American Journal of ORTHODONTICS

T’olume 58, Number 2, August, 1970

ORIGINAL ARTICLES

Orthodontic treatment using canines in

place of missing maxillary
lateral incisors
Donald 1. Tuverson, B.S., D.D.S., M.S.
Pasadena, Calif.

P atients often present themselves for orthodontic treatment with the

ltpper lateral incisors missing. Whether congenitally absent or lost as the result
of an accident or pathologic condition, missing maxillary lateral incisors present
a problem which complicates orthodontic treatment.
The orthodontist must decide between two treatment procedures : (1) pro-
vision of spaces that would normally be occupied by the missing teeth, followed
by the use of artificial teeth in these spaces; and (2) contouring the canines to
resemble lateral incisors and positioning them to function in place of the missing
incisors. I have used both methods of treatment and agree with &rang1 that the
most satisfactory results are consistently achieved when spaces are closed by
repositioning the upper canines in the missing lateral incisors’ positions.
The purpose of this article is to describe the treatment of cases in which
~ttninrs are lisa to replace missin g maxillary lateral incisors. This treatment
procedure is not appiicable io all eases in nrhich maxillary lateral incisors are
missing. There are cases which require the opening of spaces for artifiicial teeth.
The usual procedure followed when space is provided for artificial lateral in-
cisors is to incorporate plastic incisors in the retaining appliance. At a later
stage of tooth maturity, a fixed prosthetic appliance is made to replace the
plastic teeth. A favorable result R-hen plast,ic teeth are incorporated in the
retainer is that, for esthetic reasons, the patient will Wear the retainer con-
scientiously. However, because of the size of the lateral incisors, breakage is a
problem. Too often, these patients arrive at the office with the plastic tooth
broken from the retainer; they are embarrassed to be seen in public with the
109
 110 Tuverson Amer. J. Orthodont.
August 1970

resulting edentulous space. To avoid these embarrassing periods, the patient

may be provided with an extra retainer.
The decision to place the canines in the positions of the missing lateral in-
cisors is dependent upon several factors and will be described by explaining
the advantages and disadvantages of this treatment procedure.
Advantages of positioning maxillary canines to function in place of missing lateral incisors

1. The result is permanent, eliminating the need for any prosthetic appli-
ances and their subsequent maintenance and replacement. This procedure elimi-
nates the potential risks that are involved when teeth are used as abutments.
Even the best made dental bridges are not expected to last indefinitely. Why
subject a child to a lifetime of prosthetic dentistry when it can be avoided?
2. Consistently better esthetic results are achieved. Not only is a superior
tooth shade relation attained than with artificial teeth, but normal gingival and
alveolar architecture is established, eliminating the hollowed-out, receded al-
veolar areas associated with missing teeth. These receded areas are more pro-
nounced when two adjacent teeth are congenitally absent or lost before comple-
tion of vertical jaw growth. The eruption process of the teeth that are present
establishes alveolar bone morphology and height. The edentulous area of bone is
left behind, producing the receded alveolar ridges associated with areas of
missing teeth. When this is the result of missing maxillary central and lateral
incisors, the extent of the receded area will be reduced by placing the canines in
the positions of the missing lateral incisors. Alveolar morphology is improved,
and the number of missing teeth to be replaced is reduced.
3. In mandibular arch-length discrepancy cases, a favorable interocclusal
relation may be established by placing the maxillary canines in the missing
lateral incisors’ positions and extracting two mandibular premolars without
extracting maxillary premolars.
4. Placing well-shaped canines in positions created by the removal of peg-
shaped lateral incisors is often an esthetic and functional improvement.
5. This procedure avoids the necessity of depending upon someone else to
provide a successful prosthetic result.
Disadvantages of positioning maxillary canines to function in place of missing lateral
incisors

1. In some cases poorly formed and extremely large canines cannot ade-
quately be shaped to resemble lateral incisors or function properly in their place.
Very few canines are of this type, however; most canines can be shaped to re-
semble and function as lateral incisors.
2. This procedure is not desirable in patients with unilateral absence of
lateral incisors, unless the canine can be contoured to be esthetically and func-
tionally in harmony with the existing lateral incisor. Better esthetic results
are usually attained in cases in which one lateral incisor is missing if (1) space
is provided for an artificial tooth or (2) the existing lateral incisor is extracted
and both canines are placed in the lateral incisors’ positions.
3. When an efficient functioning neutral occlusion already exists, the absence
Volume 58 Use of canines in pi&e of missing lateral in&ors 111
Number 2

of teeth is usually the result of trauma or pathologic complications, rather than

a congenital anomaly. The corrective treatment should follow a prosthetic rather
than a more involved orthodontic procedure.
4. Criticism of eliminating canine protection (canine disarticulation) when
placing the canines adjacent to the central incisors seems unjust. Canine protec-
tion may be produced with the upper canine rising off the mesial rather
than off the usual distal slope of the lower canine.
Although the upper canines are larger than the lateral incisors they are
replacing, an efficient interocclusal relation is consistently established without
major mesiodistal crown reduction of the canines. A greater amount of overjet
and overbite would be expected when the larger canines are placed in the lateral
incisors’ positions. However, as the models and intraoral photographs included
in this article demonstrate, this is not the case. None of the cases treated show
excessive overjet or overbite. On the contrary, some of the completed cases might
be criticized for lacking sufficient overbite and anterior incisal guidance.
Several factors make it possible to establish an efficient interocclusal relation
when the upper canines are used in place of missing lateral incisors: (1) the
similarity between the mesiodistal crown widths of the maxillary canines and
lateral incisors ; (2) the upper first premolars functioning in the canines’ normal
positions are smaller mesiodistally than the canines ; (3) the tendency in
many orthodontic cases toward a dental arch-length discrepancy between the
upper and lower anterior teeth, where additional dental arch length is required

Table I

Mesi.odistal crown widths

iiverage Greatest Least
Teeth (mm.) (mm.1 (mm.1
Maxillary lateral incisors 6.4 7.0 5.0
Maxillary canines 7.6 9,O 7.0
Maxillary first premolars 7.2 8.0 7.0
Mandibular first premolars F.9 8.0 6.0
Mandibular second premolars 7.1 8.0 6.5
(After Black: Andomy of t,he Human Trrth, fourth edition, Philadelphia, 1902, 8. S. White
Dental Manufacturing Company.)

Table II

Naxillary lateral incisor 6.6 5.8 to 7.4

Naxillary canine 7.8 7.1 to 8.5
Maxillary first premolar 6.9 6.3 to 7.5
Mandibular first and second premolars 7.0 6.4 to 7.6

(After Salzmann: Orthodontics-Principles and Prevention, Philadelphia, 1957, J. B. Lippin-

eott Company.)
112 TUWYSO~L

in the upper anterior teeth to produce a normal occlusion; (4) the thickness 01’
the enamel, espe’cially on the distal surface of the canines, permits mesiodistal
crown reduction.
In both Tables I and II, the mean range of mesiodistal crown width betw-celr
the maxillary canines and the lateral incisors is 1.2 mm., an amount reatlil)
removed by judicious narrowing of the proximal surfaces when necessary. Tht:
differences in width are also partially offset by the upper first premolars, func-
tioning in the canines’ normal positions, which are smaller mesiodistally than tllq:
canines. In Table I the average width of the upper first premolars is 0.4 runt.
smaller than that of the canines, while in Table II there is a mean differenctl (it’
0.9 mm.
Another factor which may be equally important in allowing the larger canine
teeth to replace missing lateral incisors is the frequency of dental arch-length
deficiences of upper anterior teeth. This may be the result of excessively width
lower incisors, but more commonly it is the result of smaller upper central
incisors and canines. Although this problem of dental arch-length deficient:
appears to occur consistently in patients in whom lateral incisors are missing,
it is also prevalent in persons with a full complement of teeth. In these cases,
small or pegged lateral incisors are usually the major cause of the deficiency.
On rare occasions, an extensive amount of upper anterior dental arch-width
reduction may be necessary because of excessively large canines. The thickness
of enamel on the mesial and especially the distal surfaces of the canines lends
these teeth to mesiodistal reduction. However, not all the reduction need be al
the expense of the canines. Prudent reduction of enamel on the mesial ant1
distal surfaces of the central incisors and the mesial surfaces of the first ~IV
molars is also possible to help establish the correct amount of dental ar~l-
length.
Note in Tables I and II that the mean difference in mesiodistal crown width
between the maxillary lateral incisors and mandibular premolars is less than
1 mm. This similarity in width explains why it is possible in mandibular arch.
length discrepancy cases to establish a favorable interocclusal relation I)>-
placing the maxillary canines in the missing lateral incisors’ positions an(l
extracting the mandibular first premolars without extracting maxillary prl.-
molars.

Treatment

The procedures described in this article include those variations in treat-

ment that are used for placing upper canines in the positions bf the missing
lateral incisors.
A diagnostic setup is important in determining whether or not a harmonious
occlusal relation is attainable. It determines the amount of mesiodistal crown
reduction of the maxillary anterior teeth and aids in contouring of the canines
to better resemble and function as lateral incisors. The setup is also useful in
the case presentation.
The degree of esthetic success when the canines replace the missing incisors
is directIy related to the original shape of the upper canines and the operator’s
 1:s~ of cnwines in plac~e of ntissing lateral incisors 113

ability to shape these teeth to resemble lateral incisors. If only the tips of the
canines are removed, the teeth may not resemble canines but they also will not
resemble lateral incisors. A definite procedure should be followed to shape the
different surfaces of the canines to resemble and function as lateral incisors.
Since the final occlusal result is the orthodontist’s responsibility, the orthodontist
should contour the canines himself, or the contouring procedure be carried out
under his personal supervision.
The contouring procedure is accomplished at the beginning of orthodontic
treatment. A special appointment is made, with adequate time provided for the
shaping procedure. Occasionally, it may be necessary, in the finishing stages a-f
treatment, to remove the canine and central incisor bands for additional mesio-
distal reduction and refinements. New bands are then cemented and a.ctive
treatment is completed.
Instrumeds required for maxillary ca?&e contouring. -4 diamond burr in a,n
air turbine instrument is useful for gross incisal and labial reduction. However,
the entire shaping procedure may be accomplished by means of 5/s inch medium
garnet disks followed by fine sandpaper or cuttle disks for final polishing. This
procedure should be carried out under an air coolant. A tapering green stone
may be useful for labial reduction of enamel at gingival areas and for placing
developmental anatomy on the labial surfaces. In rare instances, where there is
no interproximal spacing and mesiodistal narrowing is required, a mechanical.
separator may be used. An Elliot separator is useful for separation of both upper
and lower anterior teeth. With care and experience on the part of the operator,
this is not a painful procedure for the patient. The separator is adjusted slowly,
as it, takes about 30 seconds for the periodontal ligaments to yield to the pressure
of the separator. Only enough separation is provided to allow space for tht:
garnet disks. After gross reduction is accomplished with the garnet disks, tht:

Fig. 2

Figs. 1 and 2. Reshaping maxillary canines to resemble and function as lateral incisors.
Fig. 1. A, Tip of canine flattened to produce an incisal edge. 6, Mesiodistal reduction. C,
Distal incisal angle is slightly rounded. Fig. 2. A, Reduction of canine eminence on labial
surface. B, Lingual surfaces is reduced at incisal area to enable adequate overbite and
overjet to be established.
114 Tuverson Amer. J. Orthodont.
August 1970

separator is removed and final polishing of the surfaces is accomplished with

fine cuttle or sandpaper disks. The use of an ultrasonic unit (Cavitron)
with special insert tips and abrasive paste is an excellent method of removing
enamel from the proximal surfaces of teeth. Fine cuttle or sandpaper disks are
used following this procedure to polish the enamel surfaces.
Maxilky canine-contouring procedwes. First, the tip of the canine is
flattened to produce an incisal edge (Fig. 1, A). Mesial and distal reduction, as
indicated by the diagnostic setup, is accomplished mostly at the expense of the
more bell-shaped distal surface (Fig. 1, B) . The distal incisal angle is slightly
rounded to simulate that of a lateral incisor (Fig. 1, C) . The canine eminence
of the labial surface is then reduced (Fig. 2, A). Extreme care should be ex-
ercised in this reduction. The canines have a slightly darker shade than the
central incisors, and too much labial reduction may result in a darker-appearing
tooth. Finally, the lingual surface is reduced at the incisal area to permit ade-
quate overbite and overjet to be established (Fig. 2, B) .
The canine-contouring procedure is accomplished without local anesthesia,
as sensitivity is a useful indicator of the amount of enamel reduction possible.
For enamel protection, topical fluoride is applied to the tooth immediately
following the contouring procedure. None of the patients whose canines have
been reshaped has complained of sensitivity; nor have there been any pathologic
complications resulting from this procedure.
Variations in maxillary arch wire manipulation
1. There are no typical lateral offset bends. In their place, canine step-out,
rounded bends are placed in the arch wires because of the thicker labial lingual
crown dimension of the canines.
2. Lingual root torque of the canines is required to conform to the shape
of the alveolar bone in the incisor area. Excessive labial root torque of the
canines could damage the apical ends of these long-rooted teeth by forcing them
against cortical bone in the nasal area of the maxilla.
3. Typical canine offset bends are placed in the first premolar area to enable
these premolars to simulate canines. Buccal root torque is also incorporated to
produce some root eminence.
4. When mandibular premolars are not extracted and the occlusion is finished
in a Class II dental relation, there are no first molar bayonet bends for molar
rotations.
The normal arch form and bends incorporated in the mandibular arch wires
are usually not affected in treatment where upper canines replace missing
lateral incisors.
Post-treatment equilibration of the teeth is usually no more involved than
equilibration required following other orthodontic treatment procedures. Addi-
tional contouring refinements of the anterior teeth may be necessary to improve
the esthetic result. Occasionally the lingual cusp of the upper first premolar
requires equilibration to relieve occlusal prematurities. However, if the first
premolars have been positioned to simulate canines with sufficient buccal root
torque to produce some root eminence, the lingual cusps of these teeth &o&l
be clear of any occlusal prcm~t?+kz.
Volume 58 Use of cuwines in place of missing lateral incisors 1 IS
Nlkmber 2

Case reports

In the five cases reported in this article, treatment involved placing the max-
illary canines in the positions of the missing lateral incisors, The first two eases
represent the two basic treatment procedures for this orthodontic problem. The
first is used when there is a mandibular arch-length discrepancy or the case
otherwise indicates a mandibular premolar-extraction procedure. The mandibular
first premolars are extracted but the maxillary premolars are left in place and
treatment is finished with the posterior teeth occupying their normal occlusal
relations. The second ease represents the treatment followed when it is not neces-
sary to extract mandibular teeth. In this procedure treatment is finished with the
posterior teeth occupying Class II occlusal relations. The third case illustrates
a unilateral approach of placing one canine in a missing lateral incisor’s posi-
tion. The fourth and fifth cases demonstrate the usefulness of replacing maxillary
lateral incisors with canines in two unusual and difficult situations.

Fig. 3. Case 1. Before-treatment models. The maxillary lateral incisors were congenitally
missing.
 Amer. J. Orthodont.
Au.yust197O

Comp1et.e records are indispensable in establishin, (r an accurate diagnosis of

the orthodontic problems involved. It is not the purpose of this article to present
a complete diagnostic approach to the orthodontic treatment. Full-mouth radio-
grams, cephalometric records, and complete case histories have been purposely
omitted for the sake of brevity. Each of the five cases will be presented in the
form of a synopsis.

Case 2
The patient was a 17-year-old girl whose maxillary lateral incisors were congenitally
missing. The upper canines had erupted me&al to their normal position, with resulting spacing
on each side of the canines. There was mandibular arch-length discrepancy as evidenced by
anterior crowding (Fig. 3).
The treatment plan was to extract the mandibular right and left first premolars, contour
the maxillary canines to resemble lateral incisors, and place them in the missing lateral
incisors’ positions.

Fig. 4. Case 1. After-treatment models, The maxillary canines were shaped and positioned
to function in place of the missing lateral incisors. Treatment also included extraction of
the mandibular first premolars.
 Use Of canines in place of missing lateral incisors 117

A full edgewise appliance was utilized in the treatment of the malocclusion. Sectional
arch Rires were used for initial retraction of the mandibular canines to gain band space for
the crowded incisors. Upper and lower round arch wires were used to level and correct rota-
tions. Closing loops incorporated in rectangular arch wires were used simultaneously in both
arches for space closure. In the refinement stages of treatment rectangular finishing arch
wires with vertical elastic force rrere used.
A positioner was worn for a final tooth positioning for 6 weeks and then was worn during
the sleeping hours as a retaining appliance.
The active treatment time was 21 months.
Results achieved. A normal and efficient functioning posterior occlusion was established.
The mandihular ant,erior crowding was resolved, space closure was complete, and there was an
esthetic improvement in the dentition (Fig. 4).

Case 2
The patient was a Q-year-old girl with a Class II malocclusion. The maxillary right
and left lateral incisors mere congenitally missing, and the upper permanent canines were

Fig. 5. Case 2. Before-treatment models. The maxillary lateral incisors were congenitally
missing.
118 l'uuerso~ Amer. J. Ortlmdcmt.
August1970

erupting mesinl to their normal positions. Spacing was evident between the upper anterior
teeth. There was adequate mandibular arch length, and the mandibular incisors were upright
over supporting bone (Fig. 5).
The treatment plan was to contour the maxillary canines to resemble lateral incisors
and place them in the missing lateral incisors’ positions. Since there were no dental units
missing in the lower arch, the interarch relation would be finished in a Class II occlusion.
Active treatment was postponed until the canines had erupted sufficiently to be adequately
contoured and banded.
A full edgewise appliance was utilized in the treatment of the malocclusion. The arches
mere leveled and rotations were corrected by means of round arch wires. Closing loops in-
corporated in a rectangular arch wire were used in the upper arch for space closure. In the
refinement stages of treatment rectangular finishing arch wires with vertical elastic force
were used.
A positioner was worn for final tooth positioning for 6 weeks and then was worn during
the sleeping hours as a retaining appliance.
The active treatment time was 14 months.
Re.s&ts a&&owed. An efficient functioning Class II dental occlusion was established. Space

Fig. 6. Case 2. After-treatment models. The maxillary canines were shaped and positioned
to function in place of the missing lateral incisors.
Volume 58 Use of canines in place of missing lateral inckors 119
Number 2

closure of the upper anterior teeth was complete, and an esthetic improvement was achieved
(Fig. 6).

Case 3
The patient eras an ll-year-old girl whose maxillary left lateral incisor was congenitally
missing. The upper left canine had erupted into the missing lateral incisor’s position, result-
ing in a Class II occlusion on the left side. The occlusion on the right side exhibited a Class
II tendency. Although there was some mandibular anterior crowding, adequate arch length
was evident in the lower arch (Fig. 7).
The treatment plan was to follow an asymmetrical procedure. The maxillary left canine
was contoured to resemble and function in place of the missing lateral incisor. Since the
canine was replacing the lateral incisor, it was necessary to maintain the Class II occlusal
relation on the left side while establishing a normal occlusal relation on the unaffected right
side.
A full edgewise appliance was utilized in the treatment of the malocclusion. Initially,
unilateral face-bow cervical traction was instituted to begin establishing normal occlusal rela-

Fig. 7. Case 3. Before-treatment models. The maxillary left lateral incisor was congenitally
missing.
 Anwr. J. Orthodont.
Awwt 1970

tions on the riglit. side. h mandibular lingual arch was inserted to maintain mandibular arch
length. After 3 months of face-bow treatment, the upper left canine ww reshaped to resemble
a lateral incisor and the upper and lower anterior and premolar teeth were banded. Round
arch wires were used to level and correct rotations.
Closing loops incorporated in a maxillary rectangular arch wire were used for necessary
space closure. In the refinement stages of treatment rectangular finishing arch wires were
used with Class II elastic force applied to the right side and Class III elastic force applied
to the left side. In the final stages of treatment the elastic force was changed to vertical
positions.
A positioner was worn for final tooth positioning for 6 weeks and then was worn during
the sleeping hours as a retaining appliance.
The active treatment time was 18 months.
Results achieved. An efficient functioning interocclusal relation was established in this
asymmetric treatment involving a missing maxillary lateral incisor. It was not possible
to reshape the upper left canine to closely resemble the upper right lateral incisor; however,
an acceptable esthetic result was achieved and a prosthetic problem was eliminated (Fig. 8).

Fig. 8. Case 3. After-treatment models. The maxillary left canine was shaped and posi-
tioned to function in place of the missing lateral incisor.
VoZume 58 Use of canines in place of missing lateral incisors 121
Number 2

Case 4
The patient was an 11-year-old girl with a Class II, Division 1 malocclusion. There was a
midline diastema of 4 mm. The upper arch was constricted, with a resulting cross-bite of the
left permanent first molars. Roentgenographic examination revealed pathologic complications
involving the maxillary right central and lateral incisors. The maxillary right canine was
impacted, wifh its crown displaced mesially to the root area of the central incisor. Man-
dibular arch length was adequate, and the mandibular incisors were upright over supporting
bone (Fig. 9).
Treatment involved extraction of the pathologically involved maxillary right central and
lateral incisors and surgical exposure of the crown of the unerupted maxillary right canine.
h full edgewise appliance was utilized in the treatment of the malocclusion. Face-bow
cervical traction was used to reduce the maxillary protrusion and to support Class III elastic
force. When the upper right canine had erupted sufficiently, it ww banded and moved into
occlusion. The band was then removed, the canine was contoured to better resemble a lateral
incisor, and a new band was applied. The canine was placed in the lateral incisor’s position

Fig. 9. Case 4. Before-treatment models. Roentgenograms reveal the pathologically in-

volved maxillary right central and lateral incisors and the impacted position of the upper
right cuspid.
 Amer. J. Orthodoltt.
122 [ruverson August 1970

with push coil springs on a rectangular arch wire. A plastic upper right central incisor was
made, banded, and tied to the arch wire for esthetic purposes. It also provided a stop for
maintaining the correct position of the contoured canine.
The resulting space between the maxillary right first premolar and canine was closed by
means of a closing Ioop in a rectangular arch wire with Class III elastic force on the right
side and Class II elastic force on the left side. After normal occlusal relations had been
established on the left side, vertical elastics were worn to maintain this relation during com-
pletion of the space closure and Class III elastic force on the right side.
In the refinement stages of tooth movement, rectangular finishing arch wires were used
with vertical elastic force. The case was finished in a Class II occlusal relation on the right
side.
A positioner was used for final tooth positioning. To satisfy the esthetic problem created
by the missing central incisor, a relieved maxillary acrylic plate containing a plastic right
central incisor was made to be used while the positioner was not being worn. After 6 weeks
of positioner treatment a new accurately fitting maxillary acrylic plate containing a plastic

Fig. 10. Case 4. After-treatment models. The pathologically involved maxillary right ceni kal
and lateral incisors were extracted and the impacted canine was positioned and shaf )ed
to fl Jnction in place of the extracted lateral incisor. A plastic right central incisor was in-
carp lorated in the maxillary retainer.
Fig. 11. Case 5. Before-treatment models. The four first premolars had been extracted and
active treatment was about to begin when an accident caused the four maxillary incisors
to be knocked from the mouth. The two central incisors were immediately replanted fol-
lowing root canal therapy, but the two lateral incisors were too badly fractured to br
replaced.
 about, to begin when tragedy struck. The patient was involred in an accident in which the
four maxillary incisors were knockrd from the mouth. The two central incisors vver~~ replanted
immediately following root canal therapy, but the two lateral imisors were too badly frac-
turd to be replaced (Fig. 11).
The wcident required a re-evaluation of the orthodontic proldrms. Four teeth (two first
premolnrs and two lateral incisors) ww now missing from tllf, maxillary arch, and the future
loss of the two replanted central incisors was probable. The treatment plan was changed to
place the maxillary canines in the missing lateral incisors’ positions and close all existing
spaces. Treatment would then be finished with the posterior teeth in a Class IT occlus:~l rclx-
tion.
It was thought that the central incisors should bc maintained as long as possible to
establish normal alveolar bone morphology in that area. Teeth lost prior to completion of
vertical jaw growth result in poor alveolar 11onra morphology. A receded, hollowed-out alveolar
ridge is produced, which complicates future prosthetic restorative treatment. Placing the
canines adjacent to the central incisors not only would afford :I better opportunity for dcvc~lop-

Fig. 12. Case 5. After-treatment models. The upper canines were shaped and positioned
to fc mction in place of the missing lateral incisors.
 A

Fig. 13. After-treatment photographs of the five cases described in this article. A, Case 1
6, Case 2. C, Case 3. D and E, Case 4. (Note plastic tooth in E.) F, Case 5.
 Amx J. Orthodont.
August 1970

Results achieved. An efficient, functioning Class 11 ocolusal relation of the posterior teeth
was established. Placing the upper canines in the lateral incisors’ positions resulted in im-
proved alveolar morphology. When the central incisors are eventually lost, the canines mill
make excellent abutment teeth in their newly acquired positions (Fig. 12).

Conclusion

This article has described treatment in which canines are positioned to

replace missing maxillary lateral incisors. Although a few cases require the
opening of spaces for artificial teeth, the recommended procedure is to move the
canines into the spaces of the missing lateral incisors whenever possible.
Prosthetic problems are eliminated and, if the canines are properly shaped to
resemble lateral incisors, consistently better esthetic results are achieved.
The degree of esthetic improvement varies. The original size and shape of

Fig. 14. After-treatment photographs of cases treated by shaping and posF+ioning of maxil-
lary canines to function in place of missing lateral incisors.
the canines as well as the ability to shape and position these teeth to resernblv
and function as lateral incisors are the importaM factor% in the suwess of these
C’BSCS.

REFERENCES
1. Strang, K. IV., and Thompson, W. M.: Textbook of orthodouti:l, chd. 1, Philadelphia, 1959,
Lea & Febiger.
2. Black, G. V.: Descriptive anatomy of the human twth, ed. -$ Phihdelphia, 1902, S. S.
White Dental Manufacturing Compwy.
3. Salzmann, J. A. : Ortllodolitieu--Plinc,iplc,s and pwwntion, t’l~iladelphia, l!Gi, .1. 13.
I~ippinvott Comp:~ny.

Francis Bacon says of innovations, “It is true that what is settled by custom, though
it be not good, yet at least it is fit; and those things which have long gone together
are, as it were, confederate within themselves; whereas new things piece not so well,
but though they help by their utility, yet they trouble by their inconformity. This would
be true if time stood still, which contrariwise, moveth so round that a forward retention
of custom is as turbulent a thing as an innovation; and they that reverence too much
old things are but a scorn to the new. It were good, therefore, that men, in their
innovations, would follow the example of time itself, which indeed, innovateth greatly,
but quietly and by degrees, scarce to be perceived.” (Pullen, Herbert A.: President’s
Address, Transactions of the seventh annual meeting of the American Society of Ortho
dontists, Oct. 2 to 4, 1907, p. 7.)