09 May 2021

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Unilateral mesialization after trauma related upper central incisor loss: a case report

Authors: BRUNO Giovanni, DE STEFANI Alberto, DI FIORE Adolfo, GIACCAGLIA Francesca, MAZZOLENI Sergio, STELLINI Edoardo, GRACCO Antonio

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Traumatic Dental Injuries represent a major public health problem, potentially affecting growth, function and aesthetics of the entire orofacial district and impacting oral-health-related quality of life, with relevant social and psychological aspects.

It is estimated that the 80% of all Traumatic Dental Injuries occurs in children and adolescences within 20 years of age, patients in which implant-positioning is not recommended, if not contraindicated. Many therapeutic alternatives for these group of patients have been described in literature, going from removable prosthetic appliances to Maryland-bridges and other fixed prosthetic appliances supported by orthodontic miniscrews. All these solutions appear to be temporary, requiring a second treatment once the patient’s growth has ended.

The aim of this report is to describe the combined orthodontic and prosthetic treatment of a Traumatic Dental Injury-related upper incisor loss in a young patient.

An 11-year-old boy presented with the loss of the permanent upper left central incisor, complaining chiefly of his unpleasant smile aesthetic. The complete documentation of the case was collected, including intra and extraoral photos, dental impressions and a CBCT scan. No agenesis was found, based on a panoramic radiography. Cephalometric analysis showed a normo to hypodivergent path of growth, with skeletal first class and average overjet and overbite.

He was proposed the mesialization of the entire upper left hemiarch and the prosthetic enhancement of all teeth of the second sextant.

The orthodontic treatment lasted four and a half years and did not require skeletal anchorage. Intermaxillary elastics were the main anchoring system, used asymmetrically to obtain and then finalize the patient’s occlusion. At the end of the orthodontic treatment the patient underwent the prosthetic treatment: since he could not afford the enhancement of all upper frontal elements, only the camouflage of element 2.2 in element 2.1 was made, using a ceramic dental veneer.

The final occlusion was asymmetric, with molar and canine first class on the right side and molar and canine class two on the left side. Overjet and overbite were maintained within average values. A mild midline deviation was present, but within clinical acceptability limits. Considered the patient’s hypodivergent growth path, slightly altered gingival margins and emergence profiles were not seen as representing a problem. The patient and his parents were both satisfied with the treatment outcome.

Orthodontic space closure can be a valid and definitive therapeutic alternative in a young patient, not yet suitable for fixed prosthetic appliances, in case of loss of one or two teeth, especially in the upper anterior sextant. A good collaboration between orthodontists and prosthodontists is needed for the success of this therapy.