Hypodontia of mandibular incisors: considerations on the orthodontic treatment

A retrospective analysis of the patient journey for children with an unerupted maxillary central incisor

BACKGROUND

Maxillary central incisors (MCI) are the third most impacted teeth. Timely multidisciplinary management is indicated as unerupted incisors can cause functional- and appearance-related distress.

AIM

To assess the patient journey for children with unerupted MCI, including referral, clinical assessment, surgical management and follow-up treatment, and highlight areas for improvement, as well as identify factors impacting orthodontic treatment burden (OTB).

DESIGN

A retrospective service evaluation of children aged 6-16 years who had surgical management of unerupted MCI under general anaesthetic (GA) between 2018 and 2021.

RESULTS

Fifty-two children with 62 unerupted MCI were identified. Mean age at referral was 8.8 years. Most children (82.7%) had supernumerary teeth in the anterior maxilla. Mean time between listing for GA and surgery increased from 4.3 to 15.2 months following the COVID-19 lockdown. Mean age at surgery was 10.4 years. Supernumerary removal and incisor exposure and bond was the most common treatment (56.6%). Most patients required hospital orthodontic treatment post-surgery (65.4%).

CONCLUSION

Most children referred were below 9 years (60.1%); these children had reduced OTB compared to those who had been referred at an older age. Stage of root development was also a significant predictor in OTB. An unexpected finding was that conical supernumeraries were found to prevent MCI eruption.

Research algorithm for the detection of genetic patterns and phenotypic variety of non-syndromic dental agenesis

Introduction: Dental agenesis (DA), brings together the anodontia, oligodontia, hypodontia, characterized by a deficit in the development of a variable number of teeth. The objectives of the study were to illustrate the phenotypic variability of non-syndromic DA, to identify cases of DA with hereditary genetic transmission, and establish the mode of DA genetic pattern in these cases, together with the determination of DA prevalence in the population group study. Patients, Materials and Methods: The cross-sectional observational study was performed on a mixed population group, consisting of 861 Caucasian patients, between January 2018–December 2019. The clinical evaluation protocol of patients with DA, used to illustrate their phenotype, included the following stages: oral examination, photographic examination, and radiological examination. The evaluation protocol specific to the family genetic study of patients with DA, involved the following three stages: family survey, construction of the family tree and analysis of the pedigree structure. Results: The prevalence of DA in the population group was 2.78%. Regarding the phenotype, DA mainly affected the upper arch (50% of cases); bilateral DA had a significantly increased incidence (83.33% of cases) compared to unilateral form; in most cases (75%), a patient lacked one to two teeth, the lack of two teeth being the most common form (83.33% of cases); the upper lateral incisors were the teeth most frequently involved in DA (31.11% of the total missing teeth). Regarding the family genetic study, hereditary DA with autosomal dominant inheritance was present in 37.50% of cases. In the other cases (62.50%), isolated, sporadic forms of DA were registered, suggesting a spontaneous de novo mutation or a disorder of odontogenesis of a non-genetic nature. Conclusions: We consider that this study is of interest for current scientific research with applicability in dental medicine, by bringing actual information on the prevalence of non-syndromic DA in South-East Romania, the variety of phenotypic spectrum of DA for this geographic area, and the role of heredity in the DA genetic determinism in the studied population.

Successful treatment modalities for missing lateral incisors- A systematic review

BACKGROUND

Effective management of Missing lateral incisor has remained a challenge for the clinicians. A multi-disciplinary approach involving orthodontist, restorative dental specialist, pediatric dental specialist, periodontist, oral surgeon and general dentist has proved ideal. Our aim is to review the ultimate esthetic success, and long term survival results between the orthodontic and restorative management of missing lateral incisor.

MATERIALS AND METHODS

Following the PRISMA guidelines, a systematic review of the published articles pertaining to the topic of interest was done. Searches were carried out in four different databases since February 2021 to April 2021.

RESULTS

A total of 580 references were found from searches conducted in PubMed, Scopus, Cochrane and Web of Science, and 19 articles were selected and analyzed fully, after screening the title and abstract, 6 articles were included for the study.

CONCLUSION

An essential orthodontic space closure in combination with modern aesthetic prosthetic tooth replacement techniques has been reported to achieve greater success.

Association between hypodontia of permanent maxillary lateral incisors and other dental anomalies

Introduction:

Tooth agenesis is often associated with other tooth anomalies, such as microdontia, delayed eruption and ectopic eruption. Moreover, they may be found all in the same individual, as certain genetic mutations may have a variable phenotypic expression. Treatment of cases of hypodontia of anterior teeth should not involve only opening or closing space for prosthetic rehabilitation. Individuals with hypodontia of permanent maxillary lateral incisors may have teeth with a mesiodistal width smaller than that of patients with a normal dentition, and which may need reshaping to achieve an esthetic and functional occlusion.

Objective:

This clinical case report discusses the association of hypodontia of permanent maxillary lateral incisors with other tooth anomalies and their treatment alternatives.

Different approaches to the treatment of skeletal Class II malocclusion during growth: Bionator versus extraoral appliance

INTRODUCTION

Class II malocclusion, which has a significant incidence in the population, may compromise facial esthetics and the smile, as well as the masticatory and respiratory functions. Often associated with skeletal abnormalities, it severely affects and compromises quality of life. An accurate diagnosis is fundamental to prepare a treatment plan to correct dental and skeletal anomalies.

OBJECTIVES

This study discusses treatment alternatives to the correction of Class II division 1 and 2 malocclusion in growing patients, using a Bionator and an extraoral appliance.