Canine substitution vs implant vs Maryland bridge
Canine substitution vs implant is a debate many orthodontists have internally with cases of missing laterals. Another solution is also the Maryland bridge, although many consider this more of a long term temporary solution.
When deciding between canine substitution and dental implants what should you consider?
Bite (occlusal) considerations that allow a canine substitution.
From an occlusal standpoint, there are two situations were canine substitution works well. The first situation is a Class II individual that does not have any mandibular crowding. When this is the case, the molars remain in Class II but the pre-molars are forward to act as a canine. The other situation is a Class I individual with enough mandibular anterior crowding that we need pre-molar extractions on the lower jaw.
Profile considerations for a canine substitution.
What is the canine shape and color?
If we move the canine to the lateral site then we must evaluate the canines shape and color. Canines are always larger than lateral incisors and so we want to see how much wider. We pay speacila attention to the width at the CEJ since this area can not be changed. The wider the tooth at the CEJ, the more difficult it will be to make them look like lateral incisors. Canines are the teeth with the most color and thus appear more yellow than a natural later would. We can deal with the color by whitening but it is something we look at before hand.
Smile line consideration for canine substitution.
So what is best canine substitution or implant?
The correct answer to the canine substitution vs implant debate, likely depends on who you ask. It is often best to go with what your orthodontist and dentist feel is best and what they prefer. They likely prefer what they are capable of best doing. Whether that is truly best or not is debatable, but it is likely the best treatment result you will get in their particular hands. Research might favor canine substitution but it’s not definitive. Most important is to choose the right docs though, as seen above. We can’t undo some things without spending a lot of time and money. Patient satisfaction tends to favor canine substitution and esthetics seem to be as good or better for canine substitution, especially to patients (Schneider AJO-DO 2016 references 23-28).
What to do if only have one missing lateral, canine substitution vs implant?
In these cases the midline and crown shape, peg lateral or microdont, of solo lateral are paramount.
Extract the one lateral if
1. There was a peg-shaped lateral incisor. An alternative option in the presence of a normal lateral incisor could be to extract the contra-lateral second premolar.
2. Crowding on the contra-lateral arch.
3. A class II malocclusion.
4. Deviation of the center line towards the absent lateral incisor.
Open the space for an implant or Maryland bridge if
1. Class I buccal segment relationship bilaterally.
2. Inclination of the upper incisors is favorable to proclination.
3. Class III camouflage is appropriate.
4. Spaced upper arch.
5. Lack of alveolar bone.
Close the space for with canine substitution if
1. Class II buccal segment relationship on the side of the arch with the absent lateral incisor.
2. Class II canine relationship on the side of the arch with the absent lateral incisor.
Canine substitution vs implant research
I will be including studies and more info in this blog as time goes on.
The layperson does not notice a difference if do a canine substitution. BDJ 2015