Multiple agenesis in young patients: how to preserve function and esthetics

Ortho and Kids - Direct anteriors
15 Jun 2016

Preserving decidous teeth in young people with dental agenesis is mandatory. Maintaining space for any future prosthetic restoration and esthetics during the adolescence is one of the weightiest treatment goals in planning our treatment.
Sometimes this treatment option can provide adequate esthetics for long time, even more than expected. And, if done with care, it´s possible to move deciduous teeth orthodontically, in order to facilitate the final restorations.
Deciduous teeth preservation is a mandatory clinical behaviour in young patients affected of dental agenesis. In those cases the treatment goals are, at first during adolescence, to keep a pleasant smile, and then space maintenance until the end of growth, waiting for prosthetic restoration.

Fig. 1

Img. 1

Fig. 2

Img. 2 – It was back in 2006 when F, 8 years old, came to our observation. She was affected by agenesis of many teeth, as visible in X-ray.

Fig. 3

Img. 3 – With the aim of solving the transversal maxillary discrepancy, a rapid palatal expander was banded on second upper deciduous molar and bonded on upper decidous canine.

Fig. 4

Img. 4

Fig. 5

Img. 5 – Waiting for the occlusal and skeletal stabilization, Rapid Palatal Expander was removed and the patient was monitored during dentition and growth.

Fig. 6

Img. 6 – A new X-Ray was done, in order to match decidous root status.

Fig. 7

Img. 7 – 3 years later, at the end of mixed dentition, begins the second phase of the orthodontic treatment. The purpose was to shift upper right canine in substitution of missing upper right lateral incisor and move carefully upper left deciduous canine in substitution of upper left lateral incisor. Furthermore, both upper first cuspid will replace permanent cuspid. As well, decidous central lower incisors and second lower left molar will be maintained.

Fig. 8

Img. 8 – 16 months later the good dental display allowed performing of the direct restoration of the front teeth, in order to change canine in lateral incisors and bicuspid in cuspid.

Fig. 9

Img. 9 – Debonding on polishing after ortho therapy. No prep semindirect resin buildup were planned, using Prefabricated shell (EGR, Esthetic Guided Restoration)

Fig. 10

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Fig. 11

Img. 11

Fig. 12

Img. 12 – One week after restoration of 1.1,1.3, 1.4, 2.1, 6.3 and 2.4, before polishing.

Fig. 13

Img. 13 – Post polishing view.

Fig. 14

Img. 14 – lower deciduous central incisors, before and after direct restorations.

Fig. 15

Img. 15 – 3 years follow up. No periodontal pathological probing was found on 6.3. Despite recommendations, the patient did not bleach the upper right cuspid moved in lateral position.

Fig. 16

Img. 16 – Dento-labial view, at 3 years follow up.

 

Conclusions

Conclusions

As reported in this case, maintaining decidous teeth in cases with dental agency could be one of the treatment option. Especially in young patients it could probably be the best choice. It allows to give a pleasant smile in adolescent patients without fixed or removable prosthetic solutions. Furthermore, it doesn’t keep us form any change in the future.
Special Thanks to Dr. Marco Rosa for the daily teamwork in treatment planning and for the orthodontic treatment.

Bibliography

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