Esthetic Restoration of Multiple Congenitally Missing Anterior Teeth with Oral Implants: A Clinical Case Report

Having multiple congenitally missing anterior teeth heavily influences the patient's countenance and pronunciation. There are few reports on the esthetic restoration of such situations with oral implants. This clinical case history report presents a multidisciplinary approach to treat a young woman with multiple congenitally missing anterior teeth using implant-supported prostheses. The treatment steps and clinical implications are discussed.

Cost-Effective Management of Patients with Unilateral Congenitally Missing Second Maxillary Premolars

Two case presentations are utilized to review the cost-effective treatment options in patients with unilateral congenitally missing second maxillary premolars. Once diagnosed, the dentist can either preserve or remove the respective primary molar. Preservation will lead to a tooth-size discrepancy. To limit the size of the second primary molar to the dimension of the contralateralpremolar, and to allow the preservation of alveolar bone, removal of its mesio-distal aspect should be performed. Later on, the primary molar may become infraoccluded or lost, and it will be necessary to do a coronal built-up or a prosthetic replacement respectively. Any type ofprosthetic replacement will significantly increase the total cost of treatment. Clinicians should aim for ideal occlusion and profile and take into account other orthodontic problems and propose the most appropriate treatment plan for each patient.

Aesthetic rehabilitation in a young patient using a minimally invasive approach. A multidisciplinary case report

BACKGROUND

Optimal integration and long-term stability of oral rehabilitations require correct diagnostic approach, appropriate pre-prosthetic treatments and accurate therapeutic protocols. Technology provides devices to optimise therapeutic results, according to biologic constraints and aesthetic parameters.

CASE REPORT

The present report describes a multidisciplinary management in a young patient affected by lateral incisor agenesis, including pre-prosthetic orthodontic treatment and restorative and implant-supported prosthetic rehabilitation. Minimally invasive clinical procedures with veneer restorations and flapless implant placement, followed by immediate prosthesis delivery, are carried out. Tridimensional diagnostic data and dedicated software were used for treatment planning, allowing to achieve optimal results.

Use of a Resin-Bonded Bridge to Replace a Congenitally Missing Lateral Incisor: Treatment of "Intrusion" of Teeth

Craniofacial growth is an important factor to consider when providing dental implant treatment for adolescents to replace missing teeth. Ongoing longitudinal observation has demonstrated that such tooth replacements may appear intruded over time, because there may be ongoing downward and anterior movement of both the alveolus and the teeth at a rate exceeding that of the dental implant, which acts like an ankylosed unit. This case reports on a 23.5-year-old female patient who, at age 16, had orthodontics completed and was left with a space where the maxillary right lateral incisor was congenitally missing with the hope of future restoration with a dental implant. A resin-bonded bridge had been placed to fill the space in the interim. After approximately 7.5 years, the bridge loosened and the patient sought an implant option as its replacement. Clinical images revealed that the bridge, which contained two bonded wings, may have limited physiologic growth, causing both the maxillary right central incisor and canine to appear intruded compared with the left central incisor and canine. This case illustrates, at the very least, that growth and development may not be complete in females aged 16 years and that the way in which a missing tooth is replaced must be carefully considered given the impact that ongoing growth and development may have on restorative care. Moreover, further growth and development may also impact adults.

Clinical and Radiographic Evaluation of a Small-Diameter Dental Implant Used for the Restoration of Patients with Permanent Tooth Agenesis (Hypodontia) in the Maxillary Lateral Incisor and Mandibular Incisor Regions: A 36-Month Follow-Up

PURPOSE

For patients with narrow, single-tooth edentulous ridges as a result of permanent tooth agenesis (hypodontia) in the maxillary lateral and mandibular incisor regions, dental implant treatment may present a reliable and predictable restorative treatment solution. The aim of the present study was to evaluate the clinical reliability and outcome of small-diameter dental implants placed in a one-stage procedure with early loading replacing maxillary lateral or mandibular incisor teeth.

MATERIALS AND METHODS

Patients with hypodontia in the maxillary lateral incisor or mandibular incisor region analyzed in this report were selected from a larger prospective multicenter study. Small-diameter dental implants (AstraTech OsseoSpeed TX 3.0 S, Dentsply) of different lengths were placed using a one-stage surgical protocol with a 6- to 10-week healing period before loading. Probing pocket depth, bleeding on probing, and gingival zenith score were assessed after 6, 12, 24, and 36 months. Radiographic examination was assessed at 6, 12, and 36 months.

RESULTS

In total, 38 patients were included in this analysis and 62 small-diameter implants were placed. The mean distance between adjacent teeth was 6.30 mm (SD: 1.36). All patients received a titanium transmucosal abutment and cement-retained ceramic crown after 6 to 10 weeks of healing. Two implants were lost during the healing period before loading, providing a total implant survival rate of 96.8%. No implant fractures were reported. Mean marginal bone level change from surgery to follow-up visits at 6, 12, and 36 months were 0.39 mm, 0.22 mm, and 0.23 mm, respectively. The condition of soft tissue was stable at all follow-up visits with clinically insignificant changes in probing depth, bleeding on probing, and gingival zenith score.

CONCLUSION

This study evaluated the behavior over 36 months of AstraTech Osseospeed TX 3.0 S dental implants placed into narrow one-tooth defect edentulous ridges as a result of hypodontia. The data collected highlighted the stability of the marginal bone level and soft tissues around the dental implants in conjunction with durable mechanical function. Small-diameter implants can be considered a valid solution in the restorative treatment of hypodontia in the maxillary lateral and mandibular incisor regions.

Prosthodontic Rehabilitation for a Patient with Ellis-Van Creveld Syndrome: A Case Report

Patients suffering from Ellis-Van-Creveld syndrome are a challenge for dental management. Aesthetics are a major concern with limited manual dexterity, making choice of treatment critical. A 38 year old female diagnosed with Ellis-Van-Creveld syndrome presented with stained teeth and un-aesthetic smile and related that to her low self-esteem and depression. Intra-oral examination revealed mal-aligned megadont central incisors in the maxillary arch, fused mandibular canines with laterals and missing central incisors with space discrepancy and pronounced reverse over jet and overbite. Treatment involved non-surgical periodontal management, fabrication of veneers and dentine bonded crowns for maxillary anteriors and fixed-fixed resin retained bridge for mandibular arch.

[A novel technique to preserve the alveolar ridge width following tooth extraction in the maxillary frontal area]

OBJECTIVE

To introduce a novel ridge preservation technique with micro-titanium plate avoiding the use of bone grafting materials, and evaluate the potential horizontal bone preservation effect of this new technique, applied on single maxillary central incisors after tooth extraction for future implant restoration.

METHODS

Nine patients (six women and three men), mean age (26.0 ± 5.7) years(from 18 to 34 years) referred to the Department of Oral Implantology, Peking University School and Hospital of Stomotology, were selected and diagnosed with unsalvageable single middle incisor with fine general conditions, no signs of acute local inflammation, no ongoing or previous periodontitis, healthy neighboring teeth and intact buccal bone walls. Tooth extraction, delayed implant placement and implant-supported single crown restoration were selected as treatment plan. The teeth were extracted atraumatically with local anesthesia, followed by a reflection of a minor flap to exposed 2-3 mm of the buccal bone plate. After that, a micro-titanium plate was trimmed and bended to fit the convexity of the labial bone and fixed by two mini pins with intent to support the labial soft tissue. The flap was then repositioned over the micro titanium plate and secured with two single sutures. No bone grafting materials or releasing incisions were needed. The sockets were left to heal without any intention of primary wound closure. Cone-beam computed tomographic (CBCT) scans were obtained before and four months after tooth extraction. Horizontal ridge widths were measured with CBCT software, and the preservation effects were calculated and recorded by the percentage of horizontal ridge alteration.

RESULTS

The nine extraction sockets were healed uneventfully. The average socket width before extraction was (7.51 ± 0.48) mm (6.92-7.82 mm). The average alveolar ridge labial-palatal width at the control point of the edentulous area was (6.81±0.44) mm (6.04-7.38 mm) 4 months after tooth extraction, the mean percentage of ridge width preserved was 90.87% ± 2.91% (87.28%-95.60%).

CONCLUSION

This novel ridge preservation method by the usage of a micro-titanium plate did not interfere with the natural socket healing process, and at the same time, largely preserved the width of alveolar ridge without any bone grafting procedures. Long term results remain to be seen.

Surgically Assisted Orthodontics: Use of Piezocision in a Case of Oligodontia to Accelerate the Rate of Tooth Movement

Conventionally the use of surgical assisted tooth movement is to hasten orthodontic tooth movement. In this article, a case of 13 year-old male with oligodontia has been described in whom piezocision has been used to improve bone turnover and remodeling in long standing edentulous spaces which have less medullary bone and more cortical bone.

Treatment options for congenitally missing lateral incisors

AIM

The aim of this systematic review was to identify studies that examined maxillary lateral incisor agenesis treatment, by either orthodontic space closure by canine mesial repositioning and reshaping, or by a prosthodontic intervention, in order to compare the biological, functional and aesthetic outcomes of these two approaches.

MATERIALS AND METHODS

An electronic MEDLINE search was conducted by two independent reviewers in order to isolate English language articles, published in scientific journals between January 1975 and March 2015, reporting on treatment of agenesis of maxillary lateral incisors, accomplished either by canine orthodontic repositioning or prosthodontic intervention. The search terms were categorised into the four groups comprising the PICO (problem, intervention, comparison and outcome) question. Supplementary manual searches of published reviews and other full-text articles were also performed.

RESULTS

The initial database search produced 8,453 titles. After careful examination and discussion, 12 articles were selected for inclusion, where 5 of them compared the two therapeutic options directly. No randomised controlled trials were identified.

CONCLUSIONS

Definitive conclusions cannot be drawn, since randomised controlled trials and more prospective and retrospective studies directly comparing the two therapeutic options are required. According to this systematic review, both therapeutic options are effective. However, it seems that the orthodontic space closure, whenever this is possible, is advantageous over the prosthodontic rehabilitation.

Resin-bonded fixed dental prosthesis with a modified treatment surface in a zirconia framework: a case report

Although resin-bonded fixed dental prostheses (RBFDPs) were developed almost 40 years ago, their implementation in clinical practice did not achieve success due to biomechanical failures of the restorative materials. Nowadays, the evolution of ceramic materials and bonding procedures has allowed for the revival of the dental prosthesis. Zirconia is the dental ceramic with the highest flexural strength under compression. However, there are still some concerns regarding the bonding strength of zirconia to enamel that require further research. In this article, through the presentation of three clinical cases, the authors show how modifying the surface of zirconia frameworks by applying a feldspathic veneering on the retainer's buccal surface allows for a bonding procedure to dental structures. The goal of this treatment method is to simultaneously improve structural strength, esthetic integration, and bonding optimization to enamel. In a 3-year prospective evaluation, this framework modification shows promising results, with a survival rate of 100% and no biological or mechanical complications.

[Combined orthodontic and restorative treatment]

In patients with agenesis or enamel anomalies in anterior teeth combined orthodontic and restorative treatment is often necessary to achieve an optimal aesthetic result. How both can best be achieved, but also how to maintain the result, requires communication between the dentist and the orthodontist. The orthodontic treatment plan needs to be established in cooperation with the dentist who will carry out the restorative treatment while the patient is at a young age. Since with these young patients, who are still growing craniofacially and whose teeth are still developing, possible future restorative and/or orthodontic treatment, as well as the means of orthodontic retention, need to be included in the treatment plan. In cleft palate patients, it is also important that methods of orthodontic retention of maxillary arch width are given timely attention in the restorative treatment plan because it is especially vulnerable to relapse.

Conservative approach for the management of congenital bilateral agenesis of permanent mandibular incisors: case report and literature review

BACKGROUND

Agenesis of mandibular incisors can lead to compromised dental and facial aesthetics and therefore requires appropriate treatment. When retained primary incisors are associated to this condition, a medium-term restoration may be provided before any definitive treatment to provide aesthetic relief to the young patient.

CASE REPORT

The aim of this paper is to discuss the aesthetic management of a case with bilateral congenital agenesis of permanent incisors and retained primary incisors, which were successfully treated with direct composite restorations.

CONCLUSION

This appears a viable technique that restores function and aesthetics with a very conservative approach.

Semidirect Restorations in Multidisciplinary Treatment: Viable Option for Children and Teenagers

Due to the esthetic necessity required nowadays, the multidisciplinary treatment became a fundamental step in the restoration success. When the patient exhibits dental agenesis of one or more elements, he can show difficulty in social interactions. The age of the patient is a limiting factor to esthetic procedures, however, it should be evaluated as a real indicative with each case. The utilization of semi-direct restorations is a viable option due the cost, esthetic and improvement of physical and mechanical properties. The purpose of this paper is to present a case detailing the confection and cementation of anterior semi-direct restorations aimed at an anatomic reestablishment associated with integrated treatment with periodontics and orthodontics.

Multidisciplinary Management of a Patient with Unusual Hypodontia: A Case Report

The congenital absence of a maxillary central incisor is a rare condition. This case report described a 16 years old male presented to the Orthodontic Department at Aberdeen Dental Hospital U.K. with a congenitally absent maxillary right central incisor in association with the congenital absence of both maxillary lateral incisors. Multidisciplinary approach with orthodontic space closure of the maxillary lateral incisors and space opening for the maxillary right central incisor followed by an implant replacement was carried out. The rationale for choosing this treatment option and alternative management options were discussed. A good treatment outcome was achieved to manage such a challenging unusual case.

Agenesis of maxillary second premolar--diagnosis and clinical management

Controlling the eruption and development of dentitions is fundamental for a good oral health. The early diagnosis and adequate treatment of occasional developmental disorders are essential to achieve occlusal, functional and esthetic harmony. Abnormality is the term used for classification of alterations and is the most common developmental anomaly in humans. Even though several factors causing tooth malformations have been identified, many are still partially understood, thus requiring a more thorough study. Anyway, the available knowledge provides bases to attempt the early diagnosis of tooth abnormalities, to allow the adoption of preventive and effective therapeutic approaches.

Interdisciplinary Approach for Management of Congenitally Missing Maxillary Lateral Incisors: A Case Report

Maxillary lateral incisors are frequently found congenitally missing, and their replacement has to be done prosthodontically. However, there are a variety of treatment options; a justified solution after orthodontic correction is the use of Maryland Bridges. Following is a case report of congenitally missing maxillary lateral incisors and an impacted canine and their orthodontic correction followed by prosthetic replacement of the lateral incisors using Maryland bridges.

Multidisciplinary Rehabilitation in a Case of Congenital Aglossia with Situs Inversus Totalis

Aglossia is a rare congenital disorder with complete absence of tongue that can also be associated with limb deformities, syndromes and aberrant positioning of the visceral organs. The present case report describes multidisciplinary rehabilitation in a patient with Aglossia Congenita along with dextrocardia, situs inversus, mutilated dentition with a lack of occlusal table and compromised esthetics.

Functional and Esthetic Treatment of Lateral Incisor Agenesis with a Mini-Implant in a Young Patient: A Case Report

This article reports the treatment of lateral incisor agenesis in a young patient. Treatment was performed with a mini-implant and a temporary crown. Radiographic and clinical follow up for one year demonstrated a very satisfactory restoration with regard to function and esthetics as well as the stability of the mini-implant.

Splintless orthognathic surgery: a novel technique using patient-specific implants (PSI)

In the past few years, advances in three-dimensional imaging have conducted to breakthrough in the diagnosis, treatment planning and result assessment in orthognathic surgery. Hereby error-prone and time-consuming planning steps, like model surgery and transfer of the face bow, can be eluded. Numerous positioning devices, in order to transfer the three-dimensional treatment plan to the intraoperative site, have been described. Nevertheless the use of positioning devices and intraoperative splints are failure-prone and time-consuming steps, which have to be performed during the operation and during general anesthesia of the patient. We describe a novel time-sparing and failsafe technique using patient-specific implants (PSI) as positioning guides and concurrently as rigid fixation of the maxilla in the planned position. This technique avoids elaborate positioning and removal of manufactured positioning devices and allows maxillary positioning without the use of occlusal splints.

Choosing a pre-adjusted orthodontic appliance prescription for anterior teeth

A common orthodontic task is to correct anterior tooth position using brackets whose torque, tip and in-out are pre-adjusted. Bracket prescription greatly influences final aesthetics and function. Pre-adjusted orthodontic brackets have in-built prescriptions of torque, tip and in-out which are optimized for average cases. Refinement of tooth position can be achieved by archwire adjustment or archwire auxiliaries. Modifications to bracket position such as inversion can also help achieve individual tooth movements. Planning bracket position must be considered at the outset of treatment to achieve the maximum benefit. A number of clinical scenarios will be discussed including: a Class II division 1 malocclusion with lateral incisors palatally displaced, and another case with absent lateral incisors for space closure. Also, Class III malocclusions with consideration given to: canine angulation; a palatally displaced canine requiring labial movement; absent upper central incisors (space closure), and finally, a Class III case where incisor inclination requires consideration. By using a typodont to illustrate some of the points, this article aims to (1) show how three pre-adjusted orthodontic bracket systems (Andrews, Roth and MBT) vary significantly in their ability to influence tooth position and appearance; (2) inform clinicians how modified bracket position can influence tooth position.