CLINICAL CASE: Management of Peg shaped lateral incisors and missing mandibular incisors using a modified T-shaped implant

Peg shaped lateral incisors and hypodontiacan compound to difficulty in orthodontic treatment in terms of space management and aesthetics.

This case report demonstrates the management of such a case with the help of a modified T-shaped Implant. A 16 year old female presented with a class I malocclusion, Peg shaped laterals and partial anodontia in the Mandibular central incisor region.

She was treated with a Preadjusted Edgewise appliance ,ceramic crowns and also a T-shaped dental Implant following osteoplasty which was performed to modify the alveolar bone prior to implant placement. 

Result: The treatment proved to be effective with functional and aesthetic improvement in the patients overall oral health. Conclusion: This case could have been managed in a number of different ways; the authors feel that this was the best treatment plan for this case.

Peg lateral incisors or Peg shaped lateral Incisors, can be defined as a condition where the Permanent Maxillary lateral incisors are relatively much smaller in proportion to the Maxillary central Incisors. 

This situation occurs when the permanent lateral incisors do not fully develop. Care must be taken during the diagnosis of peg laterals to rule out the possibility of misdiagnosing over retained deciduous teeth.

Apart from Unaesthetic appearance due to the small size of the laterals in the maxillary arch they also cause spacing which may further lead to mesial migration of the posterior teeth causing an alteration in the occlusal pattern and an impairment in mastication. 

The Peg laterals are a fairly common condition and may be treated in a variety of ways ranging from a crown ( in case of sufficient root support) or a Bridge where the clinical crown and root are malformed and the tooth is extracted .

The canines may be substituted for the extracted lateral incisors and reshaped to appear as the lateral incisors.

This is called Canine Substitution. Close to the heels of Peg laterals is a condition of Missing permanent teeth which is called as partial anodontia. This condition is usually treated with fixed or removable prosthesis or in some cases through substitution with an adjacent tooth.

This case presented with both peg shaped Maxillary lateral incisors as well as partial anodontia with lower central Incisors and it has been managed with orthodontics, a T-shaped Prosthetic Implant as well as Ceramic Crowns.