Esthetic and periodontal management of missing lower anterior teeth

Abstract

The issue of missing teeth in the lower esthetic zone can either be addressed by orthodontic space closure or opening with subsequent prosthodontic substitution. Space closure bears the risk of postreatment open gingival embrasures especially in older patients and suboptimal occlusal outcomes due to lack of intercanine and interincisal contact which may render space opening the preferred treatment. To date modern CAD/CAM technology for fabricating custommade zirconia resin-bonded devices in combination with connective soft tissue grafting offers a minimally invasive approach for achieving excellent esthetic and functional outcomes in patients for which space opening is the only treatment option.