Inward-Tilted Teeth Orthodontic Treatment Review | A Real Case of Treating Congenitally Missing Lower Incisor (Three Lower Front Teeth) Without Extractions

Hello,

This is a post from a Gangnam orthodontic clinic in Apgujeong.

Today, I would like to share a case involving treatment of inward-tilted teeth.

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This patient had a congenitally missing lower front tooth.

How would the midline be finalized after orthodontic treatment?

Please read to the end.

23.02

The patient visited us in February 2023 to address inward-tilted and crowded teeth.

This was a case of severe deep overbite, to the extent that the lower front teeth were barely visible.

23.02

The two upper central incisors had descended downward and tilted backward, creating inward-tilted teeth.

23.02

The lateral incisors—the teeth next to the central incisors—were rotated and elevated, resulting in crowding.

23.02

One lower front tooth was congenitally missing, leaving three lower front teeth.

Because there was no protrusion, we decided to proceed with non-extraction orthodontic treatment.

The two impacted upper wisdom teeth were extracted, and the upper teeth were planned to be moved backward into the space left by the wisdom teeth. This would create space to address the crowding and inward-tilted teeth, while also establishing a Class I occlusion.

The patient wanted Clippy-C orthodontic treatment, so treatment was started.

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This image shows the patient 1 year and 4 months after treatment began.

The deep overbite, inward-tilted teeth, and crowding had been corrected. Miniscrews were placed, and the entire upper dentition was in the process of being moved backward.

24.06

When there are three rather than four lower front teeth, there is a limitation in that the space between the upper and lower teeth may finish slightly larger than normal.

However, congenital absence of a lower front tooth is relatively common, and many cases are completed orthodontically with three lower front teeth rather than proceeding with an implant.

Treatment was finally completed 1 year and 11 months after it began.

25.01

Can you see that the upper dental midline is positioned at the center of the middle tooth among the three lower front teeth?

When one lower front tooth is congenitally missing, the midline is finalized in this way.

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The occlusion is good.

Now, let us compare the results before and after treatment.

The treatment period was from February 2023 to January 2025.

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Now, let us compare the facial appearance before and after treatment.

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A desirable smile line and appropriate buccal corridors

These are very important for smile aesthetics.

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The improvement in the previously backward-tilted inward teeth is clearly visible.

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The natural lip profile, which was not protrusive, was also well maintained.

When inward-tilted teeth occur together with a deep overbite and crowding, a good result may also be achieved with non-extraction orthodontic treatment if there is an accurate diagnosis and treatment plan.

In addition, because congenitally missing lower front teeth (three lower front teeth) require different treatment goals from conventional orthodontic cases, it is important to prioritize functional occlusion and natural aesthetics rather than focusing solely on whether an implant is placed.

As in this case, developing a customized treatment plan based on the patient's dental condition and facial features can help maintain the lip profile while achieving a stable orthodontic result.

Q. Do inward-tilted teeth have to be treated with extractions? No.

Depending on the degree of protrusion and the space analysis, some cases can be treated sufficiently with non-extraction orthodontic treatment.

Q. If one lower front tooth is missing, is an implant necessary? Not necessarily.

If the occlusion and tooth proportions are appropriate, many cases can be completed orthodontically while maintaining three lower front teeth.

Q. How is the midline aligned when there are three lower front teeth?

The reference is different from that used for the usual four lower front teeth. In most cases, the upper midline is aligned with the lower central incisor, while considering both function and aesthetics during treatment.