Clinician’s corner
Congenitally missing mandibular second premolars: Clinical options

https://doi.org/10.1016/j.ajodo.2006.05.025Get rights and content

Introduction: Congenital absence of mandibular second premolars affects many orthodontic patients. The orthodontist must make the proper decision at the appropriate time regarding management of the edentulous space. These spaces can be closed or left open. Implications: If the space will be left open for an eventual restoration, the keys during orthodontic treatment are to create the correct amount of space and to leave the alveolar ridge in an ideal condition for a future restoration. If the space will be closed, the clinician must avoid any detrimental alterations to the occlusion and the facial profile. Significance: Some early decisions that the orthodontist makes for a patient whose mandibular second premolars are congenitally missing will affect his or her dental health for a lifetime. Therefore, the correct decision must be made at the appropriate time. Purpose: In this article, we present and discuss various treatment alternatives for managing orthodontic patients with at least 1 congenitally missing mandibular second premolar.

Section snippets

Patient 1

A girl, age 12 years 4 months, was congenitally missing the mandibular right second premolar. The deciduous right second molar was present but submerged below the occlusal levels of the adjacent teeth (Fig 1, A). The radiograph of the deciduous tooth showed that the bone levels between the deciduous molar and the adjacent permanent teeth were flat (Fig 1, B). This indicated that the deciduous tooth was not ankylosed and had erupted evenly with the adjacent teeth. The mesiodistal width of the

Patient 2

A girl, age 8 years 3 months, had bilateral submerged mandibular second molars (Fig 2, A). The radiograph (Fig 2, B) showed that the bone levels between the right deciduous second molar and the adjacent permanent first molar were angled or oblique, indicating that the permanent tooth had continued to erupt. All remaining deciduous teeth were extracted, no space-maintaining appliances were placed, and the remaining permanent teeth were allowed to erupt (Fig 2, C). Even though a significant

Patient 3

This woman was missing her right mandibular second premolar and first molar. The mandibular second molar was in an Angle Class II relationship with the maxillary first molar (Fig 3, A), and the edentulous space between the second molar and the first premolar (Fig 3, B) was too large for 1 tooth and too small for 2 teeth. After initial orthodontic alignment (Fig 3, C), a diagnostic wax-up was constructed to determine the precise position for a second premolar implant (Fig 3, D). After

Patient 4

This girl, age 13 years 8 months, had an Angle Class II malocclusion, with a 5-mm anterior overjet (Fig 4, A). She had a minor arch-length deficiency in both arches but was congenitally missing the right maxillary, and right and left permanent mandibular second premolars (Fig 4, B). Her maxilla and mandible were well related (Fig 4, C), and the maxillary and mandibular incisors were in a relatively normal anteroposterior position. Extraction of the left maxillary second premolar and remaining

Patient 5

This girl, age 14 years 6 months, was congenitally missing her left mandibular second premolar (Fig 5, A), and the deciduous second molar was ankylosed and submerged. The left maxillary second premolar was present but delayed in its eruption. After the deciduous second molar was extracted, substantial bone resorption with significant vertical and buccolingual narrowing of the alveolar ridge occurred (Fig 5, B). This ridge defect would probably have narrowed even further and required a bone

Discussion

Congenital absence of mandibular second premolars affects many orthodontic patients. The clinician must make the proper decision at the appropriate time regarding management of the edentulous space.1 If the space will be left open for an eventual restoration, the correct amount of space must be created and the alveolar ridge must be left in an ideal condition for a future restoration. In the past, either conventional bridges or resin-bonded bridges were used to fill edentulous spaces. However,

Summary

We described and illustrated several methods of managing patients with congenitally missing mandibular second premolars. In the past, orthodontists primarily made the treatment decisions for these patients. However, with newer solutions for restoring edentulous spaces, surgeons and restorative dentists can play significant roles in helping to manage these orthodontic patients. Although the orthodontist sees the patient at a young age, some decisions made at that time will affect him or her for

References (22)

  • M. Zalkind et al.

    Resin-bonded fixed partial denture retention: a retrospective 13-year follow-up

    J Oral Rehabil

    (2003)
  • Cited by (91)

    • Dental and Craniomaxillofacial Implant Surgery

      2023, Journal of Oral and Maxillofacial Surgery
    • Autotransplanted premolars with incomplete root formation in a growing patient with multiple missing teeth

      2020, American Journal of Orthodontics and Dentofacial Orthopedics
      Citation Excerpt :

      Space maintainers such as a removable plate with pontics or temporary resin-bonded bridges could be considered if the deciduous teeth fall out before the patient has completed his growth. It is not easy to retain such space for a long time, but it is even more difficult to maintain the volume of the edentulous ridge.13 Without the eruption of the permanent teeth, the osseous ridge does not fully develop.

    • The congenitally missing second premolar: Space closure. A viable option

      2020, American Journal of Orthodontics and Dentofacial Orthopedics
    • Treatment of a Class II Division 1 malocclusion with the combination of a myofunctional trainer and fixed appliances

      2019, American Journal of Orthodontics and Dentofacial Orthopedics
      Citation Excerpt :

      We did not choose this option because the deciduous second molars had intact crowns and long roots. Perform hemisection of the deciduous second molar and remove its distal half,30 or reduce the mesial and distal surfaces to the size of a second premolar,31 then close the space followed by placement of implants until the end of growth. Northway32 reported that patients who underwent hemisection showed less retraction of the incisors and less change of facial profile.

    View all citing articles on Scopus
    View full text