Correction of Proclined Teeth and Crowding, Microdontia, Congenital Missing Teeth, Three Lower Incisors, No-Prep Laminate Veneers, Invisalign Orthodontics

Hello,

This is Apgujeong Orthodontic Dental Clinic.

Today, we will introduce a case of correcting proclined teeth and crowding.

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Lower front teeth are teeth with a high frequency of congenital absence.

This is a case where there are 3 lower front teeth instead of 4.

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Just because a tooth is missing does not mean an implant is always necessary.

Orthodontic treatment alone can create a sufficiently good bite.

Today, I will show you the treatment process with Invisalign in a case where one lower front tooth is congenitally missing and a microdontic tooth is present as well.

This patient visited us for orthodontic treatment in February 2024.

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One lower front tooth is missing, and the microdontic tooth has erupted as a crowding tooth.

There is also a large black triangle between the lower front teeth.

The cause of the black triangle is the tooth axis.

If the root spacing is wide, black triangles appear. The root spacing of the lower front teeth must be narrowed so that the size of the black triangle can be reduced in a healthy way.

In the facial photo, the dental midline is shifted toward the microdontic crowded tooth side.

The upper front tooth midline needs to be moved so that it matches the nose and philtrum.

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Also, from the profile view, the upper front teeth are protrusive.

In other words, the teeth are tipped backward.

The molar relationship is Class II.

To achieve a Class I bite, the upper wisdom teeth need to be removed and the upper molars must be moved backward into the wisdom tooth space.

The patient chose Invisalign treatment and started wearing the appliance in March 2024.

It was decided that the microdontic tooth would be restored to normal size with no-prep laminate veneers after orthodontic treatment.

A total of 58 aligners were made in the first set.

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The treatment continued with one change every 7 days.

Intermaxillary elastics and orthodontic miniscrews were used to move the upper molars backward.

In May 2025, after wearing all 58 aligners over 1 year and 2 months, this is the result.

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If there are 3 lower front teeth, the upper front tooth midline should align with the center of the middle tooth among the lower front teeth in order for the midline to be correct.

The microdontic crowding tooth has moved into place well, and the alignment is good.

To improve a few minor remaining points, additional aligners were made, and after wearing all 13 additional aligners from July to October 2025, the treatment was completed.

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Now it is time for the no-prep laminate veneer treatment for the microdontic tooth.

The front tooth with an oblique wear pattern was also restored at the incisal edge with resin.

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These are photos taken in order: immediately after orthodontic treatment was completed - after no-prep laminate veneer bonding - after resin treatment of the incisal edge of the front teeth.

In November 2025, all treatment, including prosthetics such as veneers and resin, was completed.

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The midline is well aligned,

and the molar bite is also good.

The total treatment period, including the prosthetic phase, was 1 year and 8 months.

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

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The black triangle between the lower front teeth was reduced in size by improving the tooth axis and performing a small amount of interproximal reduction.

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Looking at the before-and-after panoramic X-rays, you can see that the tilting of the lower front tooth axis, which had been the main cause of the black triangle, has been corrected.

The axis of the upper front teeth has also become more parallel.

The statement, “Root movement cannot be achieved with Invisalign,” is incorrect.

There was no root resorption during the 1 year and 8 months of treatment.

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The molar bite achieved a Class I relationship from the previous Class II relationship.

A tight, leak-free bite is the foundation of orthodontic treatment.

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The front tooth midline, which had been shifted toward the microdontic crowding side, was finally aligned to the center.

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The improvement in the protrusion of the upper front teeth made the smile brighter.

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The root parallelism is good.

The lip line was well maintained without change, and the improvement in the protrusion angle of the upper front teeth is noticeable.

I hope this post will be helpful for those who need orthodontic treatment for microdontia or congenitally missing teeth.