Comprehensive insights and clinical pathways for managing congenitally missing mandibular incisors: A literature review

Congenitally missing mandibular incisors present a unique clinical challenge in orthodontics due to their relative rarity and association with craniofacial variations. This literature review synthesized existing case reports and studies to outline diagnostic considerations, craniofacial characteristics, etiology, and treatment strategies. Genetic factors, developmental anomalies of the mandibular symphysis, and evolutionary theories have been implicated in the etiology of incisor agenesis, with higher prevalence observed in East Asian populations. Affected individuals often exhibit skeletal Class III tendencies and distinctive mandibular symphysis morphology. Treatment modalities include extraction strategies, space closure, and prosthetic space creation, with planning guided by Bolton analysis, digital model setup, and facial esthetics. A treatment decision flowchart was developed based on decades of clinical evidence to support individualized, interdisciplinary care. Advances in 3D imaging and digital simulation offer enhanced precision in evaluating treatment feasibility and outcomes. This review emphasizes the importance of integrating skeletal analysis, occlusal balance, and patient-specific factors to achieve optimal functional and esthetic results in cases of congenitally missing mandibular incisors.