Management of Maxillary Lateral Incisor Agenesis: A Multidisciplinary Approach in Two Clinical Cases

Introduction

Congenitally missing maxillary lateral incisors represent one of the most frequent dental agenesis after third molars and mandibular second premolars, affecting approximately 1–2% of the population with a female predilection. This anomaly poses functional, esthetic, and periodontal challenges related to space management and the decision between prosthetic replacement and orthodontic space closure. A multidisciplinary approach involving periodontics, orthodontics, and prosthodontics is essential to achieve stable functional and esthetic outcomes.

Observation

Case 1: A 25-year-old female patient presented with unilateral agenesis of tooth 12, adequate mesiodistal space, and a horizontal alveolar ridge deficiency. Treatment included horizontal ridge augmentation using an onlay block bone graft prior to implant placement. A two-stage implant protocol was performed, allowing submerged healing before prosthetic rehabilitation.

Case 2: A 21-year-old female patient was referred after orthodontic treatment for bilateral agenesis of teeth 12 and 22, with properly managed symmetrical space distribution. Two implants were placed at the sites of the missing maxillary lateral incisors using a one-stage surgical protocol with immediate placement of healing abutments, following achievement of adequate primary stability. After uneventful osseointegration, implant-supported ceramic crowns were delivered, providing satisfactory functional and esthetic outcomes.

Discussion

These cases illustrate the variability of clinical presentations in maxillary lateral incisor agenesis and highlight the importance of individualized treatment planning. While orthodontic space closure remains a valid option in selected cases, implant-supported rehabilitation provides a predictable esthetic solution when adequate hard and soft tissue conditions are achieved. Ridge augmentation, soft tissue management, and periodontal biotype optimization are critical factors for long-term esthetic integration and peri-implant stability. Close interdisciplinary coordination, particularly between orthodontic and implant teams, is essential for optimal timing and sequencing of treatment.