American Board of Orthodontics (ABO) Practice Exam 2026 - Free Orthodontics Practice Questions and Study Guide

Kokich recommends canine substitution in cases of upper second incisor agenesis primarily within Angle Class II occlusions. This recommendation is based on the characteristics of occlusion in Class II, which often show a more favorable relationship for canine substitution due to the positioning of the upper canines in relation to the malocclusion.

In Angle Class II, the upper molars are positioned more buccally than the lower molars, typically resulting in a relationship where the upper canines can take on more functional responsibility at the anterior segment. Canine substitution can help to maintain occlusal function and aesthetics when the upper second incisors are missing, as the canines can serve as the primary contact points during occlusion.

Further, substituting the canines for incisors can also simplify treatment and emphasize achieving a stable occlusion, especially important in Class II cases, which may inherently have challenges associated with overjet and overbite. This strategy not only addresses tooth loss but also aligns with the goals of orthodontic treatment to create a functional and aesthetically pleasing result.