23/08/2026
Bilateral agenesis of the lateral incisors.
In this case, we adopted the technique of Ciarlantini & Melsen (AJO-DO 2017;151:989–94).
This young lady had space opened orthodontically for later implants — but a waiting space loses ridge width and height, and the alveolar process is still developing as the adjacent teeth erupt. The space has to be held without stopping that development.
- Two mini-implants inserted perpendicular to the palatal mucosa of the alveolar process, each carrying a sectional wire adapted 0.5–1 mm from the mucosa with no occlusal interference.
- A composite pontic built up chairside layer by layer.
- A small V-bend in the wire allows each pontic to be moved occlusally as the adjacent teeth erupt, without remaking it.
Unlike a TAD placed perpendicular to the occlusal plane, this position does not prevent vertical development of the alveolar process. At five years the authors reported the ridge following the eruption of the adjacent teeth, with morphology and bone density maintained, and later implant placement possible without additional surgical buildup.
Grateful to Dr. Roberto Ciarlantini for this incredible technique.
Thanks to Dr. Barham Ahmed for his insightful supervision.
