Cost-Effective Management of Patients with Unilateral Congenitally Missing Second Maxillary Premolars.

Two case presentations are utilized to review the cost-effective treatment options in patients with unilateral congenitally missing second maxillary premolars. Once diagnosed, the dentist can either preserve or remove the respective primary molar. Preservation will lead to a tooth-size discrepancy. To limit the size of the second primary molar to the dimension of the contralateralpremolar, and to allow the preservation of alveolar bone, removal of its mesio-distal aspect should be performed. Later on, the primary molar may become infraoccluded or lost, and it will be necessary to do a coronal built-up or a prosthetic replacement respectively. Any type ofprosthetic replacement will significantly increase the total cost of treatment. Clinicians should aim for ideal occlusion and profile and take into account other orthodontic problems and propose the most appropriate treatment plan for each patient.