Child's mouth with a large arched gap between the two front teeth. In certain cases with young patients, traditional therapy can be inadequate or even impossible. In a recent article, I discussed the autotransplantation method when correcting geminating central incisors in still-growing patients. Another great option in treating these cases is to use the orthodontic substitution method.

Orthodontic substitution is the horizontal movement of teeth laterally into the defective area. This procedure is ideal for younger patients mainly because you can use the growth and development of your patient to your advantage. It requires early extraction of the geminating central incisors, which will ultimately aid in moving the teeth towards the midline.

After the extraction of the defective centrals, one of two things will occur and will guide you through the rest of your treatment planning procedures:

  • The lateral incisors will automatically move into the central position, bringing bone and gingiva with it. After bone is developed in the area, you can orthodontically move the laterals back to their origin and replace the centrals.
  • The lateral incisors will move into the central incisors position and stay there. The laterals will then be modified with composite to give them the appearance of central incisors.

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