Aesthetic and Functional Rehabilitation with Pontic and Tooth Reshaping in Children wwith Malocclusion and Agenesis of Teeth 12 and 22: A Case Report

Abstract

Maxillary lateral incisor agenesis is a developmental dental anomaly with significant esthetic, functional, occlusal, and psychosocial consequences during adolescence. Treatment planning in growing patients is challenging because definitive implant-supported rehabilitation is generally postponed until skeletal maturity is achieved. Therefore, an interim approach integrating orthodontic space management, tooth reshaping, and provisional pontic replacement may help preserve esthetics and function during active growth.A 14-year-old female presented with a chief complaint of irregular anterior teeth and decreased self-confidence. Clinical and radiographic examinations revealed bilateral agenesis of the maxillary lateral incisors (teeth 12 and 22), Angle Class II Division 1 subdivision malocclusion with a skeletal Class I relationship, maxillary anterior diastema, a mandibular midline deviation of 4 mm to the right, mild overjet and overbite, and anterior mandibular crowding. Comprehensive treatment consisted of oral preparation, fixed orthodontic therapy for alignment, leveling, diastema closure, and space redistribution using open-coil spring mechanics, followed by minimally invasive reshaping of tooth 13 to simulate the morphology of tooth 12 and provisional pontic replacement for tooth 22. Orthodontic alignment and leveling were achieved after approximately two years, resulting in improved anterior esthetics, midline correction, and more favorable occlusal relationships. Posterior interdigitation and definitive prosthetic rehabilitation remained under observation until completion of growth. In a growing patient with bilateral maxillary lateral incisor agenesis, a conservative multidisciplinary approach involving orthodontic space management, tooth reshaping, and provisional pontic placement can improve smile esthetics and oral function while maintaining future options for definitive prosthetic rehabilitation. Careful diagnosis, patient-centered treatment planning, and long-term follow-up are essential for achieving stability and esthetic refinement.