Maxillary Lateral Incisors have been proven to be specifically difficult with adult cases, most of the time its rotations, extrusion, and intrusions that laterals have issues with. Sometimes laterals can remain out of alignment even after revisions and despite compliance not being an issue, nor tight contacts.
The most significant challenge with maxillary lateral incisors is that they are a relatively smaller tooth compared to the adjacent maxillary central incisor. The smaller size results in less tooth structure for the aligner material to adapt to for tooth movement.
Additionally, the relatively narrower width of relative to the maxillary incisor makes rotational moments about the incisal edge more difficult. In other words, there is simply less tooth for the aligner to hold onto.
Another complication is the lateral incisor's root position. Since the lateral incisors erupt after the central incisors, in situations of arch length deficiency, they are often out of alignment with the root in a more palatal position. In this situation, not only does the incisal edge of the lateral incisor need to be moved into alignment but the root also requires significant movement.
Stubborn maxillary laterals can also be caused by the following:
- Ankylose teeth
- Peg laterals
Given the above considerations, it is not surprising that movement of the lateral incisor requires extra effort.
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