show your work Replacing Missing Upper Lateral Incisors Management of an interesting case involving two phases of aligners and implants by Dr Andy Toy Andrew Toy, MMedSci BDS (Bristol) MFGDP(UK), is a GDP with more than 35 years' experience of all forms of orthodontics. Toy started using Invisalign in 2007 and has since completed more than 500 cases. He is a member of the Aligntech Academy, teaching Invisalign throughout the UK and Europe. He also works for Aligner Consulting, supporting dentists using the Invisalign Go system. Andy is an alumni and former faculty member of the Pankey Institute, USA. He is an honorary senior lecturer for University of Kent and has published research in the fields of consent and occlusion/TMJ function. The patient in this case was a male in his mid-20s who was a trainee when he first attended the practice. His upper lateral incisors were congenitally absent, for which he (rightly) blamed his parents. He had been offered fixed appliances as a teenager but he had refused at the time. This meant that he now had to fund his own orthodontics, for which he (wrongly) blamed his parents for not forcing him into orthodontics 10 years previously. There are generally two ways of dealing with missing upper lateral incisors: 1. Close the spaces and reshape the canines (a relatively cheap option). 2. Open up the spaces and restore with an implant, bridge or denture (a great deal more expensive option). The patient was also very keen on the idea of long-term restoration with implants, using his actuarial skills to determine that this would be a much better quality result that would also work out cheaper over his expected lifetime. He used these figures and a degree of coercion to gain funding from the 'Bank of Mum and Dad'. There are a number of issues to consider when choosing the best of these two options: * How much room is required to open the spaces between UR1-UR3 and Fig. 1. Preorthodontic treatment. Fig. 2. Preorthodontic treatment ClinCheck. Fig. 3 Postorthodontic Phase 1 treatment dentaltownuk.com \\ JUNE 2018 11http://www.dentaltownuk.com