Orthodontic and Implant Rehabilitation of a Patient with Missing Mandibular Incisors:A Case Report

AbstractIntroduction: The loss of mandibular incisors, whether congenital or acquired, presents aesthetic, functional, and biomechanical challenges for orthodontists. Restoring anterior guidance, space balance, and smile esthetics and harmony often requires interdisciplinary planning with prosthetic rehabilitation.Case Report: A 17-year-old female patient reported with a Class I molar and canine relationship. Clinical examination revealed microdontia of tooth 41 along with congenital absence of teeth 31 and 42. Overjet and overbite could not be assessed due to the absence of mandibular anterior teeth. Orthodontic treatment with a 0.022-in MBT fixed appliance system was initiated to redistribute space and align arches while maintaining molar and canine relationships. Sequential archwire progression (0.014-in NiTi to 0.019 × 0.025-in stainless steel) achieved proper space distribution. Therapeutic extraction of 41 was done and CBCT confirmed adequate alveolar bone. Two implants were placed in the 31 and 42 regions. Following osseointegration, screw-retained crowns were delivered. Retention was provided with a fixed mandibular canine-to-canine retainer and a removable maxillary retainer.Results: Treatment achieved well-aligned arches with preservation of Class I relationships and ideal space for prosthetic rehabilitation. Implant supported crowns successfully restored aesthetics, phonetics, and function. At the 12-month follow-up, occlusion remained stable, with improved esthetics, function, and patient satisfaction.Discussion: This case underscores the importance of orthodontic biomechanics in space creation and root positioning prior to implant placement. Literature supports that interdisciplinary collaboration is essential for long-term stability and aesthetic success in cases of anterior tooth loss. Implant supported crowns offer a durable and aesthetic alternative compared with space closure or conventional prostheses.Conclusion: An interdisciplinary orthodontic–prosthodontic approach is essential in managing patients with missing mandibular incisors. Sequential archwire therapy optimized space distribution and root parallelism, enabling successful implant placement and long-term aesthetic and functional outcomes.