Management of a patient with a severely infraoccluded primary molar and hypodontia

Therapeutic Strategies of Primary Molar Infraocclusion: A Systematic Review

BACKGROUND

Infraocclusion of deciduous molars is a clinical disturbance that occurs during primary and mixed dentition and has some orthodontic implications. Infraoccluded teeth are believed to be potential sites of malocclusion, with a risk of tipping neighbouring teeth and losing space. This systematic review aims to analyse the management of primary molars infraocclusion and to provide updated guidelines.

METHODS

A literature search was performed using PubMed, Scopus, and Web of Science databases from 1 January 2017 to 28 November 2022. The inclusion criteria were: studies only on human subjects, open access studies, case reports, randomised trials, retrospective, observational studies, and English language.

RESULTS

A total of 372 publications were identified from the databases and a final number of nine studies were included in the review for qualitative analysis.

CONCLUSION

Management of patients suffering from infraocclusion depends on the severity, age at diagnosis, and presence of succeeded premolars. Early diagnosis of infraoccluded primary elements is fundamental and cannot be postponed. Preservation of the primary molars may be a valid option with long-term stability if there is no or moderate primary molar infraocclusion, root resorption of less than half of the root, and no decay or restoration.

Management of a patient with a severely infraoccluded primary molar and hypodontia

Infraocclusion of a primary molar is a relatively common occurrence which seldom leads to serious complications, particularly when the succedaneous permanent tooth is present. Despite the relative infrequency of unfavorable outcomes, an infraoccluded primary molar may be associated with other dental anomalies, including hypodontia. If diagnosis is delayed, infraocclusion of a primary molar can become severe, with associated negative effects on the adjacent teeth and alveolar bone. This emphasizes the need for routine and periodic orthodontic assessment of growing patients. Any deviation from the normal eruption sequence of teeth should be diagnosed and managed in a timely manner, to preserve dental arch integrity and reduce the potential for undesirable outcomes. This case report demonstrates how comprehensive assessment of the dentition, logical treatment planning and careful management of challenging orthodontic tooth movements can combine to provide a pleasing treatment outcome.