Their reasoning is that the presence of replacement teeth will hold the tongue in a better position. In this way, the development of a tongue thrust is less likely. We are aware of no well validated empirical research which actually demonstrates an association between missing primary anterior teeth and the development of tongue thrust. Nevertheless, replacement of multiple missing primary maxillary incisors is standard practice for some practitioners as a precaution. We cannot identify any serious risks to this approach, and it may indeed turn out to be a useful strategy as research provides more information on the topic of tongue thrust development.

Of course, many parents applaud the procedure because of the improved esthetics.

There also are many pediatric dental offices and many dental schools where multiple missing primary anterior teeth are not replaced, at least routinely. Space loss usually is not a consideration, and monitoring for that problem can be used to insure that it does not occur. Most third party carriers also will not cover the prosthetics procedure (i.e., insurers will not reimburse you for the procedure and it will be an out-of-pocket cost for the parents).

The authors prefer to leave the decision to the individual clinician, based on particular circumstances.