Spaced dentition--open, close or redistribute?

A spaced dentition can be due to various reasons such as hypodontia, tooth size discrepancy and impeded eruption. The dilemma for clinicians is whether to close, open or redistribute space. Closing space by orthodontics eliminates the need for prosthetic rehabilitation but it might compromise aesthetics and function. On the other hand, opening space is more complex and requires long-term maintenance. Based on these drawbacks, a careful occlusal analysis and an individualized treatment plan are mandatory for achieving the best result. The prognosis for closing space and substituting congenitally missing maxillary laterals with canines depends on factors such as overjet, lip support, crown colour, shape and root position. If these are unfavourable, opening space for prosthetic replacement is then preferred. Discrepancy between tooth and jaw size results either in spacing or crowding. The location of the spacing and the amount of overjet are important factors guiding the direction of treatment.