Lateral incisor transposition, prosthetic treatment, and periodontal surgery in a patient with missing maxillary central incisor and severe crowding: an interdisciplinary treatment strategy

ABSTRACTObjective To describe comprehensive orthodontic treatment, including periodontal surgery and prosthetic treatment, to manage severe disharmonious gingival margins.Case A 16-year-old man presented with chief complaints of multiple crooked teeth and a missing maxillary central incisor due to a traffic accident. He was diagnosed with Angle Class I malocclusion with severe anterior crowding and a missing upper right central incisor. We orthodontically treated him with an upper left lateral incisor, lower first premolar extractions, and transposition of the upper right lateral incisor to the central incisor using a pre-adjusted edgewise appliance. After 30 months of active orthodontic treatment, periodontal surgery, involving gingivectomy/gingivoplasty of the upper right lateral incisor, was performed for clinical crown lengthening, and a provisional restoration was fabricated. The final restoration was delivered after gingival healing. A stable occlusion with even gingival margins was obtained after 2 years of retention.Discussion and Summary This case revealed that orthodontic transposition of a lateral incisor to replace a missing central incisor could be a valid treatment option. Additionally, interdisciplinary orthodontic treatment combined with periodontal surgery and prosthetic treatment is effective to resolve severe anterior crowding with a successful esthetic and functional result.KEYWORDS: Missing toothperiodontal surgeryprosthetic treatmentinterdisciplinary orthodontic treatment AcknowledgmentsThe authors wish to thank Dr. Junya Kusumoto and Dr. Keita Yamagata for their scientific revision.Author contributionsYasuhiko Oga contributed to orthodontic treatment, conception, data acquisition, interpretation, and drafted and critically revised the manuscript. Yoshinori Shirakata contributed to periodontal surgery, data acquisition, interpretation, and drafted and critically revised the manuscript. Hiroshi Tomonari contributed to orthodontic treatment, conception, interpretation, and drafted and critically revised the manuscript. Shouichi Miyawaki contributed to conception, data acquisition, interpretation, and drafted and critically revised the manuscript.Disclosure statementNo potential conflict of interest was reported by the author(s).Ethical approvalThe patient consented to publication of the case in writing.Additional informationFundingThis work did not receive any grant.