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Ugly Duckling Stage Reassurance — ORE Part 1 MCQ

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EasyOrthodonticsUgly Duckling Stage ReassuranceORE Part 1

A 12-year-old presents with a midline space between the maxillary permanent central incisors. Both maxillary permanent lateral incisors are present and the permanent canines have not yet erupted. There are no signs of delayed or ectopic canine eruption. The parent is concerned about appearance. What is the most appropriate advice?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: B — Reassure, review eruption, and defer treatment unless the space persists

Explanation lettering: D = shown as A · A = shown as B · E = shown as C · B = shown as D · C = shown as E

A is correct. This is the physiological late mixed-dentition “ugly duckling” stage: maxillary incisor spacing may occur before eruption of the permanent canines. In the absence of ectopia, asymmetry or delayed canine eruption, provide reassurance and review eruption before considering treatment. If the diastema persists after canine eruption, orthodontic assessment may then be appropriate. Extracting sound lateral incisors is harmful and does not address a normal developmental stage. Veneers are inappropriate in a developing dentition. A frenectomy is not indicated solely because a diastema is present at this age, and fixed-appliance treatment is premature when spontaneous reduction in spacing may occur with canine eruption.

Reference: Ristaniemi J et al. Minimally invasive orthodontic management: a paradigm shift in interceptive care. Part I - concept and palatally displaced canines, 2025; Figure 2 describes the physiological late mixed-dentition ugly duckling phase. https://pubmed.ncbi.nlm.nih.gov/41711802/