Download multiple agenesis in young patients: how to preserve

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.
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ESTHETICS
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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.
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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.
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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.
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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)
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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.
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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
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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.
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;139:434–445.
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. L’EGR (esthetic guided restoration): l’evoluzione
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.
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