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PATRIZIA LUCCHI -- MULTIPLE AGENESIS IN YOUNG PATIENTS: HOW TO PRESERVE FUNCTION AND ESTHETICS 9827 Views - 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. Page 1 of 10 www.styleitaliano.org - MULTIPLE AGENESIS IN YOUNG PATIENTS: HOW TO PRESERVE FUNCTION AND ESTHETICS Img. 1 Page 2 of 10 www.styleitaliano.org - MULTIPLE AGENESIS IN YOUNG PATIENTS: HOW TO PRESERVE FUNCTION AND ESTHETICS 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. 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. Page 3 of 10 www.styleitaliano.org - MULTIPLE AGENESIS IN YOUNG PATIENTS: HOW TO PRESERVE FUNCTION AND ESTHETICS Img. 4 Img. 5 - Waiting for the occlusal and skeletal stabilization, Rapid Palatal Expander was removed and the patient was monitored during dentition and growth. Page 4 of 10 www.styleitaliano.org - MULTIPLE AGENESIS IN YOUNG PATIENTS: HOW TO PRESERVE FUNCTION AND ESTHETICS Img. 6 - A new X-Ray was done, in order to match decidous root status. 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. Page 5 of 10 www.styleitaliano.org - MULTIPLE AGENESIS IN YOUNG PATIENTS: HOW TO PRESERVE FUNCTION AND ESTHETICS 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. Img. 9 - Debonding on polishing after ortho therapy. No prep semindirect resin buildup were planned, using Prefabricated shell (EGR, Esthetic Guided Restoration) Page 6 of 10 www.styleitaliano.org - MULTIPLE AGENESIS IN YOUNG PATIENTS: HOW TO PRESERVE FUNCTION AND ESTHETICS Img. 10 Img. 11 Page 7 of 10 www.styleitaliano.org - MULTIPLE AGENESIS IN YOUNG PATIENTS: HOW TO PRESERVE FUNCTION AND ESTHETICS Img. 12 - One week after restoration of 1.1,1.3, 1.4, 2.1, 6.3 and 2.4, before polishing. Img. 13 - Post polishing view. Page 8 of 10 www.styleitaliano.org - MULTIPLE AGENESIS IN YOUNG PATIENTS: HOW TO PRESERVE FUNCTION AND ESTHETICS Img. 14 - lower deciduous central incisors, before and after direct restorations. 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. Img. 16 - Dento-labial view, at 3 years follow up. 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 Page 9 of 10 www.styleitaliano.org - MULTIPLE AGENESIS IN YOUNG PATIENTS: HOW TO PRESERVE FUNCTION AND ESTHETICS pleasant smile in adolescent patients without fixed or removable prosthetic solutions. Furthermore, it doesnt 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. References 1. Zachrisson BU, Rosa M, Toreskog S. Congenitally missing maxillary lateral incisors: Canine substitution. Am J Orthod Dentofacial Orthop 2011;139:434- 444. 2. Kokich VO Jr, Kinzer GA, Janakievski J. Congenitally missing maxillary lateral incisors: restorative replacement. Am J Orthod Dentofacial Orthop 2011;139:434445. 3. Johal A, Katsaros C,Kuijpers-Jagtman AM. State of the science on controversial topics: missing maxillary lateral incisors - a report of the Angle Society of Europe 2012 meeting. Progress in Orthodontics 2013;26:14-20. 4. Tuverson DL. Orthodontic treatment using canines in place of missing maxillary lateral incisors. Am J Orthod 1970;58:109-27. 5. Rosa M, Zachrisson BU. Integrating esthetic dentistry and space closure in patients with missing maxillary lateral incisors. J Clin Orthod 2001;35:221-234. 6. Rosa M, Zachrisson BU. Integrating esthetic dentistry and space closure in patients with missing maxillary lateral incisors: Further improvements. J Clin Orthod 2007;41:563-573. 7. Rosa M, Zachrisson BU. The space closure alternative for missing maxillary llateral incisors: An update. J Clin Orthod 2010;44:540-549. 8. Rosa M, Zachrisson BU. Missing Maxillary Lateral Incisors: New Procedures and Indications for Optimal Space Closure. Chapter 25 in Esthetics and Biomechanics in Orthodontics - 2nd ed. 2014; Ed. R.Nanda. Elsevier Saunders, St.Louis. Missouri 63043:528-559. 9. Mathews D, Kokich VG. Managing treatment for the orthodontic patient with periodontal problems. Semin Orthod 1997;3:21-38. 10. Kokich V. The role of orthodontics as an adjunct to periodontal therapy. In: Newman MG, Takei HH, Carranza FA, eds. Clinical periodontology, 9thed. Philadelphia, PA: WB Saunders, 2002:704-18. 11. Lucchi P, Saracinelli M, Devoto W, Putignano A. LEGR (esthetic guided restoration): levoluzione del restauro diretto: Dental Cadmos. Oct.2015;8:577-580. 12. Czochrowska EM, Skaare AB, Stenvik A, Zachrisson BU. Outcome of orthodontic space closure with a missing maxillary central incisor. Am J Orthod Dentofacial Orthop. 2002 Feb;121(2):110-9. 13. Devoto W, Saracinelli M, Manauta J. Composite in everyday practice: how to choose the right material and simplify application. Eur J Esthet Dent. 2010;5(1):102-24. 14. Paolone G, Saracinelli M, Devoto W, Putignano A. Esthetic direct restorations in endodontically treated anterior teeth. Eur J Esthet Dent. 2013 Spring;8(1):44-67. 15. Manauta J, Salat A. Layers. An Atlas of composite resin stratification. Quintessence Publishing 2012. Visit: http://www.styleitaliano.org/multiple-agenesis-in-young-patients-how-to-preserve-function-and-esthetics Page 10 of 10