Missing Incisors: Part 1

Due to the vast amount of information necessary to make a decision regarding the treatment of missing incisors, I am going to break this topic down into three parts. Part one will consist of an overview, and the remaining blogs will focus on one of two treatment options, either replacement with an implant or a ‘bridge’, or substitution of the missing incisor with a canine or bicuspid. 

Lateral incisor agenesis, or failure of the lateral incisor to develop, or missing lateral incisors, are second in the prevalence of missing teeth only to missing lower second bicuspids. The condition exists in 3.2 % of North American male population and 4.6 % of the female population. In addition, the prevalence of lateral incisor agenesis in females was 1.37 times higher than in males. It is also more common to have both lateral incisors missing rather than just one. The cause is primarily hereditary in nature and often skips a generation, or it can also be associated with a traumatic event. It is especially common in certain craniofacial anomalies such as cleft palate.

So you’ve been told by your dentist that your daughter, the most beautiful girl in your life, next to your wife, of course, is missing one of her front teeth, the lateral incisor to be exact. Meaning that the tooth will never, as in the never with a capital N, form! With the great emphasis that our culture places on beauty-and the smile is a huge part of that, what’s your plan?

The next thing your dentist tells you is, it’s no problem, right? We can just place an implant or a bridge and REPLACE the missing tooth. Or maybe, he or she recommends a consultation with your orthodontist? There are a number of factors that go into the planning process for treatment of this dental conundrum, and seeking the expertise and knowledge of an orthodontist will help to elucidate the great majority of these factors for you.

Often times your dentist is correct in his or her assessment that it is “no-problem’ and that the tooth can be replaced with a restoration such as an implant-supported crown depending on the circumstances, however, if your child’s jaws-based on a reliable measurement such as a cephalometric radiograph-have not stopped growing, you should not proceed to this step quite yet! It is always a good idea to sit-down with an orthodontist prior to placement of any permanent restoration to assess growth, root and crown alignment, and his or her occlusion. Once something permanent has been placed, such as an implant, there is no turning back and it is often difficult, if not impossible to correct any crowding or bite problems once the restoration has been placed.

The bottom line is that there are two options available for dealing with a missing lateral incisor; one entails replacing the missing tooth or teeth with a false-tooth or prosthetic tooth as it is called, or substitute an adjacent tooth or a transplanted tooth for the missing tooth. Generally speaking, the replacement route is more costly and cannot be finalized or completed until growth of the jaws is completed. My next blogpost will address the indications for each of these options, the timing, and the associated costs.

So in summary, it is important to know that there are many restorative options available to either replace the missing tooth or substitute another tooth in the mouth for the missing tooth. It is usually genetically related-so dads, you can blame your mother-in-law!-and it is quite common, especially in females. If you have a son or daughter who has been diagnosed with a missing tooth, it is best to discuss the ramifications and treatment options at an early age, preferably around age seven or eight. 

Call our office at (228)-896-6971 or email our office at admin@frigoortho.com to schedule a complimentary examination and we can further discuss this condition with you. Look for my next blogpost which will discuss the replacement of the missing tooth option.