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: 4. The role of implants

In this fourth and final paper on the management of patients with congenitally missing teeth, the use of dental implants is considered. This group of patients often provides unique challenges when implant reconstruction is considered. Often a multidisciplinary approach is required involving orthodontists, oral surgeons and restorative dentists. The use of dental implant systems is a rapidly developing area of dentistry and its implications on hypodontia are discussed. This paper identifies the problems associated with a congenital absence of teeth and addresses their management in relation to the use of implants. Clinical Relevance: The use of dental implants in hypodontia patients should always be considered as a treatment option. These groups of patients, however, require careful planning, often of a multidisciplinary nature, so that the timing of the various treatment modalities is seamless.     

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.     

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.     

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.     

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.     

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.     

A question of space: options for the restorative management of worn teeth

The prevalence of tooth surface loss has increased in recent years. The essence of management is an effective preventive regime; however, in many instances restoration may also be necessary. A number of strategies is available for creating sufficient space to enable restoration and several techniques for restoration known. This article reviews the significance of the vertical dimension of occlusion and describes the restorative management of a patient affected by severe tooth wear.     

Multiple congenitally missing primary teeth: report of a case

The prevalence, possible etiological factors and management of multiple missing primary teeth was briefly reviewed. Oligodontia of the primary dentition is a rare finding. This paper reports a rare case of multiple missing (n=9) primary teeth in a 3-year-old male of Asian origin.