American Journal of Orthodontics and Dentofacial Orthopedics
Clinician’s cornerCongenitally missing mandibular second premolars: Clinical options
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
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2020, American Journal of Orthodontics and Dentofacial OrthopedicsCitation 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.
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2019, American Journal of Orthodontics and Dentofacial OrthopedicsCitation 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.