To open or to close space--that is the missing lateral incisor question.

Developmentally absent permanent maxillary lateral incisors may be associated with several problems. The decision whether to open or to close the space should involve the patient/parent, orthodontist and restorative dentist. To optimize function and aesthetics, space should be opened using fixed appliances to accommodate an appropriate prosthesis. Implant-retained crowns offer several advantages, although adhesive bridges are more appropriate in certain circumstances. Removable partial dentures may be necessary in some instances. Where space opening is not feasible, practical or desirable, any residual spacing can be closed using fixed appliances and the permanent maxillary canines modified to resemble lateral incisors.