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Adult hypodontia: a method of rehabilitation
Journal
of Dentistry,
4, 66-70
Adult hypodontia: rehabilitation D. M. Menetes, Department
MDS, LDS RCS, DOrth RCS
of Dental Health, University
R. M. Basker, Department
a method of
of Birmingham
MDS, LDS RCS
of Dental Prosthetics,
University
ABSTRACT The treatment of an adult patient with hypodontia is described. Rehabilitation involved both orthodontic and prosthetic treatment and was carried out with removable appliances designed to serve more than one purpose.
of Birmingham
Hospital with problems of appearance due to hypodontia (Figs. I, 2) On clinical examination she had a normal facial appearance with a mild Class 2 skeletal pattern but a favourable soft tissue pattern which had produced an acceptable incisor relationship. X-rays confirmed the absence of 87 5432 8
INTRODUCTION
54
12 45 78 111 4.5
8’
THE congenital absence of one or more permanent teeth, a condition known as hypodontia, has interested clinicians for many years. Numerous findings have been reported concerning the population affected by hypodontia, the prevalence ranging from 2.3 to 10-l per cent (Dolder, 1937 ; Werther and Rothenberg, 1939 ; Byrd, 1943; Clayton, 1956; Grahnen, 1956; Brown, 1957; Glen, 1964; Rose, 1966; Hunstadbraten, 1973). In hypodontia the clinical problem is one of spacing and irregularity of the dentition. Frequently the positions of the teeth do not readily allow for successful replacement of missing teeth. In such instances the treatment of choice is to align the teeth by orthodontic means before prosthetic treatment. This paper reports the treatment of such a patient with hypodontia by means of orthodontic alignment and prosthetic replacement of teeth. CASE REPORT A female aged 20 years was referred to the Orthodontic Department of the Birmingham Dental
Fig.
I.-Appearanceof
the patient before treatment.
Menezes and Basker
: Adult Hypodontia
69
the
Fig. j.-Occlusal
view of study models
before
treatment.
Fig. I.-Appearance
dontic
alignment
of the teeth following orthoof !#
and the fitting
of an
immediate upper partial denture.
The following teeth had erupted: 7°F E;;,FC
E;7 (Fig. 3).
Associated with the hypodontia was the reduced size of the upper permanent central incisors, their mesiodistal width being 7 mm. The upper first permanent molars were small and triangular in shape. The only signs of ectodermal defects exhibited by the patient were thinness of the hair and dysplasia of the fingernails. Enquiries into the family history revealed that the patient’s sister had one congenitally missing tooth and psoriasis. The patient’s concern with regard to her appearance during treatment dictated the use of removable rather than fixed orthodontic appliances. Fortunately, removable appliances were found to be 111 . satisfactory since alignment of - mvolved tilting 31
Fig. 5.-Appearance of treatment.
of the patient at completion
rather than bodily or rotary movements. With regard to the upper jaw, the first stage of treatment was to bring the upper permanent central incisors together. The appliance was retained with Adams cribs on 616 and ‘C’ clasps on EJ; palatal finger springs served to close the median diastema. Once alignment of 111was completed, the position was retained with asecond appliance : a partial denture which was an immediate replacement for 3.
70
Journal of Dentistry, Vol. ~/NO. 2
The lower appliance served both prosthetic and orthodontic functions; the anterior saddle was an immediate replacement for the misaligned and mobile AIA, while a finger spring was used to move 7 mesially into a more favourable position, Once the q was aligned, it was retained by an artificial tooth added to the 5Ij saddle area. The result after 6 months of treatment (Figs. $5) showed a considerable improvement in appearance. The patient also reported an improvement in masticatory efficiency.
Acknowledgements We wish to thank Professor T. D. Foster for his encouragement and advice, and to the staff of the Department of Clinical Illustration, Birmingham Dental Hospital, for the photographs. REFERENCES BROWN R. V. (1957) Pattern
congenital 60-61.
and frequency of absence of teeth. Iowa Dent. J. 43,
BYRDE. D. (1943) Incidence of supernumerary and congenitally missing teeth. J. Dent. Child. 10, 84-86.
CLAYTONJ. M. (1956) Congenital dental anomalies occurring in 3557 children. J. Dent. Child. 23, 206-208.
DOLDER E. (1937) Deficient dentition.
Dent. Rec.
57, 142-143.
GLEN F. B. (1964) A consecutive the prevalence of congenitally private pedodontic practice in ally separated areas. J. Dent.
six-year study of missing teeth in two geographicChild. 31, 264-
270.
GRAHNENH. (1956) Hypodontia in the permanent dentition. A clinical and genetic investigation. Odont. Revy 7, l-100. HUNSTADBRATENK. (1973) Hypodontia in the permanent dentition. J. Dent. Child. 40, 115 117. ROSEJ. S. (1966) A survey of congenitally missing teeth, excluding third molars, in 6000 orthodontic patients. Dent. Pratt. Dent. Rec. 17, 107114.
WERTHER R. and ROTHENBERGF. (1939) Anodontia. Am. J. Orthod. 25, 61-81.
of Dentistry,
4, 66-70
Adult hypodontia: rehabilitation D. M. Menetes, Department
MDS, LDS RCS, DOrth RCS
of Dental Health, University
R. M. Basker, Department
a method of
of Birmingham
MDS, LDS RCS
of Dental Prosthetics,
University
ABSTRACT The treatment of an adult patient with hypodontia is described. Rehabilitation involved both orthodontic and prosthetic treatment and was carried out with removable appliances designed to serve more than one purpose.
of Birmingham
Hospital with problems of appearance due to hypodontia (Figs. I, 2) On clinical examination she had a normal facial appearance with a mild Class 2 skeletal pattern but a favourable soft tissue pattern which had produced an acceptable incisor relationship. X-rays confirmed the absence of 87 5432 8
INTRODUCTION
54
12 45 78 111 4.5
8’
THE congenital absence of one or more permanent teeth, a condition known as hypodontia, has interested clinicians for many years. Numerous findings have been reported concerning the population affected by hypodontia, the prevalence ranging from 2.3 to 10-l per cent (Dolder, 1937 ; Werther and Rothenberg, 1939 ; Byrd, 1943; Clayton, 1956; Grahnen, 1956; Brown, 1957; Glen, 1964; Rose, 1966; Hunstadbraten, 1973). In hypodontia the clinical problem is one of spacing and irregularity of the dentition. Frequently the positions of the teeth do not readily allow for successful replacement of missing teeth. In such instances the treatment of choice is to align the teeth by orthodontic means before prosthetic treatment. This paper reports the treatment of such a patient with hypodontia by means of orthodontic alignment and prosthetic replacement of teeth. CASE REPORT A female aged 20 years was referred to the Orthodontic Department of the Birmingham Dental
Fig.
I.-Appearanceof
the patient before treatment.
Menezes and Basker
: Adult Hypodontia
69
the
Fig. j.-Occlusal
view of study models
before
treatment.
Fig. I.-Appearance
dontic
alignment
of the teeth following orthoof !#
and the fitting
of an
immediate upper partial denture.
The following teeth had erupted: 7°F E;;,FC
E;7 (Fig. 3).
Associated with the hypodontia was the reduced size of the upper permanent central incisors, their mesiodistal width being 7 mm. The upper first permanent molars were small and triangular in shape. The only signs of ectodermal defects exhibited by the patient were thinness of the hair and dysplasia of the fingernails. Enquiries into the family history revealed that the patient’s sister had one congenitally missing tooth and psoriasis. The patient’s concern with regard to her appearance during treatment dictated the use of removable rather than fixed orthodontic appliances. Fortunately, removable appliances were found to be 111 . satisfactory since alignment of - mvolved tilting 31
Fig. 5.-Appearance of treatment.
of the patient at completion
rather than bodily or rotary movements. With regard to the upper jaw, the first stage of treatment was to bring the upper permanent central incisors together. The appliance was retained with Adams cribs on 616 and ‘C’ clasps on EJ; palatal finger springs served to close the median diastema. Once alignment of 111was completed, the position was retained with asecond appliance : a partial denture which was an immediate replacement for 3.
70
Journal of Dentistry, Vol. ~/NO. 2
The lower appliance served both prosthetic and orthodontic functions; the anterior saddle was an immediate replacement for the misaligned and mobile AIA, while a finger spring was used to move 7 mesially into a more favourable position, Once the q was aligned, it was retained by an artificial tooth added to the 5Ij saddle area. The result after 6 months of treatment (Figs. $5) showed a considerable improvement in appearance. The patient also reported an improvement in masticatory efficiency.
Acknowledgements We wish to thank Professor T. D. Foster for his encouragement and advice, and to the staff of the Department of Clinical Illustration, Birmingham Dental Hospital, for the photographs. REFERENCES BROWN R. V. (1957) Pattern
congenital 60-61.
and frequency of absence of teeth. Iowa Dent. J. 43,
BYRDE. D. (1943) Incidence of supernumerary and congenitally missing teeth. J. Dent. Child. 10, 84-86.
CLAYTONJ. M. (1956) Congenital dental anomalies occurring in 3557 children. J. Dent. Child. 23, 206-208.
DOLDER E. (1937) Deficient dentition.
Dent. Rec.
57, 142-143.
GLEN F. B. (1964) A consecutive the prevalence of congenitally private pedodontic practice in ally separated areas. J. Dent.
six-year study of missing teeth in two geographicChild. 31, 264-
270.
GRAHNENH. (1956) Hypodontia in the permanent dentition. A clinical and genetic investigation. Odont. Revy 7, l-100. HUNSTADBRATENK. (1973) Hypodontia in the permanent dentition. J. Dent. Child. 40, 115 117. ROSEJ. S. (1966) A survey of congenitally missing teeth, excluding third molars, in 6000 orthodontic patients. Dent. Pratt. Dent. Rec. 17, 107114.
WERTHER R. and ROTHENBERGF. (1939) Anodontia. Am. J. Orthod. 25, 61-81.