Sheraz Burki, Saqib Rashid.
Orthodontic Management of Bilateral Congenitally absent Maxillary Lateral Incisors.
J Pak Dent Assoc Jan ;10(4):223-8.

A case report of orthodontic management of malocclusion with bilateral congenitally absent lateral incisors; anterior cross-bite; and narrow maxillary dental arch with a functional shift on closure is presented. This case was treated by correcting the cross-bite and creating space for the lateral incisors and restoring with resin bonded bridges.

CASE REPORT: History and general clinical picture: The patient was a 12 years old Pakistani female, in good health, with no history of any unusual childhood diseases. She had an orthognathic facial profile and exhibited good facial balance in all proportions. The mandible, when placed in centric relation, disclosed a slight constriction of maxillary dental arch along with the edge to edge bite of incisors. In moving from centric relation to centric occlusion, the mandible moved anteriorly to avoid premature contact of incisors. No crepitus was noted, and the patient gave no history of pain or tenderness in the temporomandibular joint or associated muscles. The maxillary lateral incisors were not clinically visible, and the parent indicated that the patient had never had any permanent teeth removed. Her first cousins had a history of tooth agenesis. The oral hygiene was good, with no clinically visible caries, and the gingival tissues appeared healthy. The intraoral radiographs confirmed the absence of the maxillary lateral incisors. The cephalometric evaluation illustrated a protrusion of mandible in centric occlusion. Etiology: The cause of the malocclusion was thought to be both genetic (tooth agenesis) and functional (crossbite development). The anterior cross bite was due to the uprighted maxillary central incisors, which created a premature contact with the opposing incisors and anterior shift of the mandible. Diagnosis: Class-I malocclusion characterized by an anterior cross-bite, anterior shift of the mandible on closure, dental midline discrepancy, congenital missing maxillary lateral incisors were diagnosed on examination. Both maxillary and mandibular right second primary molars were present. Both maxillary primary canines and right maxillary primary lateral incisior were present. No space deficiency in the mandibular arch was seen.

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