[Agenesis of the maxillary lateral incisors: indications and clinical protocol for a ceramic cantilever bridge bonded to the canine].

INTRODUCTION: The agenesis of the maxillary lateral incisor can be treated by preservation or reopening of the space, which implies the prosthetic replacement of the missing tooth. Metal-based bonded bridges, followed by implants, have been the reference options in recent decades. However, the complexity of their implementation encouraged the closure of spaces. A better understanding of the negative impact of the phenomena of continuous facial growth on very young patients has made the implant option even less attractive. The bonded ceramic cantilever bridge then gradually emerged. This article describes the indications and protocol of this new prosthetic approach.

MATERIAL AND METHODS: Choosing the canine as the wing location offers several advantages: superior root anchorage, better morphology and palatal surface for bonding, easier dynamic occlusal balancing, less delamination. The ceramics of choice are zirconia or lithium disilicate.

RESULTS: There are several well coded steps to optimize the choice of materials, the preparation of the gingiva, the tooth preparation and the bonding of the wing to the supporting tooth. A compressive splint can be used for temporization. A groove can be provided in the bonded bridge for the retention wire.

DISCUSSION: The choice of tooth for the bonded wing remains controversial.

CONCLUSION: Orthodontic preparation must take into account the choice of supporting tooth, and allow for minimal overlap and a slightly increased incisal overhang.