Use of a Resin-Bonded Bridge to Replace a Congenitally Missing Lateral Incisor: Treatment of "Intrusion" of Teeth.

Craniofacial growth is an important factor to consider when providing dental implant treatment for adolescents to replace missing teeth. Ongoing longitudinal observation has demonstrated that such tooth replacements may appear intruded over time, because there may be ongoing downward and anterior movement of both the alveolus and the teeth at a rate exceeding that of the dental implant, which acts like an ankylosed unit. This case reports on a 23.5-year-old female patient who, at age 16, had orthodontics completed and was left with a space where the maxillary right lateral incisor was congenitally missing with the hope of future restoration with a dental implant. A resin-bonded bridge had been placed to fill the space in the interim. After approximately 7.5 years, the bridge loosened and the patient sought an implant option as its replacement. Clinical images revealed that the bridge, which contained two bonded wings, may have limited physiologic growth, causing both the maxillary right central incisor and canine to appear intruded compared with the left central incisor and canine. This case illustrates, at the very least, that growth and development may not be complete in females aged 16 years and that the way in which a missing tooth is replaced must be carefully considered given the impact that ongoing growth and development may have on restorative care. Moreover, further growth and development may also impact adults.