8 that was similar in size, shape, and color to the contralateral tooth.Īn esthetic evaluation of the patient was performed, and diagnostic data was collected. The treatment objective was to provide an esthetic replacement for the missing tooth No. 8, the coronal portion of which was attached by a bracket and orthodontic wire to maintain proper spacing and for esthetic purposes ( Figure 1 and Figure 2). 8, orthognathic surgery, orthodontic treatment, and extraction of tooth No. Her dental history included previous endodontic treatment on tooth No. This article presents two case reports that demonstrate innovative, minimally invasive treatment for replacement of a missing maxillary anterior tooth.Ī 17-year-old female patient presented to the Advanced Program for International Dentists in Esthetic Dentistry at New Yok University with the desire to improve her smile by replacing the missing maxillary right central incisor. 12 Traditionally, two wings were used for resin-bonded anterior bridges, but it was found that the facial-lingual movement of teeth created a shearing action and stress in the adhesive layer, which eventually may lead to one of the wings debonding 13-17 Zirconia has taken on an increasingly valuable role in restorative dentistry due to its excellent mechanical 9-11 and biocompatible characteristics. However, recent improvements and innovations in adhesive techniques and ceramic materials have made the choice of an all-ceramic bonded dental prosthesis a viable and desirable option. Autotransplantation is an option, as is a removable prosthesis. Proper tooth size and proportion may be difficult to achieve. 6 Orthodontic treatment to close spaces may involve complicated multidisciplinary treatment and may be limited to specific clinical circumstances. 5Ĭonventional crown preparation on a young patient is not recommended due to the size of the pulp chamber and the amount of tooth structure requiring removal to achieve an esthetic result. 3,4 The use of a resin-bonded fixed prosthesis in the anterior region created by electrolytic etching of the metal wing may be problematic, as the teeth often appear grayish from the metal on the lingual aspect. Implants may even disturb the normal development of the jaws. The placement of implants in a growing child may be contraindicated, because the implant acts like it is ankylosed and does not follow the continuous eruption of natural teeth. 1,2 The cause of the missing or lost tooth may be either congenital, trauma, or decay. Alternatively, the space may be closed by orthodontics. Options include a single-tooth implant, fiber-reinforced composite bridge, metal-ceramic (fixed dental prosthesis or resin bonded) or ceramic (fixed dental prosthesis or resin bonded) restoration, or a removable partial denture. Several treatment options exist, each having specific advantages and limitations. The replacement of single missing anterior teeth presents the clinician with challenges. In demonstrating minimally invasive treatment to replace a missing maxillary anterior tooth, this article shows how the use of a graded zirconia wing allows bonding with conventional techniques. The second case report describes an adult male patient who had had a deciduous canine extracted and wanted a replacement for missing No. Treatment options, thus, included a provisional removable appliance (flipper), an Essix appliance, or a resin-bonded one-wing zirconia bridge with only slight modification to the left central incisor. The patient was told she could not have an implant placed until she was 25 years old. 8, which needed to be extracted prior to a LeFort osteotomy because retention of the tooth may have compromised the healing. The patient had internal resorption of tooth No. In the first of two case reports presented, the treatment of a 17-year-old female patient with a missing right central incisor is described. Advances in materials and adhesion technologies have enabled innovative, minimally invasive treatment for replacement of missing maxillary anterior teeth.

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