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Orthodontic space closure is one of the treatment alternatives when a maxillary central incisor is missing. Because no systematic analysis of such treatment results is available, a sample of 20 consecutively treated patients was examined in a follow-up study. All patients had received orthodontic treatment with the objective of closing the space for the missing central incisor. Biologic features and the clinical appearance of the recontoured lateral incisor (test tooth) replacing the missing tooth were compared with the neighboring intact central incisor, which served as control tooth. The patients' opinions regarding the treatment and the result were recorded in a questionnaire. The position of the examined teeth and the appearance of the surrounding soft tissues were similar in the test and control teeth. However, in some patients (25%), certain aspects of the recontoured incisor crown (such as the width at the gingival margin) mismatched the appearance of the controls. A somewhat increased mobility and probing pocket depth on the mesial aspect was recorded for some test teeth. No obvious detrimental effects were observed on the radiographs. Most patients expressed satisfaction with the treatment result. It is concluded that orthodontic mesialization of the lateral incisor to replace a missing central incisor is a valid treatment modality, if the indications for such treatment are present and careful attention to detail in orthodontic and restorative treatment is exercised.

A treatment combining autotransplantation of developing premolars and orthodontic space closure is described as an alternative to prosthodontics in the management of patients with alveolar clefts when 2 cleft-side incisors are missing. We report on 5 consecutive patients with unilateral clefts in whom 2 cleft-side incisors were congenitally missing, severely malformed, ectopically erupting, or lost because of trauma. In each instance, a mandibular premolar with a partly developed root was transplanted to the central incisor region (3 patients had previously undergone alveolar bone grafting). Root growth continued in all transplants. After an observation period of 2 years 6 months to 7 years 8 months, all transplanted teeth were present and fulfilled the established success criteria. The physiologic status of the transplanted premolars compared favorably with that of the central incisor on the noncleft side. The appearance of the reshaped transplants was found to match the noncleft incisor in 3 patients and deviated somewhat in 2. We concluded that an acceptable clinical outcome can be obtained by tooth transplantation combined with orthodontic space closure in patients with alveolar clefts and 2 missing cleft-side incisors.