Aesthetic evaluation in subjects treated due to congenitally missing maxillary laterals. A comparison of perception in patients, parents and dentists.

The treatment of the congenitally missing maxillary lateral incisor is a challenge to the dental profession. The demand for optimal orthodontic and prosthetic treatment is high because the condition has an impact on facial aesthetic. The aims of the present study were to determine how different outcome of treatment were perceived by professionals and laypeople and to identify situations that caused dissatisfaction or satisfaction after space closure or tooth replacement. A panel of four groups (patients with missing laterals, parents to these subjects, patients with other malocclusion and general dental practitioners) were included. Sixteen cases with uni- or bilateral missing maxillary lateral incisors, treated with space closure or with prosthetic replacements were presented photographically to the panel. The prosthetic replacements included resin-bonded bridges, porcelain bonded to gold bridges and implants. The panel was asked to rate the overall appearance of the mouth, to rank up to three disturbing features and to rank the most important treatment goals in case of treatment need. An obvious difference between the panel groups was found. The general practitioners were less critical than laypeople in rating the overall appearance. Amongst dentists the tooth colour, the tooth shape and asymmetry were the most disturbing factors whilst laypeople were disturbed by colour, spacing and tooth shape. Half of the dentists did not find any treatment need whilst the corresponding figure amongst laypeople was 19 per cent.When a treatment need was confirmed the most common treatment goals amongst dentists were to change the colour or the shape of the teeth. The laypeople wanted to change the colour, the space condition or the shape of the teeth. The study has shown that professionals and laypeople are of different opinion when rating treatment outcome in cases with missing maxillary laterals. Careful planning to achieve optimal aesthetics should be performed.