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ABSTRACT Introduction: There are different possibilities of orthodontic planning for cases with congenital absence of maxillary lateral incisors. This subject divides the opinion of orthodontists and oral rehabilitation clinicians, due to the advantages and disadvantages of each treatment option, which may involve opening spaces for future implants and/or prosthetic restorations, or closing the spaces by positioning the maxillary canines in the place of lateral incisors. The correct diagnosis and careful evaluation of each patient allow to determine the best therapeutic approach. This paper discusses the main topics to be considered when planning these cases. Objectives: To evaluate the main aspects related to orthodontic treatment planning in cases of congenital absence of maxillary lateral incisors, to aid the decision-making, with clinical and scientific basis.
RESUMO Introdução: Existem diferentes possibilidades de planejamento ortodôntico para os casos que apresentam ausência congênita de incisivos laterais superiores. Esse é um assunto que divide a opinião de ortodontistas e reabilitadores orais, devido às vantagens e desvantagens de cada uma das opções de tratamento, as quais podem envolver a abertura de espaços para futuros implantes e/ou restaurações protéticas ou o fechamento dos espaços, com posicionamento dos caninos superiores no lugar dos incisivos laterais. O correto diagnóstico e uma criteriosa avaliação de cada paciente permitem determinar a melhor abordagem terapêutica. Nesse artigo, serão discutidos os principais tópicos a serem considerados no planejamento desses casos. Objetivos: Avaliar os principais aspectos relacionados ao planejamento do tratamento ortodôntico nos casos de ausência congênita de incisivos laterais superiores, de maneira a auxiliar nas tomadas de decisão, com embasamento clínico e científico.
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RESUMEN: La agenesia de incisivos laterales superiores corresponde a un desafío clínico, en cuanto a planificación de tratamiento, así como también para la obtención de resultados estéticos y funcionales adecuados. Con el fin de conseguirlo, el clínico debería informarse sobre las diferentes opciones terapéuticas disponibles en la actualidad, considerando que la indicación depende de cada caso clínico individual, es decir, del paciente en su contexto integral sumado a su condición intra-oral. Además, es importante evaluar los resultados a largo plazo de las diferentes alternativas, para lograr la resolución clínica más adecuada y estable en el tiempo. El éxito en estos pacientes, requiere de un enfoque multidisciplinario, considerando especialistas en ortodoncia, rehabilitación oral, periodoncia y cirugía oral de ser necesario. El objetivo de esta revisión es describir y comparar las alternativas terapéuticas para la agenesia de incisivos laterales maxilares.
ABSTRACT: The agenesis of upper lateral incisors represents a clinical challenge regarding treatment planning and appropriate aesthetic and functional results. In order to obtain the best results, the clinician should be informed about the different therapeutic options currently available, considering that the indication depends on each individual clinical case, that is, on the patient in his/her comprehensive context in addition to his/her oral condition. It is also important to evaluate long term results from each treatment available, in order to achieve the better outcome and most importantly, a stable clinical resolution over time. The treatment success in this kind of patients requires a multidisciplinary approach, including specialists in orthodontics, oral rehabilitation, periodontics, and oral surgery if necessary. The objective of this review is to describe and compare the therapeutic alternatives for maxillary lateral incisor agenesis.
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Humanos , Ortodontia , Implantes Dentários , Incisivo/anormalidades , Anodontia/terapia , Estética Dentária , MaxilaRESUMO
Maxillary lateral incisor agenesis (MLIA) is a condition that affects both dental esthetics and function in young patients, and represents an important challenge for clinicians. Although several treatment options are available, the mesial repositioning of the canines followed by teeth recontouring into lateral incisors; or space opening/maintenance followed by implant placement have recently emerged as two important treatment approaches. In this article, the current and latest literature has been reviewed in order to summarize the functional and esthetic outcomes obtained with these two forms of treatment of MLIA patients in recent years. Indications, clinical limitations and the most important parameters to achieve the best possible results with each treatment modality are also discussed. Within the limitations of this review, it is not possible to assert at this point in time that one treatment approach is more advantageous than the other. Long-term followup studies comparing the existing treatment options are still lacking in the literature, and they are necessary to shed some light on the issue. It is possible, however, to state that adequate multidisciplinary diagnosis and planning are imperative to define the treatment option that will provide the best individual results for patients with MLIA.
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Pacientes com agenesia de incisivos laterais superiores necessitam de um tratamento adequado para o sucesso estético e funcional do sistema estomatognático. Vários estudos têm sido realizados em busca de uma solução para esses pacientes nas áreas da Ortodontia, Dentística e Implantodontia. O objetivo deste trabalho foi demonstrar, através de um caso clínico, a solução protética encontrada para o caso de um paciente com agenesia de incisivos laterais superiores. Após correção ortodôntica dos dentes e abertura para inserção dos implantes, implantes osseointegráveis foram fixados na maxila na região dos dentes 12 e 22; posteriormente, o tratamento estético com próteses livres de metal e resinas anteriores nos elementos 11 e 21 foi executado para alinhar a simetria do sorriso da paciente, provendo um resultado satisfatório
Patients with agenesis of upper lateral incisors need a proper treatment for the aesthetic and functional success of the stomatognathic system. Several studies have been made to find a solution for these patients including orthodontic, implantodontic, and prosthetic proposals. The objective of this paper is to demonstrate through a case study, the prosthetic solution found for the case of a patient with agenesis of maxillary lateral incisors. After orthodontic correction and space making for implant placement, dental implants were positioned at 12 and 22 regions, followed by metal-free prostheses and resin composite restorations at 11 and 21 to align smile simmetry providing a satisfactory result.
Assuntos
Humanos , Feminino , Adulto , Anodontia , Implantação Dentária , Prótese DentáriaRESUMO
La hiperdoncia es una anomalía dentaria de causa desconocida, caracterizada por el aumento del número de dientes. Ocurre con mayor frecuencia en la maxila, de preferencia en el sexo masculino, siendo más común en la dentición permanente. La presencia de dientes supernumerarios puede ser responsable por alteraciones en la dentición permanente, como por ejemplo, el atraso en la erupción y dislocamientos. Además, el paciente puede presentar oclusión anormal, reabsorción de dientes adyacentes y formación de quistes. El presente artículo describe en un paciente de sexo masculino, de 9 años de edad, la presencia de dos incisivos laterales superiores derechos y un incisivo lateral superior izquierdo, permanentes, parcialmente erupcionados. El examen radiológico reveló un segundo incisivo lateral superior izquierdo, no erupcionado. Se debe resaltar que tanto en la zona de la pieza 1.2 como en la 2.2, los dientes presentaron anatomía normal y no el aspecto conoide comúnmente observado en los dientes supernumerarios. En nuestro caso, con el propósito de efectuar tratamiento de ortodoncia, fue indicado extracción quirúrgica de los dientes mencionados.
The hyperdontia teeth is an anomaly of unknown cause, characterized by increased numbers of teeth. It occurs more frequently in the maxilla, preferably in males, and is more common in permanent dentition. The presence of supernumerary teeth can be responsible for alterations in the permanent dentition, such as the delay in the eruption and dislocations. In addition, the patient may have abnormal occlusion, resorption of adjacent teeth and cyst formation. This article describes in a male patient, 9 years old, the presence of two upper right lateral incisor and one upper left lateral incisor, permanent, partially erupted. Radiological examination revealed a second left upper lateral incisor, unerupted. It should be noted that both, in the region of the 1.2 as in 2.2, the teeth showed normal anatomy and not the conoid appearance commonly observed in supernumerary teeth. In our case, in order to perform orthodontic treatment surgical removal of the teeth noted above was indicated.