a girl , aged 18 years 5 months , came to my practice with the request of having teeth fixed for upper front spacing . the intraoral examination showed half - cusp class ii molar relationships and spacing in upper arch with crowding of 3.5 mm in the mandibular arch . her maxillary dental midline was displaced 2 mm to the right of the facial midline and mandibular dental midline coincided with the body midline . overbite was 50% with a moderate curve of spee of 3 mm [ figures 19 ] . pretreatment - extraoral frontal pretreatment - extraoral profile pretreatment - intraoral frontal pretreatment - intraoral left pretreatment - intraoral occlusal lower pretreatment - intraoral occlusal upper pre treatment intraoral x - ray pretreatment - intraoral right midtreatment - intraoral the panoramic radiograph showed normal root and tooth development , with the missing maxillary lateral incisors . cephalometric assessment showed class ii ( wits , 2 mm ; anb , 4.5 ; sn - gogn , 32 ) with normally inclined incisors [ table 1 , figures 10 and 11 ] . cephalometric analysis pretreatment - lateral cephalogarm pretreatment orthopantomogram ideally , the treatment objectives would include full resolution of the replacement of the missing teeth . however , achievement of this objective might subject the restoration and orthodontics . class i molar and canine relationships , ideal overjet and overbite , and an esthetic smile with minimal change in the profile were desired . we started the case on size 022 roth preadjusted edgewise appliance ( pea ) , and did initial leveling and aligning of the upper and lower arches . after leveling , we planned to open space for the missing teeth , followed by more radiographs to confirm the position of the canine and central incisors roots . sequential arch wire changes progressing to rigid stainless steel wires were achieved in both arches . open - coil spring was used to open up the space for the laterals . after space for implants were consolidated , tapered root implants were placed by osteotomy in the lateral areas . check x - rays confirmed their positions . ideally , the treatment objectives would include full resolution of the replacement of the missing teeth . however , achievement of this objective might subject the restoration and orthodontics . class i molar and canine relationships , ideal overjet and overbite , and an esthetic smile with minimal change in the profile were desired . we started the case on size 022 roth preadjusted edgewise appliance ( pea ) , and did initial leveling and aligning of the upper and lower arches . after leveling , we planned to open space for the missing teeth , followed by more radiographs to confirm the position of the canine and central incisors roots . sequential arch wire changes progressing to rigid stainless steel wires were achieved in both arches . open - coil spring was used to open up the space for the laterals . after space for implants were consolidated , tapered root implants were placed by osteotomy in the lateral areas . check x - rays a common orthodontic restorative situation involves a patient who has congenitally missing one or two lateral incisors . if the patient has one maxillary lateral incisor missing , the contralateral incisor would determine the amount of space for the implant and crown . however , in some patients , the existing lateral may be peg shaped . in other situations , both lateral incisors missing are congenitally absent and the amount of space is determined by two factors  esthetics and occlusion  . the size relationship has been called as the  golden proportion  . ideally , maxillary lateral incisor should be about two - third the width of the central incisor . since most central incisors are about 9 mm wide , the width of the lateral incisor space should not be less than 6 mm . if the edentulous space is 6 mm wide , then 1.4 mm would exist between the implant and adjacent roots . in this case , the important things are implant site development and timing of implant placement , which are vital for the success , and had been achieved [ figures 1222 ] . posttreatment - extraoral profile posttreatment - extraoral frontal posttreatment - extraoral smile posttreatment - intraoral left posttreatment - intraoral occlusal upper posttreatment - intraoral occlusal lower posttreatment - intraoral right posttreatment - intraoral frontal posttreatment - intraoral x - rays posttreatment - orthopantomogarm posttreatment - lateral cephalogarm the restoration was fully achieved with ideal class i molar and canine relationships .
in an orthodontic patient , missing teeth will require restoration or reshaping of an adjacent tooth , after the orthodontic treatment . 
 furthermore , each type of restoration may require slightly different tooth position . 
 therefore , it is mandatory for the team to establish a treatment plan . the orthodontist should join hands with the restorative dentist and consult before the treatment plan . 
 however , some adult orthodontic patients may have several missing permanent teeth . if teeth have been absent for several years , the remaining teeth may have been drifted . 
 in such situation , it may be necessary to position the teeth in unusual place . 
 these patients may require a combination of orthodontic and restorative dentistry to rehabilitate their occlusion . in these patients 
 , it may be difficult for the orthodontist to visualize or foresee the final result as she / he may not be aware of restorative requirements or the eventual restoration plans and vice versa for the restorative dentist also .