45
A gap between the front teeth
Summary A J5-yc.u-old ffi;'lll has noticed,) g.:lp .lppcaring between Iwo incisor leelh. What is the caus... and how (;Ill you treat him?
6 years old <lnd were required to repl<lcc discoloured cl,lSS III composite restor<ltiolls.
â&#x20AC;˘
TIU' pntiellf's IlIrterior teeth nre SIIOWII ill Figllre 45.1. Wlwt do YOII see nmlllOw do Y0lt inlrrl'rl'l I/It' n/'/Ienmnc,'s?
The upper right lateral incisor is rotated meslolablally and the central InCisor dlstolablalty, There IS recession on both central and lateralmClwrs. The gingwaltissues have wme founding of the mali',lI'l and 1\0 obVIOUS glngMbS. though there IS loss of stippling and contour, The appearances suggesf labial drlftmg as a result of loss of perIOdontal support. Pocketing is probably present even though IllS not obVIOUS.
EXAMINATION Extraoral examination Tllf're i~ 110 lymph'l<.knop"thy 1Ind no temporom'lndibular joint signs. The two crowns, ,1ltbough prominent 'lnd rather light in sh'lde, ,1re ulUJcr "mtn,1 "f th~ luwt'r lip a~"o(:iatt.>d with a cOlllJX't('nt lip se'll. The p'lti('nl has a bro.1d smile <lnd moder'llcly high lip line.
Intraoral examination The or,11 mUCOS<l is healthy, there is 110 (,Hit's ,111d only ,1 f,>w ,11ll;llg,1I11 Q~luration~ bllttht'rt' b focal marginal
HISTORY Complaint The p<lticnt is concerned about the gap
bctWt'{'1l thl." CT\>wnt'd upper right (cnIT,,] incisor tooth :md later.11 incisor.
History of complaint He noticed the gap ilboul 9 months aji;o and feels Ih,'1 it hilS cnIMgt'd, that tIll,' ll't'lh have drifted forwards and that the CTOwns .lrc now loose. I te hils hild no symptoms from thC">(! or any other teeth.
Medical history He hilS mild asthrnil cuntrolled with an inh.lled steroid and salbutamol. H.. d()('S not smoke.
Dental history The piltienl is new to your practice. He attended the dentist regularly, previously going every 6 months bUI now It..-s~ fn."<lllently. The CTOwns ;Ire llppwximllt",ly
Fil. 45.2
Further VIeWS sllowIng the aooearill1Ces 011 presentatlOl1
'"