The absence of upper incisors is a serious problem and often needs a challenging treatment. The treatment alternatives of missing upper incisors include orthodontic space closure, resin-bonded bridgework, osseointegrated implants, removable partial dentures, and autotransplantation of developing premolars. Although each of these methods is a viable treatment option, implant insertion and space closure are more popular among clinicians.
Implant substitution is considered an optimal solution considering the possibility of obtaining an ideal occlusion and the indisputable advantage of avoiding any damage to the adjacent teeth. Orthodontic space closure, by mesial movement of the adjacent teeth, also provides satisfactory aesthetic and functional long-term results. One of the major advantages of space closure is that treatment is finished immediately after orthodontics and, in the case of adolescents, there is no necessity of waiting years until the ‘end of growth’ to replace the missing tooth. Moreover, the result is natural and all the changes in the long term will also be natural, unlike what could happen in the presence of a foreign body.
Following images show a patient with a missing upper lateral incisor before treatment and 5 years after implant insertion: