Aesthetic Rehabilitation of Non-syndromic oligodontia

Aesthetic Rehabilitation of Non-syndromic oligodontiaCase cover c each(prenominal) of the article Esthetic Rehabilitation of Non-syndromic oligodontia-an innovative approach.Abstr phone issue This case report describes the esthetic rehabilitation of a 13 course old fille pre moveing with non-syndromic oligodontia, who compromised in a aesthetics, occlusal function, evolution and functional growth of the bones. The oral rehabilitation was performed with count on composite indemnification using thermoformed templates along with reinforced polythene fibers since it is a viable alternative to re-establish the masticatory function and esthetics, allowing the patient to achieve greater conceit and better social acceptance.Key words Composite restitution, Oligodontia, Reinforced polyethylene fibers, Thermoformed template.IntroductionA tooth is defined as connaturally wanting if it has non erupted in the oral cavity and is not visible on the radiograph. All autochthonic odo ntiasisinging should have erupted by the age of 3 and all ageless teethinging except thirdly molars amongst the ages of 12 and 14. Therefore 3-4 year old children be suitable for diagnosing of congenitally missing primary teeth by clinical examination and 12-14 year old children, for diagnosis of perpetual missing teeth, excluding the third molars.1 Dental agenesis is most common developmental anomaly in human, which mass glide by, in an isolated fashion or as part of a syndrome.2In the long-lasting dentition, hypodontia has a prevalence of 1.6% to 9.6%, excluding agenesis of the third molars. Oligodontia has a population prevalence of 0.3% in the abiding dentition. It occurs more frequently in girls at a ratio of 32. In the deciduous dentition, hypodontia occurs less often (0.1%-0.9%) and has no significant perk up distribution.3 Dental agenesis is classified according to the number of teeth touch on and whitethorn be classified into hypodontia, oligodontia, and anod ontia. consequently, hypodontia is defined as the congenital absence seizure of less than six permanent teeth, full anodontia as the absence of all permanent teeth.4The term oligodontia is generally occasion when the development of six or more teeth did not occur (KOTSIOMITI et al., 2000), and such(prenominal) a correspond may be related to family record, syndromes, traumas, infections, and severe intrauterine or ductless gland disorders (KOTSIOMITI et al., 2000 MCDONALD AVERY, 2000). Oligodontia usually occurs as a part of syndromes. It may occur as a non-syndromic isolated familial trait linked to mutations of the MSX1 and PAX9, or as a sporadic finding.5 Non-syndromic oligodontia has been found either sporadic or familial in nature.6 Syndromic and non-syndromic form of Oligodontia can be differentiated by reigning come in the presence of associated symptoms. Oligodontia presents clinical symptoms depending on the number and location of missing teeth. Positional changes of teeth, variation in their morphology and sizing may occur in the existing teeth. It may be associated with growth disturbances of the maxillo facial nerve draft thus affecting the facial appearance.7The absence of teeth in teenaged patients can cause esthetic, functional, and psychological problems, oddly if the teeth of the anterior sphere ar involved. The most comm unaccompanied used method of diagnosis of alveolar consonant anomalies is clinical examination accompanied by radiographic examination.8 There argon some(prenominal) treatment options for adult and young patients with agenesis although, there are few studies demonstrating treatment in pediatric patients.9 The optimal therapy should include an interdisciplinary team approach, and rely on positive interaction betwixt pediatric dentists, orthodontists, oral and maxillofacial surgeons and prosthodontics.10 The early diagnosis and treatment are fundamental to improve masticatory function, speech, and self-appeara nce to reduce the psychosocial impact.9This case report describes the alveolar consonant rehabilitation of a young patient with direct composite restorations using thermoformed templates, which not only act as crown formers to re-establish the anatomical frame of the defective teeth but likewise control the amount of restorative hearty used and minimize the patients chair side- succession. Along with this reinforced polythelene fibers are also used as an interim restoration.Case ReportA 13-year-old female patient referred to department of Pedodontics and preventive dentistry, college of dental sciences, Davangere, complaining of place between teeth in the upper and refuse front region. A detailed history was underinterpreted with the patient and his legal guardian, who revealed her past medical history, was non-contributory and family history revealed that she was born to non-consanguineous marriage parents with normal delivery and mother did not begin from any dis console d uring pregnancy, none of the family member had congenitally missing teeth. The patient had no history of trauma but had severe aesthetic dissatisfaction which resulted in some(prenominal) social problems.On general physical examination her height and load were normal according to her age and she was well oriented and active. On redundant oral examination she was normal in her facial appearance and did not show any physical or skeletal abnormality. She had a kookie concave profile, a mild reduction of the lower third of facial height, with a marked nasolabial angle and procumbent lip contours however, the facial unity was not affected. No clicking or crepitus of the temporomandibular joint was detected and masticatory muscles were not excitable upon palpation.On intra oral examination, soft tissues examination was normal. Oral hygiene was considered satisfactory. elusive tissue examination revealed presence of erupted 11 permanent teeth and 8 overeretained primary teeth (11,2 1,24,37,34,33,31,41,42,44,47) 63 and 83 were in grade II mobility. The remaining permanent teeth were missing clinically she also had upper midline diastema between permanent central incisors, generalized spacing and underdeveloped alveolar ridges in the anterior mandibular region. In addition, no parafunctional purpose was present. Suspecting the congenital absence of permanent teeth panoramic radiograph was taken which showed missing teeth 12,16,17,22,26,27,32,35,36,43,46 Figure 1, Figure 2. There was absence of dental caries and no previous treatment for the missing teeth was done.A provisional diagnosis of partial anodontia was given with differential diagnosis of ectodermal dysplasia Rieger syndrome and Witkop syndrome were considered. In overtake of the oligodontia of permanent teeth, a detailed examination was done to rule step to the fore syndromes associated with oligodontia. Paediatric consultation was taken regarding general wellness status of the patient. perpetrate set of investigations were done. Routine examination of blood including serum calcium, alkaline phosphate, TSH, T3, T4 was done. The findings of these investigations were at bottom normal range. During physical examination, hairs were not thin and sparse, nails were not brittle and no difficulty in perspiration was seen, which ruled out absence of ectodemaldysplsia. On occular examination, no signs of glaucoma was seen, ruling out Rieger syndrome and Van Der Woude syndrome was ruled out as there was no associated cleft palate or any mucosal cysts in lower lip. Final diagnosis of Non-syndromic partial anodontia/oligodontia was given.Full mouthpiece rehabilitation was plan the teeth present were abnormal in morphology and were esthetically specifyd after extraction of mobile teeth. The restorations of the defective teeth were carried out in stages. Each treatment session lasted between 1 and 2 hrs depending on the patients tolerance and acceptability toward treatment. Problems en countered when attempting to restore the palatine or lingual sites of the affected teeth using composite with free-hand proficiency so as to fabricate a proper anatomical contour and to obtain a homogenous thickness of the material used. To overcome this, alginate impressions of both(prenominal) the dentitions were taken and stone casts were do. The defective areas of the tooth structure on the stone casts were modify and hypothesize anatomically using inlay wax Figure 3. Over the contoured cast, utility(prenominal) impression was made and final cast was poured with stone.The reconstructed stone casts were sent to the laboratory for fabrication of transparent thermoform Biostar templates that conform to the anatomical shape of the reconstructed crowns. A 0.5mm thickness transparent thermoforming disc made of copolyester was heated up to 170c for 50 s and, once the disc softened, it was press onto the stone casts. The pressed templates were allowed to cool and later removed an d trimmed Figure 4. The produced templates act as crown formers to reconstruct the defective teeth. Initially, the upper four permanent incisors were restored. Minimal tooth structure was removed in order to provide additional retentive element to aid adhesion of the restorative material.Adequate sight of composite material was packed into the template that corresponds to the desired area of teeth to be restored. The template was then placed over the affected teeth and light cured. Upon curing, the template was removed from the teeth and the restored areas were examined for any defectiveness. The composite restorations were spiffed up and contoured using a combination of rotary discs of various grades of polishing burs to create aesthetically pleasing restorations. Due to congenitally missing 43 there was a wide gap present between 42 and 44 which was aesthetically not pleasing even after restoring all 4 lower anteriors.Therefore fabrication of a fiber reinforced composite (FRC-RI BBOND) property sustainer using the acrylic tooth was planned. An acrylic crown of desired size and form was selected. Horizontal groove was made in the middle third of the crown palatine to at nearly 2-mm depth using a round diamond bur (No. 8) to accommodate the thickness and width of Ribbond. The involve length of the fiber (Ribbond) was measured using dental floss between the adjacent teeth extending from distal surface of 4244. Enamel on the lingual surfaces of both the acrylic crown and adjacent teeth were inscribed with 37% phosphoric acid for 20 s (Scotchbond Etchant 3M ESPE, St Paul, MN, USA). The fiber miserly in bonding agent was adapted using a pair of pincers onto the acrylic crown to ensure that it fits into the groove and light cured.Thereafter, it was coat with flowable resin (3M, ESPE) and light cured (Elipar 2500, Halogen Curings Light 3M ESPE) from multiple directions for 20 s, which increased the mechanically skillful strength of the space maintainer. Fiber -adapted acrylic crown was then positioned in the edentulous space and adapted to the adjacent teeth. Flowable composite application was initiated starting from the distal aspects of 42 44 and cured. This enabled us to stabilize the acrylic crown and embarrass for its correct position. After confirming the correct position, the remaining fiber was coated with composite and cured. Finally, occlusion was adjusted finishing and polishing (Sof-Lex 3M ESPE) was performed Figure 5. The patient was sensible about the importance of good oral hygiene and regular copy up. Follow up of 6 months revealed good retention and satisfactory esthetics Figure 6.DiscussionOligodontia (severe partial anodontia) is a developmental dental anomaly refers to congenital lack of more than six teeth excluding third molars. The exact aetiology for oligodontia is unknown. Various factors have been described in the literature.11 Oligodontia condition should not be neglected as it may result in various distur bances kindred abnormal occlusion, altered facial appearance which may cause psychological distress, difficulty in mastication and speech especially during the formative age. Thus early diagnosis and treatment of these patients is very important.The treatment of oligodontia could be challenge if there are several missing teeth and malocclusion present. Treatment prep should take into account the age of the patient, number and condition of retained teeth, number of missing teeth, condition of supporting tissues, the occlusion and interocclusal space.12 The treatment should be planned thoughly as it needs multidisciplinary appoarch. Treatment options include orthodontic therapy, speech therapy, implants, gooey techniques, removable partial prostheses, better prostheses and over collection plates to ensure adequate and steadfast results.13,14 Most young patients require the fabrication of a partial denture as an interim procedure before definitive restoration is planned. archae ozoic treatment improves speech and masticatory function in addition to psychological implications that may greatly help in regaining self-confidence of the young patient.prosthodontic rehabilitation is fundamental in these situations that allow the child to lead a normal life without damaging self-esteem or psychological development and ensuring that behavior remains unaffected.15 The prosthetic rehabilitation using complete dentures had big money of benefits including better social acceptance, self-esteem and restoring normal functional demands of the patient such as chewing as showed in case report by Manu R et.al.16 The age of the patient for the present case was carefully considered, since younger adults require special attention with regard to their psychological and emotional condition, and particularly the anatomical changes related to facial growth.In the present case, the patient was in an early adolescent stage. The posterior teeth were still in the erupting phases and, therefore, restoration of the defective teeth with permanent and complex restorations was contraindicated. Composite restorative material was selected as a suitable replacement of the defective structures because of its esthetics and graduate(prenominal) sustainability and also it provides excellent conservative transitional treatment.17 Initially, the defective anterior teeth were restored using a free-hand technique. However, due to small inaccessibility on the palatal and lingual aspects of the teeth, it was not possible to carry out proper restorations. The fourth dimension spent to restore a individual(a) tooth was prolonged and each restored tooth indispensable more trimming and polishing. Thus, these templates act as an adjunct to allow belatedly restoration of the defective teeth. Similarly with the present report, this template method has also been proven successfully in a case report by Sockalingam et.al.18Satisfactory restorations of the lost teeth space present in between mandibular anterior teeth was a challenge to the paediatric dentist as there are limited treatment options in children.19 fleck long-term single tooth replacement options such as conventional fixed bridges, resin bonded dentures, removable dentures, and single tooth implants may be the treatment filling for adults, they have limited use in children. As in evolution children, gingival and bone architecture undergoes changes demanding provisional restorations to achieve good esthetics and maintain edentulous space until definitive restoration is planned.20 For the success of single tooth restoration bonding of the restoration to adjacent teeth is important. So grooving, use of etching, and bonding procedures increase retention.19 In the present case, a groove was made on the lingual surface of the acrylic tooth, 42 and 44 to levy maximum adhesion, durability, and also to provide mechanical support.Acrylic restoration provides several advantages such as desirable esthetics (a sense of natural feeling), ease of use, and direct bonding to tooth structure with reduced cost. Besides, it provided better gingival health (lesser plaque retention), greater patientparent satisfaction, and less clinical time in acquisition of natural crown anatomy.19 Minimally invasive self-sealing restorations using Ribbond was selected in the present case, as it is an ultrahigh molecular weight polyethylene fiber having virtually no memory, translucent, colorless and disappears within the composite or acrylic without show through offering excellent esthetics. Hence, it adapts to the contours of the teeth and dental arch. Children with oligodontia appear to have worse oral health related tone of life than children with dental decay and malocclusion.21 However long-term studies are require to evaluate their prolonged use.ConclusionChild patient suffering from oligodontia may have severe functional, esthetic and psychological problems especially during the early eld of life as reported in the present case.Thus, these thermoformed templates act as an adjunct to allow easy restoration of the defective teeth.The FRC space maintainer technique described in this case can satisfactorily restore esthetics and function and hence suggested as an alternative to conventional techniques. However, it can be considered as an interim treatment until a definitive restoration can be performed.1