Restorative dentistry clinical decision-making for hypodontia: peg and missing lateral incisor teeth

Peg-shaped and missing lateral incisor teeth are common features for patients affected by hypodontia. While improvements in dental appearance may be a strong motivating factor for these patients, providing dental treatment to improve the clinical condition and achieve an acceptable and stable outcome can be complex and lengthy. For patients affected by hypodontia, discussion and consideration of various approaches to their individual treatment are best achieved in a multidisciplinary team environment. This allows debate of options and joint agreement between at least orthodontic and restorative dentistry specialist colleagues, based largely on clinical factors, towards a treatment plan that is acceptable to the patient. As most patients with this lateral incisor form of hypodontia are initially treated as teenagers and young adults, there is also an understanding that treatment outcomes will have lifelong maintenance and resource implications to consider. This paper identifies and discusses the key clinical features that influence the treatment planning process for a patient with either missing or peg lateral incisor teeth. These will often involve consideration of whether to open or close the lateral incisor spaces and whether to restore or replace a peg lateral incisor tooth. The process should be patient-centred, evidence-based, and aim to minimise the lifelong treatment burden, retaining options for future maintenance and retreatment.