Options for replacing missing teeth during orthodontic treatment

Anterior teeth play a vital role in aesthetics, function and psychosocial wellbeing of patients.^{1, 2} Spacing in the upper labial segment has been shown to have a high impact on the quality of life of patients.³ A missing anterior tooth has been considered to be the most unattractive occlusal trait in at least one study⁴ and associated speech difficulties have also been reported in the literature.^{5, 6} Absent incisors can affect self-esteem, as well as social interaction, and it is important as orthodontists to be aware of the impact of such features of malocclusion. A recent systematic review and meta analysis of the prevalence of hypodontia reported the prevalence of missing upper central and lateral incisors to be 24.3% and 1%, respectively.⁷ The prevalence of missing lower incisors was reported as 6.1% and 4.3% for central and lateral incisors. Upper and lower canines were missing in 2.5% and 1.3% of subjects. Concern about missing units during orthodontic treatment is common and often patients presenting with missing teeth in the aesthetic zone have the added concern about how aesthetics will be affected over the duration of treatment. In cases where treatment is planned to open space for the missing tooth or teeth, a small space becomes larger and, if left throughout treatment, can present a real concern to the patient.