Joshi et al. IEJDTR, 2016; 5(2):346-349 346 ISSN: 2454-311X MANAGEMENT OF CONGENITAL MISSING MAXILLARY LATERAL INCISOR BY ORTHODONTIC TREATMENT FOLLOWED BY PROSTHETIC IMPLANT HARSHIL JOSHI 1 , SANTOSH KUMAR GOJE 1 , VISHAL PARMAR 2 , BHAVNIT VAGHANI 1 1 Dept. of Orthodontics and Dentofacial Orthopaedics, 2 Dept. of Prosthodontics and Crown & Bridge, K.M. Shah Dental College & Hospital, Sumandeep Vidyapeeth University, Piparia, Waghodia, Vadodara (Gujarat) India. Corresponding Author :- Dr. Harshil Joshi, Dept. of Orthodontics and dentofacial orthopaedics, K.M. Shah Dental College & Hospital, Sumandeep Vidyapeeth University, Piparia, Waghodia, Vadodara (Gujarat) India. E-Mail:- drharshiljoshi11@gmail.com (M):- +919429896300 ABSTRACT Malformed or absence of anterior teeth always compromises the aesthetic smile. The maxillary lateral incisor is the second most common congenitally absent tooth. There are several treatment options for replacing the missing maxillary lateral incisor, including canine substitution, tooth-supported restoration, or single-tooth implant. Dental implants are an appropriate treatment option for replacing missing maxillary lateral incisor teeth in adolescents when their dental and skeletal development is complete. This case report presents the treatment of a patient with congenitally missing maxillary lateral incisor with contra lateral peg shaped lateral incisor using dental implants. The paper discusses the aspects of pre-prosthetic orthodontic diagnosis and the treatment that needs to be considered with conservative and fixed prosthetic replacement. KEYWORDS: Congenitally missing teeth, orthodontic space opening, pre-prosthetic orthodontics, dental implant. INRODUCTION An aesthetic smile can be deeply compromised by malformed or absence of anterior teeth, which subsequently can affect the appearance, temperament, personality and psychological well being of an individual. Hypodontia, the congenital missing teeth, is the most typical dental developmental problem in humans. The lateral incisor, with the prevalence of 1 to 3% stood 1 st among all maxillary anterior teeth. In contrast to male, females are 1.37 times more affected than males. 1 Missing lateral incisor has been correlated with their anatomical position in the fusion area of facial processes. Congenitally missing teeth is a result of disruption during the early stages of development and is proposed as a mild dysplastic expression of the ectoderm. When a deciduous tooth is congenitally absent, its permanent counterpart might also be missing. Genetics plays a pivotal role in congenital dental aphasia, as confirmed by various studies 2,3 on monozygotic twins. This multi-factorial etiology can comprise environmental factors as well, since the mixture of environmental and genetic factors might devote to the incidence of dental agenesis. Several studies 2,3 have shown that MSX1 and PAX9 genes perform a role in early teeth development. PAX 9 is a paired domain transcription factor that perform a critical role in odontogenesis. 2 Congenitally missing teeth can be associated with other conditions such as reductions in coronal or radical dimensions of teeth, delayed eruption of other teeth, retained primary teeth, ectopic canine eruption and abnormal dental morphologies such as taurodontism and peg-shaped lateral incisors. Some authors reported that Congenitally missing teeth are correlated with dental anomalies such as decreased size of the incisors and canines as well as conical or tapered teeth such as peg lateral. 2,3,4 One of the most challenging problems in dentistry is the treatment option for replacement of one or more maxillary lateral incisors that have been lost as a result of traumatic injuries or congenitally missing. 5 Age, location, space limitations, alveolar ridge deficiencies, uneven gingival margins, occlusion, and periodontal factors often necessitate an interdisciplinary approach. 6,7 Thus the management of maxillary lateral incisor agenesis needs multiple dental specialties like orthodontics, oral surgery, Periodontics and Prosthodontics. In general, the treatment options include space maintenance or later incisor rehabilitation with prostheses, dental implants, or orthodontic space closure with camouflaging the maxillary canine to resemble the appearance of a lateral incisor. 8,9 The prominence of the canine root eminence is another esthetic consideration of the space closure approach in patients with high smile lines. 1 When space opening is indicated, both orthodontist and prosthodontist perform a key role in determining and establishing space requirements. 10 The restorative approaches can be divided into two categories (single tooth implant, and tooth supported restorations) where dental implants are the most commonly used to rehabilitate congenitally missing maxillary lateral incisors once skeletal maturity has been reached. When dental implants are contra-indicated, there are mainly three available options: removable partial denture, resin bonded