International Journal of Esthetic Dentistry (EN), Supplement/2020

In patients with missing maxillary anterior teeth, orthodontic space closure is an evidence-based, effective treatment option: probably the best if the goal is long-term periodontal health. Nowadays, this approach is possible in all malocclusions as the first step of an interdisciplinary approach, which aims not only at an optimum esthetic and functional result, but moreover at reducing the -invasiveness of the subsequent restorative treatment. Space closure should be considered the first alternative in growing patients and when the gingival margins are visible. This essay presents the rationale for space closure and provides clinical tips for interdisciplinary treatment planning and finishing. Keywords: orthodontics, space closure, missing incisors, missing laterals

Bilateral or unilateral congenitally missing maxillary lateral incisors is a common clinical situation that requires an interdisciplinary approach. It is often complicated by the presence of narrower teeth. Occlusal, periodontal, and esthetic considerations will influence the decision to close the space for a canine-lateral substitution or to open the space for a prosthodontic replacement of the missing lateral incisor. The team should define the proper dental position to provide a stable occlusion and dental esthetics obtained with a minimally invasive preparation. The restorative approach should provide a long-term functional and esthetic solution in the transitional period from adolescence to adulthood, reversible for future possible interventions. Keywords: dental position vs dental form, space closure vs space opening, hypodontia with smaller teeth, implant or one-wing fixed dental prosthesis (FDP)

New digital technologies have significantly improved patient treatment modalities, especially in interdisciplinary cases. Tooth morphology can be modified at different stages of orthodontic treatment. Defining and achieving the final tooth form at the beginning or during the treatment can help the orthodontist to move teeth into the correct position quickly and more easily. The reshaping of anterior teeth can be obtained using digital technologies and CAD/CAM procedures. Composite resins are preferred to ceramics because they can be modified and adjusted whenever necessary. The parameters to assess the timing of restorative intervention are related to the age of the patient, degree of tooth eruption, and space availability in the interproximal area, especially if an additive approach is indicated to enlarge teeth. Keywords: reshaping, anterior teeth, composites, adhesive techniques, multidisciplinary treatment, digital technologies

An unfavorable relationship between the form and dimension of the dental arch and the number, dimension, and shape of the existing teeth can pose several esthetic, biologic, and functional problems. In this article, the various restorative options are discussed based on clinical and scientific evidence: Gap closure and substitution of missing teeth: restorative transformation of substituted teeth into homologous teeth with odontoplasty, direct composite, etched pieces or porcelain veneers. Gap opening and tooth replacement with all-ceramic adhesive bridges, including pontic site development. Gap distribution and restorative compensation with direct composite restorations, etched pieces or porcelain veneers. Gap shifting and restorative compensation with all-ceramic adhesive bridges, composite, etched pieces or veneers. Gap compensation by reconstructive compensation without orthodontics. The reconstructive tools including composite restorations, ceramic veneers, and adhesive bridges are discussed, and numerous cases are presented to illustrate the concepts. Keywords: adhesive restorative options, restorative space management, substitution of missing teeth, direct composite restorations, ceramic veneers, adhesive bridges

It is common knowledge that dental implants should not be inserted in adolescents, before completion of skeletal growth, because they behave as ankylosed teeth and remain in a fixed position while the surrounding bone and teeth are still developing, with consequential worsening esthetic damage. However, there is growing evidence that this phenomenon may continue throughout life in a large number of adult patients, although with a great variability in onset, progression, and extent. Infraocclusion and interproximal contact loss are the more common complications, and the majority of clinically significant cases are located in the anterior maxilla. The esthetic impact is mostly minimal, but in some cases the patient's smile may be severely compromised. Therefore, adult patients need to be informed when dental implants are considered to replace anterior missing teeth. Keywords: adult alveolar growth, dental implants, infraocclusion