Early Management of Congenitally Missing Teeth

Often children and adolescents are congenitally missing their maxillary lateral incisors or mandibular second premolars, and frequently it is the orthodontist who diagnoses the agenesis. In fact, early orthodontic intervention may eliminate some of the periodontal and restorative problems that could arise in these patients as adults. An excellent implant site can be developed in the mixed dentition by extracting the maxillary primary lateral incisor and guiding the eruption of the permanent canine into the lateral incisor space. Occasionally, the mandibular primary second molar also may require extraction during early adolescence. This is due to ankylosis, which could become a significant periodontal concern, if not addressed early. When there is no permanent successor, an ankylosed primary molar may need to be extracted so the alveolus will develop vertically as the patient grows. Therefore, the orthodontist plays a key role in monitoring eruption and growth of these patients at an early age. If this were done, the final result could be esthetic and predictable. This article will discuss the importance of early diagnosis and intervention in order to preserve various treatment options in the future.