Bitonto Federica, Verdecchia Alessio, Lombardo Massimiliano, Lipani Erica, Dettori Claudia, Spinas Enrico
Department of Surgical Sciences, Postgraduate School in Orthodontics, University of Cagliari, 09124 Cagliari, Italy.
Department of Surgical Sciences, School of Dental Medicine, University of Cagliari, 09124 Cagliari, Italy.
Dent J (Basel). 2025 Apr 17;13(4):169. doi: 10.3390/dj13040169.
Managing unilateral maxillary lateral incisor agenesis (UMLIA) with an associated microdontic or peg-shaped contralateral incisor (Mi or Peg MLI) presents clinical and esthetic challenges. Deciding between orthodontic space opening (OSO) or closure (OSC) and whether to restore or extract the Mi or Peg MLI are critical factors for achieving optimal treatment outcomes. A systematic review was conducted using a dual strategy across Scopus, Web of Science, Embase, PubMed, and Cochrane Central Register of Controlled Trials databases. The Cochrane RoB2 tool was used for randomized controlled trials (RCTs), the ACROBAT-NRSI tool for non-randomized studies, and the JBI Manual for case reports. High-quality case reports were included when the literature was limited. The GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) tool evaluated the certainty of evidence, considering bias, inconsistency, indirectness, imprecision and other considerations. Thirty-five studies met the inclusion criteria, assessing treatment modalities, esthetic outcomes, periodontal health, and occlusal and temporomandibular joint (TMJ) function. Both OSO and OSC demonstrated similar occlusal and TMJ outcomes, while slight differences in esthetic and periodontal results were noted between the two approaches. Direct composite and indirect ceramic restorations showed comparable effectiveness for reshaping the Mi or Peg MLI. Extraction combined with OSC contributed to improved smile symmetry. A personalized, multidisciplinary approach is essential for treating UMLIA with an Mi or Peg MLI. Both OSO and OSC are viable options, and the choice should be tailored to the patient's specific clinical scenario, with attention to achieving the best esthetic and periodontal outcomes. Further research is needed to refine treatment protocols and support clinical decision-making.
处理伴有对侧侧切牙过小牙或钉状侧切牙（微小侧切牙或钉状微小侧切牙）的单侧上颌侧切牙先天缺失（UMLIA）存在临床和美学挑战。决定采用正畸扩隙（OSO）还是关闭间隙（OSC），以及是否修复或拔除微小侧切牙或钉状微小侧切牙，是实现最佳治疗效果的关键因素。使用双检索策略在Scopus、Web of Science、Embase、PubMed和Cochrane对照试验中央注册库数据库中进行了系统评价。Cochrane RoB2工具用于随机对照试验（RCT），ACROBAT-NRSI工具用于非随机研究，JBI手册用于病例报告。当文献有限时纳入高质量病例报告。GRADE（推荐分级、评估、制定和评价）工具评估证据的确定性，考虑偏倚、不一致性、间接性、不精确性和其他因素。35项研究符合纳入标准，评估了治疗方式、美学效果、牙周健康以及咬合和颞下颌关节（TMJ）功能。OSO和OSC在咬合和TMJ方面的结果相似，而两种方法在美学和牙周结果上存在细微差异。直接复合树脂修复和间接陶瓷修复在重塑微小侧切牙或钉状微小侧切牙方面显示出相当的效果。拔除并结合OSC有助于改善微笑对称性。采用个性化、多学科方法治疗伴有微小侧切牙或钉状微小侧切牙的UMLIA至关重要。OSO和OSC都是可行的选择，应根据患者的具体临床情况进行选择，同时要注意实现最佳的美学和牙周效果。需要进一步研究以完善治疗方案并支持临床决策。
