Initial situation
- Agenesis of the lower right and left second premolars (4.5 and 3.5)
The decision
Treatment addressed agenesis of the lower 4.5 and 3.5 by creating and maintaining proper space in each site to prepare for future prosthetic restoration.
A restoration of the central incisor was also planned as part of completing the smile.
Coordinating orthodontic space management with the restorative plan from the outset supports a stable, functional outcome.
The result
Treatment with the Damon Q bracket system over 26 months produced a stable, functional, and esthetically pleasing result, with sites prepared for planned prosthetic work.
Cases involving congenital tooth agenesis benefit from early coordination between orthodontic space management and the restorative plan.
About skeletal expansion & MARPE
Congenitally missing teeth change the treatment sequence: space must be created or preserved with the eventual restoration in mind, not simply closed or left unmanaged. Staged planning that accounts for the restorative endpoint from the start of orthodontic treatment reduces the risk of inadequate space, poor root angulation, or occlusal interferences later. This case illustrates how transverse and sagittal space management intersect with prosthetic treatment planning in agenesis cases.
Questions clinicians ask
What is dental agenesis?
Agenesis refers to the congenital absence of one or more teeth, in this case the lower second premolars.
Why was space maintained rather than closed?
Space was created and preserved at the agenesis sites to prepare them for future prosthetic restoration rather than closing the gaps orthodontically.
How long did this treatment take?
This case was completed in 26 months using the Damon Q bracket system.
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Original case shared by Dr. Mark Radzhabov on Instagram @orthodont_mark · Published for professional education.
