Treatment options for the replacement of a missing central incisor in the aesthetic zone

Zain Rizvi lists the options along with the advantages and disadvantages for a missing central incisor.

Central incisors can be missing for a variety of reasons. They can be lost due to disease or trauma, as well as being congenitally absent. Whilst it is rare to have congenital absence of the maxillary central incisor, the affected patient may present with retained deciduous teeth. Or a midline shift due to drifting of the contralateral central into the available space. A multidisciplinary approach is required in these scenarios. This is to redistribute space for a suitable fixed prosthesis (Krishnappa et al, 2014). A similar demand for space redistribution also can arise in cases where the tooth has been lost due to disease or trauma.

The possibilities around replacing a missing central incisor revolve around prosthetic rehabilitation. There are fixed and removable options available to the patient, which are accompanied by their respective advantages and disadvantages. Examples include: removable partial dentures, resin bonded bridges, fixed conventional bridges, fibre-reinforced composite resin bridges and implants. There is always an option to not perform any treatment and leave the space. However this is unlikely to be a popular choice in this scenario due to the aesthetic considerations. Ultimately the best treatment option for the patient is the one that addresses the patient’s individual needs and meets their expectations. These needs and expectations should be identified at the initial consultation with the patient.

Aesthetic needs and considerations

Garber et al defined the aesthetic zone as being ‘composed of the the size, shape, position and colour of the displayed teeth, the gingival contour, the buccal corridor, and the framing of the lips’. The range varies from person to person. It is defined by the movements of the upper and lower…