodontic Perspectives. J Dent Med Sci 15: 90-99.
• Abu-Hussein M, Watted N, Abdulgani A, Borbély B (2015) Modern Treatment for Congenitally Missing Teeth: A Multidisciplinary Approach; International Journal of
Maxillofacial Research 1: 179-190
• Abu-Hussein M, Chlorokostas G, Watted N, Abdulgani A, Jabareen A (2016) Pre-Prosthetic Orthodontic Implant for Management of Congenitally Unerupted Lateral
Incisors – A Case Report. J Dent Med Sci 15: 99-104
• Abu-Hussein M, Watted N, Hegedus V, Péter B (2015) Congenitally Missing Upper Laterals. Clinical Considerations: Orthodontic Space Closure 1: 1-6
• Abdulgani M, Abdulgani Az, Abu-Hussein M (2016) Two Treatment Approaches for Missing Maxillary Lateral Incisors: A Case. J Dent Med Sci 15: 78-85
• Abusalih A, Ismail H, Abdulgani A, Chlorokostas G, AbuHussein M (2016) Interdisciplinary Management of Congenitally Agenesis Maxillary Lateral Incisors:
Orthodontic/Prosthodontic Perspectives. J Dent Med Sci 15: 90-99.
• .Abu-Hussein M, Watted N, Abdulgani A, Borbély B (2015) Modern Treatment for Congenitally Missing Teeth: A Multidisciplinary Approach; International Journal of
Maxillofacial Research 1: 179-190
• .Abu-Hussein M, Chlorokostas G, Watted N, Abdulgani A, Jabareen A (2016) Pre-Prosthetic Orthodontic Implant for Management of Congenitally Unerupted Lateral
Incisors – A Case Report. J Dent Med Sci 15: 99-104
• .Abu-Hussein M, Watted N, Hegedus V, Péter B (2015) Congenitally Missing Upper Laterals. Clinical Considerations: Orthodontic Space Closure 1: 1-6
• . Abdulgani M, Abdulgani Az, Abu-Hussein M (2016) Two Treatment Approaches for Missing Maxillary Lateral Incisors: A Case. J Dent Med Sci 15: 78-85
•

Management of Congenitally Missing Bilateral Lateral Incisors with Fixed Orthodontic Treatment, Ridge Augmentation and Two Stage Implant Therapy: Multidisciplinary Approach

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Management of Congenitally Missing Bilateral Lateral Incisors with Fixed Orthodontic Treatment, Ridge Augmentation and Two Stage Implant Therapy: Multidisciplinary Approach