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Medical Forum / General / Dentistry / November 2004congenitally missing lateral incisors /underbite
I am missing 2 upper lateral incisors congenitally. When I try to bite, my front teeth can meet, but back teeth can not. So I have to jut my bottom teeth out to bite down. In this way, all my back teeth meet okay, but bottom front teeth are in front of the top front teeth. So the underbite. There are no spaces between the teeth. Most ortho suggest to open up spaces for lateral incisors by push top centrals forward. How easy/difficult to open up spaces? If we don't open up spaces, just use the cannies as lateral incisors, is it possible? > I am missing 2 upper lateral incisors congenitally. When I try to > bite, my front teeth can meet, but back teeth can not. So I have to [quoted text clipped - 5 lines] > If we don't open up spaces, just use the cannies as lateral incisors, > is it possible? There are multiple ways to treat this situation dependant on a variety of factors. It's difficult to say without an exam and beginning ortho records. Even then you probably would get a number treatment plans if you went somewhere else for a 2nd, 3rd etc., opinion. Differing ortho treatment plans do not necessarily mean only one is the correct one. carabelli Ideally, an orthodontist or equivalent trained general dentist can perform comprehensive orthodontic treatment to spread your upper teeth out - you make it sound as if there's not enough of room, ideally, your bottom front teeth should rest behind your upper front ones. This sounds complicated, with no easy alternative, except for no treatment.  SignatureShad Lewis www.WyomissingSmiles.com > I am missing 2 upper lateral incisors congenitally. When I try to > bite, my front teeth can meet, but back teeth can not. So I have to [quoted text clipped - 5 lines] > If we don't open up spaces, just use the cannies as lateral incisors, > is it possible? > Ideally, an orthodontist or equivalent trained general dentist can perform > comprehensive orthodontic treatment to spread your upper teeth out - you [quoted text clipped - 6 lines] > Shad Lewis > www.WyomissingSmiles.com What is the equivalent of a 3 year residency? carabelli Getting a little nasty here. (me) "If you want an education, go to college" "If you want to bet, go to a casino" Gail >Getting a little nasty here. (me) > >"If you want an education, go to college" >"If you want to bet, go to a casino" When betting Mancuso I don't have to pay the vig. >Gail -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com > Ideally, an orthodontist or equivalent trained general dentist can perform > comprehensive orthodontic treatment to spread your upper teeth out - you > make it sound as if there's not enough of room, ideally, your bottom front > teeth should rest behind your upper front ones. > > This sounds complicated, with no easy alternative, except for no treatment. What are the possible options, pros and cons for each option: 1. Since i have no spaces anywhere (even without spaces between the upper centrals & canines), one option is: don't open spaces for laterals, use canines as laterals(my canines are small, easy to reshape). Advance upper front teeth forward, move lower front teeth inward... I am not sure how much spaces be can created by advance upper front teeth? that has to been closed somehow. 2. 2nd option: most ortho will do in this way. open up spaces for laterals ..... I don't know how difficult it is to open up spaces for 2 teeth. This must need a lot of movement of all upper teeth? 3. 3rd option: remove lower front teeth since they are too long, replace them by small fake teeth, so the bite can easily correct. Please let me know your opinions. Thanks! > What are the possible options, pros and cons for each option: One thing you haven't mentioned, but could also be considered is orthognathic surgery combined with orthodontics. You could have one or the other arcade moved partially or totally to make a better approximation of tooth contact. The whole thing would then be fine tuned by orthodontics, before, after or both. Can you get to a schood of Dentistry that teaches Orthodontics as a graduate course? Just a suggestion SP SignatureNot a real Addy, yet >If we don't open up spaces, just use the cannies as lateral incisors, >is it possible? Possible but never looks quite right IME. -- W_B Take out the G'RBAGE wubbabubbazG@RBAGEyahoo.com I recall someone saying that if you strip 1/2 mm from each side of the lower anteriors you can pick up 6 mm. Stripping the lower anteriors and pulling them back might allow for a normal overbite/overjet relationship. The patients concerns were related to occlusion not esthetics. or possibly a combination of both SignatureRoy DotSeaEh is .ca | >If we don't open up spaces, just use the cannies as lateral incisors, | >is it possible? [quoted text clipped - 6 lines] | Take out the G'RBAGE | wubbabubbazG@RBAGEyahoo.com > I recall someone saying that if you strip 1/2 mm from each side of the lower > anteriors you can pick up 6 mm. [quoted text clipped - 4 lines] > > or possibly a combination of both Do you mean that if the lower anteriors are "slendered" 1/2 mm on each side, it is like pick up 6 mm on the upper? I read that for missing upper laterals, if we want to open up spaces, 10 mm of inciso-gingival bone is needed, 6 mm of facial-lingal bone is needed, right? So opening up spaces for laterals is more difficult, but will look better. Use canines as laterals, and stripping lower anteriors is easier, but not look very good. Am I right? >> I recall someone saying that if you strip 1/2 mm from each side of the >> lower [quoted text clipped - 17 lines] > Use canines as laterals, and stripping lower anteriors is easier, but > not look very good. Am I right? Roy- It depends. I would guess - not Evidenced Based Dentistry (just what I've seen - need to check the lit again on that) - that many adults with congenitally missing upper laterals and upper cuspids, that erupt uneventfully into the lateral space end up with a horizontal skeletal discrepany between the maxilla and mandible (I could elaborate, but this run on sentence is long enough). The thesis would be that the anterior maxilla doesn't grow as much when the stimulus of developing lateral incisors is absent. As far as treating this particular case - who knows without an exam and records. But there are a whole lot of ways to skin a cat, and a whole lot of ways to screw it up. Dan -- Bob's 47 is in KC again for a short while!! | > "Roy Brown" <roybrown@sympatico.DotSeaEh> wrote in message | [quoted text clipped - 23 lines] | | Dan -- Bob's 47 is in KC again for a short while!! Dan, The "horizontal skeletal discrepany" explains it all to me. Thanks SignatureRoy DotSeaEh is .ca > | > "Roy Brown" <roybrown@sympatico.DotSeaEh> wrote in message > [quoted text clipped - 4 lines] > | >> > | >> or possibly a combination of both The most concern is on occlusion, to correct the underbite problem because the underbite will affect the esthetics 100%. > The thesis would be that the anterior maxilla doesn't grow as much when the > stimulus of developing lateral incisors is absent. [quoted text clipped - 4 lines] > > Dan -- Bob's 47 is in KC again for a short while!! Again: this would tend to suggest the need for surgery here, would it not? Move the anterior segment of the MX forward, at least, and perhaps move the anterior segment of the MN back with removal of one PM on each side. Then Roy's idea would really do something. You could end up with alot of space to work with to get a good anterior guidance. I'd think you'd have to erupt the posterior segments to get a good occlusion there as well. This all is just whistlin' in the wind. Perhaps the Original Poster could get photos of his models and post them. Just some ideas SP Thanks SP SignatureNot a real Addy, yet Straight Teeth , Comments in text | > I recall someone saying that if you strip 1/2 mm from each side of the lower | > anteriors you can pick up 6 mm. [quoted text clipped - 7 lines] | Do you mean that if the lower anteriors are "slendered" 1/2 mm on each | side, it is like pick up 6 mm on the upper? It is similar in effect to creating 6 mm of spaces on the upper. Remember we are speaking about altering the length of a curve, which is like talking about changing the circumference of a circle. Not the overbite/overjet relationship which would be analagous to changing the radius of a the circle. (assuming your front teeth formed a perfect 1/2 circle) Been a while since I've touched the math kind of calculus, but I'm sure someone can come up with the right function for this. | I read that for missing upper laterals, if we want to open up spaces, | 10 mm of inciso-gingival bone is needed, 6 mm of facial-lingal bone is | needed, right? I'm not sure what you are talking about. All I know is that if you add bone in the directions you suggest, the bone will essentially replace the current position of the teeth. Where are the teeth going to be then? | So opening up spaces for laterals is more difficult, but will look | better. | Use canines as laterals, and stripping lower anteriors is easier, but | not look very good. Am I right? The ease of the procedure and the relative success of final results is based on what you present. Carabelli has touched on that already, and is much more knowledgeable in ortho than I. SignatureRoy DotSeaEh is .ca |
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