What happens when a child loses a permanent central incisor on the maxilla?
What happens when a 9-year-old loses a permanent central incisor in the upper jaw, which is perhaps the most decisive, and necessary tooth to ensure a beautiful smile? Is it possible to move the lateral incisor to the position of the central incisor, and reconstitute it to look like the missing tooth? And that, without any braces, just with the use of Invisalign transparent membranes, within 27 weeks (6 months) and with just 27 transparent removable membranes?
Any changes in the permanent central incisor at the maxilla (upper jaw) require preparation on various aspects.
- Psychologically: Ensuring good enough aesthetics, in the tender age of childhood, where a smile is an essential element of everyday life – in just 6 months. Prevention of bullying due to a missing tooth or due to bearing an orthodontic appliance (old-fashioned mobile braces or tooth restraints), permanently in the mouth.
- Medically: Ensuring the presence of a tooth in the central area, which is absolutely NECESSARY for the retention of the bone in that area. Whenever a tooth is lost, the bone recedes. In a 9-year-old child, this would mean that when it would be time to have a prosthetic restoration of the missing tooth, i.e., at the age of 18 or 19, the lack of bone would render grafting necessary prior to place the implant, with whatever this entails for its aesthetic prognosis for later life.
- Aesthetically: In the upper front aesthetic zone, is crucial for the smile, it is much better to have our “own” natural teeth, even with aesthetic reconstruction made of resin or porcelain, as compared to implants, that may cause significant problems in dealing with possible problems with the gums.
- Prognosis: With such an intervention, the patient keeps all possibilities open for the future. At the age of 16, the gap may be re-opened at the same spot where it already existed (and the bone would be ready to receive an implant), the gap may be opened further back, away from the front aesthetic zone (where there is no issue for possible aesthetic impact of an implant), or it can be completely closed without the need to replace a missing tooth. Decisive parameters affecting the course taken after the eruption of all permanent teeth would be the existing occlusion, periodontal condition, and all the other parameters that play a role in the preparation of any orthodontic treatment plan.
PS.1: I would like to thank the dentist Dimitris Tsanis, for the excellent reconstruction of the lateral incisor, following the orthodontic intervention.
PS.2: The orthodontic intervention solely concerned the movement of the lateral incisor to the position of the central incisor. All other issues will be addressed at a second phase, after the full eruption of all permanent teeth.
PS.3: Dealing with such cases in this way is not a new method or protocol. Distinguished Professors Dr. Bjorn Zachrisson and Dr. Marco Rosa have been dealing with this type of cases in this manner since the 90s (having hundreds of publications and seminars on the subject), taking into consideration that an implant placed at the age of 19 is certain to create aesthetic issues after a few years.
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