In orthodontic therapy, spaces are often created by molar distalization, incisor proclination, interdental stripping, extraction, and, finally, arch enlargement. All possibilities were thoroughly considered in this situation before settling on the best way to open the area for the lost teeth. Molar distalization needed headgear, which the patient did not want, and incisor proclination was not a possibility because the patient already had proclined upper incisors. Interdental stripping is often suggested when there is a Bolton disparity, which was not the case here.

Removal of upper bicuspids and creating the space for the lost central was a viable alternative, but the person in question, who already had an empty tooth, failed to enjoy it. This gave us the option of enlarging the higher arch. Expansion is known to increase space, with 0.5-0.7 mm obtained for every single mm of posterior arch expansion. This was the best solution in this situation for a variety of reasons.

Expansion is stable in mixed dentition and prevents crossbite development from mandibular advancement and correction. The Twin Block appliance facilitates this process. The mandible grew favorably (forward) and corrected the sagittal (Class II skeletal) problem (as evidenced by overall superimposition) [Figure 10], so no space was needed in the upper arch for repairing the increased overjet, implying that all space created by the expansion was used to compensate for the missing central. Whereas the contralateral central incisor was 9 mm, the empty area produced for the lost incisor was 8.5 mm, resulting in a 0.5 mm gap between the incisors that may be corrected for by removing the existing center 0.25 mm. The choice to strip the teeth was left up to the esthetics dentist.

Summary

Orthodontic Therapy Solution for Lost Teeth

• Consideration of various orthodontic therapy methods including molar distalization, incisor proclination, interdental stripping, extraction, and arch enlargement.
• Molar distalization required headgear, a procedure not feasible due to existing proclined upper incisors.
• Interdental stripping was suggested due to a Bolton disparity, but not in this case.
• Removal of upper bicuspids and space creation for lost central was considered, but the patient didn't enjoy it.
• Expansion of the higher arch was chosen due to its ability to increase space and prevent crossbite development.
• The Twin Block appliance facilitated this process.
• The mandible grew forward, correcting the sagittal problem, resulting in no space needed in the upper arch for repairing the increased overjet.
• The choice to strip teeth was left to the esthetics dentist.