29 April 2021

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AGENESIS OF LATERAL INCISORS: review of the literature and Maryland Bridge evolution

Authors: Andrea Savi, Aldo Crescini, Oliviero Turillazzi, Maddalena Manfredi

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The agenesis of the anterior sectors represents a therapeutic problem that necessarily involves more dental specialists. The agenesis of the superior lateral incisors are the most frequent and they mainly affect the female sex, with often the involvement of both the lateral incisors. This condition must be early assessed, during childhood or early adolescence, to plan a multidisciplinary approach. The main choice that the clinicians must evaluate in the treatment of this condition is based on the decision whether to open or close the spaces, with particular attention to the management of young patients in order to assure a conservative approach. At the moment, from the review of the scientific literature, there is still non evidence that one treatment is better that the other and both the solutions represents, in any case, a compromise. The therapeutic possibilities have evolved over time through the use of innovative materials that now allow a conservative treatment, in comparison to the past. The final goal of therapy is to provide an aesthetic solution that can be considered not temporary or at short-term, but with an expectation of much longer duration, which fully respects the dental tissues and with completely reversible characteristics that do not preclude any future therapeutic possibility.

MATERIAL AND METHODS: In this review the different therapeutic approaches for the agenesis of the anterior sectors are discussed and a multidisciplinary protocol, that the authors have been following for over 20 years, is reported, with particular regard to the adhesive ceramic materials. In particular, the use of the maryland bridge technique is here described, which was classically considered as a temporary solution to procrastinate a more definitive prosthetic restoration at patient’s older age. Thanks to the introduction of metal free materials  (fiberglass, lithium disilicate and zirconia), this technique has been modified and it could be now part of a multidisciplinary ortho-prosthetic protocol which allows to create adhesive restorations without any dental preparations. The treatment plan must be early coordinated within a multidisciplinary team.

RESULTS AND CONCLUSIONS: The treatment of the agenesis of the superior lateral incisors performed by the opening of the spaces may be resolved thanks to maryland bridges and free metal materials, that have different characteristics and that allow, through an early and careful treatment plan, to obtain a complete conservative and durable aesthetic result. This type of prosthetic restoration, carried out at the end of the orthodontic therapy, can be successfully maintained in the following years. Therefore, this therapy can represent, especially in very young patients, an immediate and long-lasting solution, which offers aesthetic and function without causing any biological damage to the tissues and not precluding any subsequent therapeutic possibility. 

CLINICAL SIGNIFICANCE: A multidisciplinary approach to the agenesis of the superior lateral incisors with the opening of the spaces allows a totally conservative functional and aesthetic rehabilitation with the conditions for a long-term follow-up.