4 C linical orthodontics is a service that should be grounded in science and biology. The science of decision in treatment planning implies identification of alternative procedures, prediction of the relative odds in favor of the desired long-term outcome for each option, and evaluation of the relative cost-risk-benefit ratios of each alternative. The decision should be comprehensible to the patient or parents and best meet the patient’s needs. Whether canine substitution, single implants, or toothsupported restorations is the method of choice for patients with missing maxillary lateral incisors, many challenges are involved in obtaining and retaining an optimal result.