Modern restorative management of patients with congenitally missing teeth: 2. Orthodontic and restorative considerations

Managing edentulous spaces in patients with congenitally missing teeth demands careful planning and, often, a multidisciplinary approach. Orthodontic tooth movement can be considered to close spaces as well as improve the distribution of available teeth. In this second paper, the advantages of a collaborative approach are discussed.     

Modern restorative management of patients with congenitally missing teeth: 3. Conventional restorative options and considerations

Restoration of spaces in hypodontia patients needs to take into account many factors including, the number of missing teeth, the distribution of space, the size of the teeth, and the age of the patient. This paper considers adhesive and conventional bridgework, as well as removal alternatives for the restoration of spaces. The various merits of each are discussed, together with treatment planning considerations for such cases.     

Modern restorative management of patients with congenitally missing teeth: 1. Introduction, terminology and epidemiology

The management of patients with congenitally missing teeth can be a challenge and, in many cases, requires multidisciplinary care. In this four-part series, a contemporary approach to managing this group of patients is discussed. This first paper examines the terminology, epidemiology and restorative challenges that such patients can exhibit.     

Skeletodental patterns in patients with multiple congenitally missing teeth.

Congenitally missing teeth (CMT) are a relatively frequent phenomenon. In severe cases of multiple CMT, the skeletodental pattern can be unique. However, the characteristics of this pattern are still controversial. Thus, it was our aim to evaluate the skeletodental patterns of patients with multiple CMT and compare them with norms. Lateral cephalograms of 115 subjects with at least 3 CMT, of at least 2 different tooth groups (excluding third molars), were analyzed. The measurements were compared with classical and Israeli norms. Differentiation between anterior and posterior lack of teeth was also evaluated. In the CMT patients, the maxillary and mandibular basal bones were more retruded than in normal populations, but the intermaxillary relationship was normal. The profile was flatter than in the normal Israeli population but more convex than the classical norms. In the vertical dimension, the study group exhibited a reduced Frankfort mandibular plane angle when compared with Israeli norms. The dental pattern was characterized by upright incisors. When differentiation between anterior and posterior lack of teeth was undertaken, the above features were exacerbated in the patients with anterior tooth absence. It was concluded that patients with multiple CMT demonstrate a characteristic skeletodental pattern, especially those with missing incisors.     

62例伴先天缺牙错畸形的正畸治疗临床分析

目的回顾性总结分析伴有先天缺牙的错畸形患者先天缺牙的部位、类型和矫治方法。方法选择结束治疗的正畸患者中伴有先天缺牙者62例,对缺牙数目、部位、类型和矫治方法进行总结分析。结果缺牙部位最常见的是下颌中切牙、上颌侧切牙和下颌侧切牙,以少数牙缺失为主,女性多于男性。7例替牙期患者行一期矫治,恒牙列中23例结合拔牙减数,19例行集中间隙、结合义齿修复,10例结合邻面去釉减径,2例行前移后牙替代的方法进行矫治,矫治结果满意。结论对伴有先天缺牙的错畸形,替牙期先行一期矫治后观察,恒牙期根据缺牙数目、部位、类型及错采用结合减数、减径或集中间隙修复的方法均可获得满意的矫治效果。     

Current restorative modalities for young patients with missing anterior teeth.

The early loss of permanent teeth following trauma or congenital aplasia may be corrected by orthodontic or prosthetic means, sometimes combined with implant therapy. The orthodontic solution results usually in different anatomic, functional, and esthetic problems. Prosthetic and implant procedures, on the other hand, are very demanding and require long-term maintenance. Considering these limitations, a comprehensive diagnostic and treatment plan is mandatory to achieve the most satisfactory clinical result. Modern restorative modalities, such as recontouring, bleaching, and resin composite bonding, may improve the final clinical result after orthodontic space closure. In more difficult situations, veneers and crowns may also be indicated.     

正畸技术联合种植修复技术治疗先天缺牙错[牙合]的临床应用体会

目的：探讨正畸技术联合种植修复技术治疗先天缺牙错的临床应用效果。方法：7例先天缺牙患者采用正畸技术集中间隙后植入14枚XIVE柱状螺纹纯钛种植体,治疗完成后用活动保持器保持。结果：14枚种植体经过12-38个月的随访无一例失败,并且牙列的咬合关系保持良好。结论：正畸联合种植义齿修复是一种较好的治疗先天缺牙错[牙合]的临床方法。     

Radiographic assessment of congenitally missing teeth in orthodontic patients

Summary. Objective. To estimate the prevalence of congenitally missing teeth (CMT) in patients evaluated for orthodontic care. A sample of 668 panoramic radiographs from Mexican population was reviewed from orthodontic healthy patients, 9–20 years old. Method. Statistical tests were used to compare maxillary and mandibular hypodontia in right and left quadrants between males and females. Results. Prevalence was 27% when all teeth were included, and was 2·7% when third molars were excluded. A significant difference was found between maxillary and mandibular symmetrical CMT in third maxillary molars, lateral incisors and second premolars (P < 0·001), and in mandibular third molars and central incisors (P < 0·001). Conclusions. We confirmed that occurrence of CMT in the permanent dentition of a Mexican population most often affects third molars, followed by maxillary lateral incisors and then mandibular second premolars.     

Delayed calcification and congenitally missing teeth. Case report

A case of delayed differentiation and/or calcification, that is, development, followed by accelerated growth of the maxillary second premolars is presented. This condition was accompanied by the congenital absence of mandibular second premolars even though maxillary and mandibular third molar germs were present. The case was followed over a five-year period. It seems that agenesis of any tooth might be found in conjunction with delay in development of any other tooth. Moreover, full development of a tooth germ (followed by an accelerated growth) as well as pathological changes may occur, despite an initial marked delay in tooth development.     

The restorative management of hypodontia with implants: 2. Planning and treatment with implants

The first paper discussed the clinical features of patients with hypodontia. A range of treatment options were considered with examples given. In this second paper, the implant treatment option for patients is discussed in detail.     

Managing congenitally missing lateral incisors. Part III: single-tooth implants

Three treatment options exist for the replacement of congenitally missing lateral incisors. They include canine substitution, a tooth-supported restoration, and a single-tooth implant. Selecting the appropriate treatment option depends on the malocclusion, anterior relationship, specific space requirements, and condition of the adjacent teeth. The ideal treatment is the most conservative option that satisfies individual esthetic and functional requirements.
Today, the single-tooth implant has become one of the most common treatment alternatives for the replacement of missing teeth. This article closely examines the many interdisciplinary issues that arise when treatment planning the placement of single-tooth implants in patients with congenitally missing lateral incisors. The specific criteria that must be evaluated illustrate the importance of an interdisciplinary treatment approach to achieve optimal esthetics and long-term predictability. This is the final article of a three-part series discussing the three treatment alternatives for replacing congenitally missing lateral incisors.     

Multiple congenitally missing teeth treated with autotransplantation and orthodontics

Treatment of children with several congenitally missing teeth is challenging, because growth and development of the oral structures must be considered. The treatment options include retaining the deciduous teeth and postponing treatment until later or extracting the deciduous teeth and doing one of the following: allowing the space to close spontaneously, closing the space orthodontically, or in patients whose growth is finished, using a prosthetic or implant replacement. One other viable option, if donor teeth are available, is autotransplantation. The treatment plan for patients with missing teeth should be based on a comprehensive evaluation of the patient's age, occlusion, and space requirements as well as on the size and shape of the adjacent teeth. This case report presents the management of a patient in the early mixed dentition with multiple missing teeth. The treatment consisted of a combination of autotransplantation of the maxillary right first premolar to the mandibular right first premolar region and orthodontic treatment with a 5-year follow-up after autotransplantation.     

Management of congenitally missing second premolars with orthodontics and single-tooth implants.

This article describes the treatment of an adolescent girl who was congenitally missing all 4 second premolars and had a retained mandibular second primary molar. Various treatment alternatives are discussed, and the final treatment plan of space opening for 3 implants and space closure of the maxillary left second premolar site is presented.     

Multidisciplinary treatment of mandibular prognathism with multiple congenitally missing teeth

Surgical orthodontic treatment and dental implant therapy were performed on a man (aged 18 years 8 months) with mandibular prognathism and seven congenitally missing teeth: upper canines, first and second premolars and lower right second premolar. After 17 months of preoperative orthodontic treatment at age 20 years 1 month, sagittal split ramus osteotomy was performed using the remaining upper deciduous teeth as an anchor for intermaxillary fixation. In postoperative orthodontic treatment, the remaining deciduous teeth were extracted, and fixture installation was performed. The entire therapy required 4 years to complete (age 22 years 8 months). After completion of orthodontic treatment, superstructures were put in place. This patient had many dental problems, so multidisciplinary care was performed in conjunction with other departments to improve oral function and facial esthetics.     

Fiber-reinforced composite bridge and splint. Replacing congenitally missing teeth

The congenital absence of permanent teeth, also known as partial anodontia, is a relatively common problem. The patient missing one or both lateral incisors is a frequent occurrence. The treatment of missing laterals involves both functional and esthetic considerations. Options include: cuspid lateralization; implant placement; conventional three-unit bridge; Maryland bridge; and a fiber-reinforced composite bridge (direct or indirect). Direct fiber-reinforced composite bridges provide a minimally invasive restorative option that allows for future implant placement. Selection of appropriate fiber reinforcement and placement of the fibers allows long-term clinical success. Adherence to appropriate adhesive protocol is mandatory.