Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Clinical
  • Published:

Multidisciplinary management of missing maxillary central incisors in children and adolescents

British Dental Journal volume 234, pages 661–667 (2023)Cite this article

Abstract

Missing maxillary central incisors can impact a patient's psychological wellbeing and smile aesthetics. Comprehensive management of such cases requires a multidisciplinary team approach, often involving orthodontic, paediatric and restorative dental teams. This paper summarises the various management options for these complex patients.

Key points

  • To understand the aetiology of missing maxillary central incisors.

  • To appreciate patient and dental factors which need to be considered when deciding treatment options for the management of missing maxillary central incisors in children and adolescents.

  • To understand and be able to communicate the risks and benefits of each treatment option in managing missing maxillary central incisors and be able to communicate this with patients and their parent/guardian.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10

Similar content being viewed by others

References

  1. Khalaf K, Miskelly J, Voge E, Macfarlane T V. Prevalence of hypodontia and associated factors: a systematic review and meta-analysis. J Orthod 2014; 41: 299-316.

  2. Blokland A, Watt R G, Tsakos G, Heilmann A. Traumatic dental injuries and socioeconomic position - findings from the Children's Dental Health Survey 2013. Community Dent Oral Epidemiol 2016; 44: 586-591.

  3. Järvinen S. Traumatic injuries to upper permanent incisors related to age and incisal overjet. A retrospective study. Acta Odontol Scand 1979; 37: 335-338.

  4. Burden D J. An investigation of the association between overjet size, lip coverage, and traumatic injury to maxillary incisors. Eur J Orthod 1995; 17: 513-517.

  5. Levin L, Day P F, Hicks L et al. International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: General introduction. Dent Traumatol 2020; 36: 309-313.

  6. Glendor U, Halling A, Andersson L, Eilert-Petersson E. Incidence of traumatic tooth injuries in children and adolescents in the county of Västmanland, Sweden. Swed Dent J 1996; 20: 15-28.

  7. Andreasen J O, Flores M T. Injuries to Developing Teeth. In Andreasen J, Andreasen F, Andersson L (eds) Textbook and Colour Atlas of Traumatic Injuries to the Teeth. pp 542-576. Oxford: Blackwell Munksgaard, 2007.

  8. Royal College of Surgeons. Management of Unerupted Maxillary Central Incisors. Available at https://www.rcseng.ac.uk/-/media/files/rcs/fds/publications/incisor-guideline-2016.pdf (accessed March 2023).

  9. Brook A H, Winter G B. Double teeth. A retrospective study of 'geminated' and 'fused' teeth in children. Br Dent J 1970; 129: 123-130.

  10. Le Gall M, Philip C, Aboudharam G. Orthodontic treatment of bilateral geminated maxillary permanent incisors. Am J Orthod Dentofacial Orthop 2011; 139: 698-703.

  11. Walker L, Enciso R, Mah J. Three-dimensional localization of maxillary canines with cone-beam computed tomography. Am J Orthod Dentofacial Orthop 2005; 128: 418-423.

  12. Seddon R P, Johnstone S C, Smith P B. Mesiodentes in twins: a case report and a review of the literature. Int J Paediatr Dent 1997; 7: 177-184.

  13. Endo T, Ozoe R, Kubota M, Akiyama M, Shimooka S. A survey of hypodontia in Japanese orthodontic patients. Am J Orthod Dentofacial Orthop 2006; 129: 29-35.

  14. Fouad A F, Abbott P V, Tsilingaridis G et al. International Association of Dental Traumatology guidelines for the management of traumatic dental injuries: 2. Avulsion of permanent teeth. Dent Traumatol 2020; 36: 331-342.

  15. Laing E, Ashley P, Naini F B, Gill D S. Space maintenance. Int J Paediatr Dent 2009; 19: 155-162.

  16. Khare V, Nayak P A, Khandelwal V, Nayak U A. Fixed functional space maintainer: novel aesthetic approach for missing maxillary primary anterior teeth. BMJ Case Rep 2013; DOI: 10.1136/bcr-2013-009585.

  17. Goenka P, Sarawgi A, Marwah N, Gumber P, Dutta S. Simple fixed functional space maintainer. Int J Clin Paediatr Dent 2014; 7: 225-228.

  18. Camargo P M, Melnick P R, Camargo L M. Clinical crown lengthening in the esthetic zone. J Calif Dent Assoc 2007; 35: 487-498.

  19. Czochrowska E, Skaare A B, Stenvik A, Zachrisson B U. Outcome of orthodontic space closure with a missing maxillary central incisor. Am J Orthod Dentofacial Orthop 2003; 123: 597-603.

  20. Gautam R, Nene P, Mehta K, Nene S, Hegde A, Jaju E. Treatment strategies for missing maxillary central incisor - an orthodontist's perspective. J Prosthodont 2014; 23: 509-513.

  21. McDowall R J, Yar R, Waring D T. 2 '2' 1: Orthodontic repositioning of lateral incisors into central incisors. Br Dent J 2012; 212: 417-423.

  22. Levin E I. Dental esthetics and the golden proportion. J Prosthet Dent 1978; 40: 244-252.

  23. King P A, Foster L V, Yates R J, Newcombe R G, Garrett M J. Survival characteristics of 771 resin-retained bridges provided at a UK dental teaching hospital. Br Dent J 2015; 218: 423-428.

  24. Czochrowska E, Plakwicz P. Guidelines for autotransplantation of developing premolars to the anterior maxilla. Seminars Orthodont 2020; 26: 61-72.

  25. Czochrowska E, Stenvik A, Bjercke B, Zachrisson B U. Outcome of tooth transplantation: survival and success rates 17-41 years posttreatment. Am J Orthod Dentofacial Orthop 2002; 121: 110-119.

Download references

Acknowledgements

We would like to thank all patients who kindly agreed for their clinical photographs to be included in this article.

Author information

Authors and Affiliations

  1. Orthodontic Department, Eastman Dental Hospital, 47–49 Huntley Street, London, WC1E 6DG, United Kingdom

    Safoora Keshtgar, Elizabeth Crawford, Joseph H. Noar & Zahra Sheriteh

  2. Restorative Department, Eastman Dental Hospital, 47–49 Huntley Street, London, WC1E 6DG, United Kingdom

    Kenneth W. Hemmings

  3. Paediatric Dentistry Department, Eastman Dental Hospital, 47–49 Huntley Street, London, WC1E 6DG, United Kingdom

    Paul Ashley

Authors
  1. Safoora Keshtgar
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Elizabeth Crawford
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kenneth W. Hemmings
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Joseph H. Noar
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Paul Ashley
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Zahra Sheriteh
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Safoora Keshtgar, Elizabeth Crawford, Kenneth W. Hemmings, Joseph H. Noar, Paul Ashley and Zahra Sheriteh made substantial contribution to the design of the work, acquired clinical photographs and drafted and revised the manuscript.

Corresponding author

Correspondence to Safoora Keshtgar.

Ethics declarations

The authors have no conflicts of interest to disclose.

Written consent to publish was obtained from all patients whose photographs/personal data was included in the manuscript.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Keshtgar, S., Crawford, E., Hemmings, K. et al. Multidisciplinary management of missing maxillary central incisors in children and adolescents. Br Dent J 234, 661–667 (2023). https://doi.org/10.1038/s41415-023-5682-3

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41415-023-5682-3

Search

Advanced search

Quick links