CATEGORY 78 AUSTRALASIAN DENTIST CLINICAL Introduction Canine substitution cases are often presented as a straightforward solution for congenitally missing maxillary lateral incisors. Orthodontic space closure is completed, the canines are repositioned, and the case is considered resolved. In reality, this is where the real challenge begins. While canine substitution is biologically sound and avoids many of the long-term complications associated with implants, achieving a natural aesthetic outcome can often be di cult. The Core Problem: A Canine Is Not a Lateral Incisor One of the most underestimated challenges in dentistry is attempting to make one tooth look like another. A canine is fundamentally di erent from a lateral incisor in several key aspects: u Gingival margin position Canines typically have a more apical gingival zenith, disrupting the ideal gingival contour. u Cervical bulk e gingival third of a canine is inherently more convex, creating a heavier emergence pro le. u Tooth morphology and chroma Canines are more saturated in colour and have stronger line angles and labial prominence. ese di erences are not minor details – they are visually dominant features. is is why: Canine substitution cases can be straightforward… until you actually try to make them look natural. Initial Approach: Composite Bonding A conservative, additive approach was undertaken using direct composite bonding. e aim was to: u Lateralise the canines visually u Reduce negative space u Improve symmetry across the anterior segment From a technical standpoint, the result was acceptable. From an aesthetic standpoint, it was an improvement. But it was not enough. After one year, the patient returned expressing ongoing dissatisfaction. e issue was not the quality of the work – it was the limitation of the approach. e canines still did not feel like lateral incisors. Case Study: Canine Substitution: Why “Good Enough” Often Isn’t Good Enough Dr. Andrew See By Dr. Andrew See BDS Hons (Syd), FRACDS, MSc(Lond), PGDipDentImplantology, FCGDENT(UK), FICOI, MFDS RCSEng Aesthetic Dentist and Educator, Founder of Dental Mastery Academy Patient Presentation A patient in her late 30s presented with congenitally missing maxillary lateral incisors. Orthodontic space closure had previously been completed, resulting in the canines occupying the lateral incisor positions. Functionally, the case was stable. Aesthetically, it was not. e patient’s primary concern was that her “lateral incisors” never looked quite right. She described them as: u Too large and pointy u Too prominent u Visually di erent from what she perceived as natural She was not willing to undergo further orthodontic treatment to reopen spaces for implant placement and preferred a conservative approach. The Turning Point: Recognising the Limitation of Isolated Treatment A common mistake in these cases is attempting to treat the substituted canine in isolation. is approach often fails because: u e canine remains visually dominant u Adjacent teeth are not harmonised u e discrepancy becomes more noticeable, not less
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