Invisalign Lite and Bridge Treatment for Congenitally Missing Upper Front Teeth and Deep Bite in an Overseas Resident

Hello,

This is Apgujeong Orthodontic Clinic.

Teeth that are missing from birth are called congenitally missing teeth.

The lower front teeth are the most common site of congenital absence, and in many cases, two of the four lower front teeth are missing together.

Invisalign Lite and Bridge Treatment for Congenitally Missing Upper Front Teeth and Deep Bite in an Overseas Resident image 1

When two lower front teeth are missing like this, a space remains between the lower front teeth.

The treatment method varies depending on the results of facial analysis.

In other words, if there is protrusion and the protrusion needs to be reduced, orthodontic treatment is sometimes used to close all of the space.

However, if there is no protrusion, it is better to restore one tooth with an implant or bridge.

Today, I will show a case treated with Invisalign Lite and a bridge in the latter situation.

Invisalign Lite and Bridge Treatment for Congenitally Missing Upper Front Teeth and Deep Bite in an Overseas Resident image 2

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This patient visited for orthodontic treatment. They came in because they wanted to treat the gap caused by the absence of two lower front teeth.

The patient lived in Europe,

so it was difficult for them to visit frequently.

A deep bite, in which the upper teeth cover the lower teeth deeply, is also seen.

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The opening shown in the photo is because the front teeth are missing, so the canine has moved into the position of the front tooth, and space has opened between the canine and the premolar.

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It looks as if the canine is missing, but in fact, the two front teeth are congenitally absent.

Another problem the patient did not know about is that the second molar indicated by the blue arrow is tipped toward the tongue.

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The tooth marked with the red tooth axis is the tipped tooth.

This tooth plays an important role in chewing, so it is definitely better to upright it.

To do that, it is better to remove the decayed wisdom tooth right behind the tipped molar.

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The patient's facial profile was not a situation in which the space should be closed carelessly.

In other words, the lips were thin and there was no protrusion at all.

This was a situation where the front teeth should not move backward even 1 mm.

Therefore, we decided to gather the space distributed left and right, create space to restore one lower front tooth, and then restore it with an implant or bridge.

We recommended Invisalign Lite and began treatment.

After waiting a month and a half, the patient started wearing the first aligner in September 2024, and left the country with all 14 aligners allowed in Invisalign Lite.

For patients living in Korea, Invisalign orthodontic treatment is usually checked every 2 to 3 months, but since this patient lives overseas, visits are limited.

Without intermediate visits, the patient changed aligners every week abroad and returned after 4 months in February 2024.

Invisalign Lite and Bridge Treatment for Congenitally Missing Upper Front Teeth and Deep Bite in an Overseas Resident image 7

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The deep bite improved slightly, and the space between the lower front teeth was gathered well toward the center.

Invisalign Lite and Bridge Treatment for Congenitally Missing Upper Front Teeth and Deep Bite in an Overseas Resident image 8

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Most of the originally spaced area has closed, but a small space remains.

Invisalign Lite and Bridge Treatment for Congenitally Missing Upper Front Teeth and Deep Bite in an Overseas Resident image 9

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The second molar that had been tipped, marked by the blue arrow, has stood up quite a bit.

We proceeded with a remaking to close the remaining space and improve the deep bite further.

Normally, remaking would also require a month, but because the patient's next stay in Korea was less than a month, we decided to receive the additional aligners abroad by international shipping and have them wear them there.

After wearing all 14 additional aligners on their own from March to August without any interim visits, this is the appearance at the visit last month.

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Now we are preparing for the lower front tooth bridge.

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All other spaces except for the lower center front tooth have been closed.

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Considering the bone condition, we determined that a bridge would be better than an implant, so we decided to restore the front tooth with a bridge.

Rather than a bridge that cuts down the neighboring teeth on both sides and crowns them as one unit, we decided to restore it with a Maryland bridge, which is attached from the back without grinding down the teeth.

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After the Maryland bridge was placed, all attachments were removed and the treatment was completed.

We are currently waiting for the Vivera retainers to be made.

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The open space caused by the congenital absence was neatly resolved.

Now let's look at the before-and-after comparison.

The total treatment period was 1 year, remaking was done once, and the interval between orthodontic treatment visits was 5 months.

Invisalign Lite and Bridge Treatment for Congenitally Missing Upper Front Teeth and Deep Bite in an Overseas Resident image 15

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Invisalign Lite and Bridge Treatment for Congenitally Missing Upper Front Teeth and Deep Bite in an Overseas Resident image 16

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The tipped second molar was successfully uprighted.

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This is how the lower front tooth space moved over the course of orthodontic treatment spanning one year.

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Now let's look at the facial profile comparison.

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There was not a major change in the lip line, but with the improvement of the deep bite, the lower lip moved slightly backward and the lips became more harmonious.

Although there were two congenitally missing teeth and visits were very limited because the patient lives overseas, we were able to achieve good results with Invisalign Lite.

Invisalign Lite and Bridge Treatment for Congenitally Missing Upper Front Teeth and Deep Bite in an Overseas Resident image 22

Invisalign Lite and Bridge Treatment for Congenitally Missing Upper Front Teeth and Deep Bite in an Overseas Resident image 23

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