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1 Dental Care Management Anomaly Microdontia on Children (Case 2 Report) 3 4 Abstract 5 One form of dental anomalies that occurred at the stage morfodiferensiasi teeth are 6 microdontia, which occurs both in primary teeth or permanent teeth. Microdonsia is teeth 7 with a size smaller than normal size, or beyond the limits of size variation in tooth and tooth 8 shape with conical or tapered called conical teeth. Factors affecting microdontia is genetic 9 and environmental factors. 10 The clinical examination microdontia done by visual inspection, radiographic examination as 11 well as a combination of both. Microdontia diagnosis should be done early to oversee and 12 maintain the development of the teeth in order to avoid complications. 13 The treatment can be carried out with esthetic restorative treatment of anterior teeth, 14 orthodontic treatment and a combination of both. 15 Key Words: Dental anomalies, Microdontia 16 17 Introduction 18 The shape of deciduous teeth begin to develop at the age of 4 months in the womb. Growth 19 and tooth development through several stages of initiation, proliferation, histodiferensiasi, 20 morfodiferensiasi, apposition, calcification and eruption. At each stage can occur disorder 21 that causes anomalies in the number of teeth, tooth size, tooth shape, tooth structure, the color 22 of teeth and tooth eruption disturbances. 23 Microscopic tooth structure consisting of hard tissue (hard tissue) and soft tissue (soft tissue). 24 Hard tissue is tissue containing limestone consisting of enamel, dentin and cementum, while 25 the soft tissue is tissue contained in the pulp cavity through the apical foramen. 26 One form of dental anomalies that occurred at the stage morfodiferensiasi teeth are 27 microdontia, which occurs both in primary teeth or permanent teeth. In microdontia, tooth 28 size smaller than normal size. As with macrodontia, microdontia can involve all the teeth or 29 limited to a single tooth or group of teeth. Usually the lateral incisors and third molars were 30 smaller. Supernumerary teeth may also experience microdontia. 31 Microdontia defined as teeth with size smaller than normal size, or beyond the limit of the 32 size of the gear variation (Shafer et al., 2009). Radiation in the jaw during tooth development 33 can also cause microdontia in the area involved (Hanne and Ivar, 2009). Microdontia most 34 common in the lateral teeth and the maxillary third molar. Frequency microdontia in 35 maxillary lateral slightly less than 1% (hanne and ivar, 2009). There are three types of 36 microdontia, namely: 37 1. True generalized microdontia (microdontia actually entirely) 38 2. Generalized relative microdontia 39 3. Microdontia involving a single tooth (microdontia involving a single tooth). 40 41 Factors Affecting the Size of the Teeth 42 Variations in the size of the teeth caused by several factors, namely: 43 44 Genetic Factors (Heredity) 45 Hereditary factors can affect the size of the teeth, genetic factors are intended. Genetic factors 46 have the greatest influence in determining the size of the tooth. Previous research expressed 47 very strong influence of genetic factors is to estimate the morphological picture of the crown 48 by 90%. In the twin brothers with their blood relations, found almost no variation in tooth 49 size. According to Rakosi et al (1993), based on current knowledge, the major networks that 50 can undergo dentofacial deformities due to genetic effects of which have included the teeth 51 which include size, shape, number, tooth mineralization, location and position of tooth germ 52 eruption (Rakosi, 1993; Swasono, 2004). 53 54 Environmental Factors 55 Growth and tooth development is influenced also by environmental factors but not much 56 change something that has been determined by heredity. The influence of environmental 57 factors on the size of the tooth is about 20%. Research on american population in the united 58 states, japan and china acquired americans born in the country compared with that was born 59 in japan and china have different size mesiodistal tooth. Environmental factors is meant 60 nutrients (Rakosi, 1993, Hong et al, 2008). 61 62 Case Reports 63 A 13-year-old girl came to a dental practice in london with a chief complaint of teeth 22 has a 64 shape and size of the abnormal causing mild diastema and esthetic problem. History of 65 patients in general good health. 66 67 Clinical Examination. 68 Extra-oral examination shows that the patient has an advance flat profile, there are no 69 abnormalities in the tmj, mouth and lips relations. Intra-oral examination showed grade 1 70 malocclusion with an overjet and overbite angle light. Microdontia on tooth 22 with mild 71 rotation of the distal direction. Visual examination with radiographs showed microdontia on 72 22 teeth. 73 74 Figure 1 Microdontia on teeth 22 75 76 77 Figure 2 Photo periapical radiography 78 79 80 Diagnosis 81 From the results of the examination was diagnosed that the patient is experiencing 82 microdontia on the upper left lateral incisor tooth. 83 84 Case Management 85 Management of the patient's case is with composite restorations as temporary care and jacket 86 crowns as permanent treatment. The treatment is carried out which treatment with composite 87 resin. Care measures: 88 1. First drain and isolate the teeth with cotton. 89 2. Giving etching for 20 seconds to the entire surface of the tooth. 90 91 92 Figure 3 Giving etching 93 94 3. Results etching seen that whiter teeth and microscopic form tag. Then proceed giving 95 resin bonding and irradiation with light cure for 15-20 seconds. 96 97 Figure 4 Results etching 98 99 100 101 102 4. After irradiation on resin bonding, it would seem to be more opaque teeth. Dental composite fillings are ready made and polishing with a rubber polishing. Figure 5 Resin aesthetic restoration 103 104 105 5. The results showed dental care 22 already has the same shape and size with 12 and no diastema. 106 107 Figure 6 Results of treatment 108 Discussion 109 Microdonsia is an abnormality that occurs in the bud stage, and its etiology is hereditary 110 factors in localized form, and endocrine dysfunction in the overall shape of the teeth involved 111 (Mary Balogh and Margaret, 2006). 112 113 Figure 7 The "peg-shaped" deformity in microdontia of a maxillary lateral incisor. 114 115 Microdontia care divided by the number of teeth affected, namely treatments for generalized 116 microdontia and for localized microdontia. 117 118 Generalized Treatment Microdontia. 119 Generalized microdontia or thorough microdontia is a state of all teeth in the oral cavity 120 having a size smaller than normal (Cameron, 1998). This condition causes a thorough and 121 migration diastema tooth causing disharmony between the dental arch width and arch width. 122 Thorough diastema found in patients with hypopituitarism (Cameron, 1998; Laskaris, 2000). 123 Thorough diastema should not be treated as the influence of the pressure of the tongue and 124 lips that often causes the teeth return to the starting position after treatment. One common 125 type of treatment on overall diastema caused by microdontia thorough is the jacket crown 126 thorough treatment (Moyers, 1988; Aschheim, 2001). 127 128 Localized Treatment Microdontia 129 Microdontia localized treatment can be done in various ways according to the microdontia 130 conditions. There are some alternative treatments that can be done on microdontia that of one 131 or more teeth: (Pinkham, 2001; Mcdonald, 2000). 132 First with diastema closure is done when the teeth are experiencing microdontia with mild 133 diastema. Diastema can be closed with a simple orthodontic appliance. Advantages of the 134 choice of this type of treatment is overjet and overbite patients experience minimal change 135 (Pinkham, 1999). Orthodontic appliance that can be used is the labial bow and coil springs 136 (Sim, 1977; Witt, 1988; Proffit, 2000). 137 138 139 140 141 142 143 144 145 Figure 8 Closing diastema simple light with tool orthodontics (Pinkham, 1999). 146 147 The second is a diastema closure is done by moving the lateral incisor tooth mesial direction 148 until contact with the incisor teeth tops and leaves room in the distal region of the lateral 149 incisor tooth. This action is generally not acceptable in terms of aesthetics, unless the rest of 150 the small room (Pinkham, 2001). Orthodontic appliance that can be used is a coil spring, 151 hawley appliance, proximal spring, spring proximal to the loop adjustment (Sim, 1977; Witt, 152 1988; Proffit, 2000). 153 154 155 156 157 158 159 160 Figure 9 Closing diastema with leaving regional space distal lateral incisor teeth (Pinkham, 1999). 161 The third is a combination treatment of orthodontic tooth movement with the tools and 162 aesthetic restoration of anterior teeth. The lateral incisor is moved to its normal position with 163 fixed orthodontic appliance that provided enough room for esthetic restorative treatment. This 164 is the best treatment (Pinkham, 2001). 165 . 166 Figure 10. Treatment combination between aesthetic orthodontic treatment and restoration 167 (Welbury, 2001). 168 169 Esthetic restoration of anterior teeth is a restoration that requires a sense of art. There are 170 several ways that can be used to change or cope with aesthetic problem (Mount, 1998). The 171 selection of appropriate materials for aesthetic anti-cariogenic properties taken into account 172 and durability (Bergen, 1989). In the case of localized microdontia, there are several ways to 173 do aesthetic restoration, namely: 174 1. Restoration form of fillings with composite resin, which restore the tooth to its normal 175 size in a simple way. How this is done to reshape the mesial and distal surfaces or 176 cover the entire crown with composite (Wei, 1988; Ascheim, 2001). Composite resin 177 restoration option is used for minor irregularities on the anterior teeth as the teeth 178 conical lateral incisor. The advantages of the composite resin that is cheap and fast 179 (Mount, 1998; Heasman, 2003). 180 2. Porcelain laminate veneer. The restoration of the form of the crown gear casing used 181 to keep young and incomplete root development and large pulp cavity because of the 182 eruption that has not been perfect. Laminating produce aesthetic porcelain veneers 183 and good abrasion resistance, does not cause changes in occlusion and can adjust to 184 the surrounding tissue (Nakazawa , 1995; Mount, 1998). 185 186 187 Figure 11. Working model porcelain veneer 188 189 190 Figure 12. Results of porcelain veneer restoration on lateral incisor (Welbury, 2001). 191 192 193 Conclusion 194 Microdontia treatment depends on the type of cases that experienced microdontia esthetic 195 restorative treatment of anterior teeth, orthodontic treatment and a combination of both, 196 depending on the condition of the teeth and mouth. 197 198 References 199 Aschheim, K.W., Dale, B.G. 2001, Esthetic Dentistry A Clinical Approach to Techniques and 200 201 202 203 204 Materials, 2nd ed. St. Louis-Philadelphia-London-Sydney-Toronto: Mosby. Bergen, S.F. 1989. The Dental Clinic of North America: Esthetic Dentistry. PhiladelphiaLondon-Toronto-Montreal-Sydney-Tokyo: W.B. Saunders Co. 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