TWO CASES ILLUSTRATING THE CLOSING UP OF LOST INCISOR

SPACES INSTEAD OF MAINTAINING THEM WITH

ARTIFICIAL RESTORATIONS·

By HARRY E. KELSEY, D.D.S., F.A.C.D., BALTIMORE, MD.

CA RE I.-Patient, twelve years old, had lost left maxillary central as the result ofan accident.

Fig 1. shows front view of case before and after treatment. It will be noted thatthe remaining central has tipped toward the space, thus partially elosing it, but leavinganother space between it and the right lateral. It was also considerably rotated as canbe seen.

·Read before the Southern Society of Orthodontists. Macon, Ga.• Jan. 31, Feb. 1-2. 1929.

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The Closing Up of Lost Incisor Spaces 1077

To close this sp ace it was necessary to permit a tendency toward distal occlusion tobecome complete on the left side, as is shown in F ig. 2, but I do not think this is nearlyas serious as condemning th e patient to wearing an a rti ficial restoration for life. Bothhe and his parents are " ery much pleas ed with the result, and not one layman in a thousandno ti ces or even kn ows how ma ny in cisors we should have.

CASE 2.-Patient eighteen and one-half years of age.Fig. 3 shows a typical Class II Division 1, malocclusion, in whi ch like the previous

case, the left ma xillary central had been lost by acci dent. In this case, however , thespace was entirely closed, owing to the protrusion of th e ante rio r teeth and the fa ct th atth e patient had resumed normal breathing and kept th e lip s closed. Th e remaining centralwas , however, nouvital and infec ted, and was also marred by a hypoplas ia of the enamel.It being apparent th at he would lose this tooth event ual ly, it was decided to remove ita nd close up the space, permitting th e two lateral incisors t o tak e th e 'place of th e centrals.

A slight spacing' will be noted between the laterals, but th is is not disfigurin~. Th eage of this patient would hav e made the reduction of the mesiodistal malocclusion prob­lematic even if the two in cisors were intact.

Fig, 4 shows left side view before ann after treatment.This case was treated p revious to my use of gnathostatic measurements, but I was

convin ced that the mesi odistal malrelation lay almost, if not ent ir ely, in the forward dis­pl acement of the upp er arch. I regret that I have not a slide of th e gnath ostatic modelwhich I intend to mak e, to see whether it will verify my opin ion regarding the mesio­dist al relations.

I would like to a dd th at I ha ve another Class II, Division 1, case, in which bot hmaxillary centrals were lost by accident, and in which I am a lso closing the space. Owingto the fact tha t t he cent ra ls were very large and th e later als quite small , I believe th ey willnever complete ly fill the space, but th e>' will serv e as spl end id vital supports for porcelainjacket crowns.