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Dental Care Management Anomaly Microdontia on Children (Case
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Report)
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Abstract
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One form of dental anomalies that occurred at the stage morfodiferensiasi teeth are
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microdontia, which occurs both in primary teeth or permanent teeth. Microdonsia is teeth
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with a size smaller than normal size, or beyond the limits of size variation in tooth and tooth
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shape with conical or tapered called conical teeth. Factors affecting microdontia is genetic
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and environmental factors.
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The clinical examination microdontia done by visual inspection, radiographic examination as
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well as a combination of both. Microdontia diagnosis should be done early to oversee and
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maintain the development of the teeth in order to avoid complications.
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The treatment can be carried out with esthetic restorative treatment of anterior teeth,
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orthodontic treatment and a combination of both.
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Key Words: Dental anomalies, Microdontia
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Introduction
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The shape of deciduous teeth begin to develop at the age of 4 months in the womb. Growth
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and tooth development through several stages of initiation, proliferation, histodiferensiasi,
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morfodiferensiasi, apposition, calcification and eruption. At each stage can occur disorder
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that causes anomalies in the number of teeth, tooth size, tooth shape, tooth structure, the color
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of teeth and tooth eruption disturbances.
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Microscopic tooth structure consisting of hard tissue (hard tissue) and soft tissue (soft tissue).
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Hard tissue is tissue containing limestone consisting of enamel, dentin and cementum, while
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the soft tissue is tissue contained in the pulp cavity through the apical foramen.
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One form of dental anomalies that occurred at the stage morfodiferensiasi teeth are
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microdontia, which occurs both in primary teeth or permanent teeth. In microdontia, tooth
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size smaller than normal size. As with macrodontia, microdontia can involve all the teeth or
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limited to a single tooth or group of teeth. Usually the lateral incisors and third molars were
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smaller. Supernumerary teeth may also experience microdontia.
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Microdontia defined as teeth with size smaller than normal size, or beyond the limit of the
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size of the gear variation (Shafer et al., 2009). Radiation in the jaw during tooth development
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can also cause microdontia in the area involved (Hanne and Ivar, 2009). Microdontia most
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common in the lateral teeth and the maxillary third molar. Frequency microdontia in
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maxillary lateral slightly less than 1% (hanne and ivar, 2009). There are three types of
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microdontia, namely:
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1. True generalized microdontia (microdontia actually entirely)
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2. Generalized relative microdontia
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3. Microdontia involving a single tooth (microdontia involving a single tooth).
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Factors Affecting the Size of the Teeth
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Variations in the size of the teeth caused by several factors, namely:
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Genetic Factors (Heredity)
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Hereditary factors can affect the size of the teeth, genetic factors are intended. Genetic factors
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have the greatest influence in determining the size of the tooth. Previous research expressed
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very strong influence of genetic factors is to estimate the morphological picture of the crown
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by 90%. In the twin brothers with their blood relations, found almost no variation in tooth
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size. According to Rakosi et al (1993), based on current knowledge, the major networks that
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can undergo dentofacial deformities due to genetic effects of which have included the teeth
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which include size, shape, number, tooth mineralization, location and position of tooth germ
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eruption (Rakosi, 1993; Swasono, 2004).
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Environmental Factors
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Growth and tooth development is influenced also by environmental factors but not much
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change something that has been determined by heredity. The influence of environmental
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factors on the size of the tooth is about 20%. Research on american population in the united
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states, japan and china acquired americans born in the country compared with that was born
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in japan and china have different size mesiodistal tooth. Environmental factors is meant
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nutrients (Rakosi, 1993, Hong et al, 2008).
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Case Reports
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A 13-year-old girl came to a dental practice in london with a chief complaint of teeth 22 has a
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shape and size of the abnormal causing mild diastema and esthetic problem. History of
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patients in general good health.
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Clinical Examination.
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Extra-oral examination shows that the patient has an advance flat profile, there are no
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abnormalities in the tmj, mouth and lips relations. Intra-oral examination showed grade 1
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malocclusion with an overjet and overbite angle light. Microdontia on tooth 22 with mild
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rotation of the distal direction. Visual examination with radiographs showed microdontia on
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22 teeth.
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Figure 1 Microdontia on teeth 22
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Figure 2 Photo periapical radiography
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Diagnosis
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From the results of the examination was diagnosed that the patient is experiencing
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microdontia on the upper left lateral incisor tooth.
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Case Management
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Management of the patient's case is with composite restorations as temporary care and jacket
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crowns as permanent treatment. The treatment is carried out which treatment with composite
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resin. Care measures:
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1. First drain and isolate the teeth with cotton.
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2. Giving etching for 20 seconds to the entire surface of the tooth.
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Figure 3 Giving etching
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3. Results etching seen that whiter teeth and microscopic form tag. Then proceed giving
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resin bonding and irradiation with light cure for 15-20 seconds.
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Figure 4 Results etching
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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
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5. The results showed dental care 22 already has the same shape and size with 12 and no
diastema.
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Figure 6 Results of treatment
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Discussion
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Microdonsia is an abnormality that occurs in the bud stage, and its etiology is hereditary
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factors in localized form, and endocrine dysfunction in the overall shape of the teeth involved
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(Mary Balogh and Margaret, 2006).
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Figure 7 The "peg-shaped" deformity in microdontia of a maxillary lateral incisor.
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Microdontia care divided by the number of teeth affected, namely treatments for generalized
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microdontia and for localized microdontia.
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Generalized Treatment Microdontia.
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Generalized microdontia or thorough microdontia is a state of all teeth in the oral cavity
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having a size smaller than normal (Cameron, 1998). This condition causes a thorough and
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migration diastema tooth causing disharmony between the dental arch width and arch width.
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Thorough diastema found in patients with hypopituitarism (Cameron, 1998; Laskaris, 2000).
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Thorough diastema should not be treated as the influence of the pressure of the tongue and
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lips that often causes the teeth return to the starting position after treatment. One common
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type of treatment on overall diastema caused by microdontia thorough is the jacket crown
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thorough treatment (Moyers, 1988; Aschheim, 2001).
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Localized Treatment Microdontia
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Microdontia localized treatment can be done in various ways according to the microdontia
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conditions. There are some alternative treatments that can be done on microdontia that of one
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or more teeth: (Pinkham, 2001; Mcdonald, 2000).
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First with diastema closure is done when the teeth are experiencing microdontia with mild
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diastema. Diastema can be closed with a simple orthodontic appliance. Advantages of the
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choice of this type of treatment is overjet and overbite patients experience minimal change
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(Pinkham, 1999). Orthodontic appliance that can be used is the labial bow and coil springs
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(Sim, 1977; Witt, 1988; Proffit, 2000).
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Figure 8 Closing diastema simple light with tool orthodontics (Pinkham, 1999).
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The second is a diastema closure is done by moving the lateral incisor tooth mesial direction
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until contact with the incisor teeth tops and leaves room in the distal region of the lateral
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incisor tooth. This action is generally not acceptable in terms of aesthetics, unless the rest of
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the small room (Pinkham, 2001). Orthodontic appliance that can be used is a coil spring,
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hawley appliance, proximal spring, spring proximal to the loop adjustment (Sim, 1977; Witt,
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1988; Proffit, 2000).
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Figure 9 Closing diastema with
leaving regional space distal lateral incisor teeth (Pinkham, 1999).
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The third is a combination treatment of orthodontic tooth movement with the tools and
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aesthetic restoration of anterior teeth. The lateral incisor is moved to its normal position with
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fixed orthodontic appliance that provided enough room for esthetic restorative treatment. This
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is the best treatment (Pinkham, 2001).
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Figure 10. Treatment combination between aesthetic orthodontic treatment and restoration
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(Welbury, 2001).
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Esthetic restoration of anterior teeth is a restoration that requires a sense of art. There are
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several ways that can be used to change or cope with aesthetic problem (Mount, 1998). The
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selection of appropriate materials for aesthetic anti-cariogenic properties taken into account
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and durability (Bergen, 1989). In the case of localized microdontia, there are several ways to
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do aesthetic restoration, namely:
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1. Restoration form of fillings with composite resin, which restore the tooth to its normal
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size in a simple way. How this is done to reshape the mesial and distal surfaces or
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cover the entire crown with composite (Wei, 1988; Ascheim, 2001). Composite resin
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restoration option is used for minor irregularities on the anterior teeth as the teeth
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conical lateral incisor. The advantages of the composite resin that is cheap and fast
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(Mount, 1998; Heasman, 2003).
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2. Porcelain laminate veneer. The restoration of the form of the crown gear casing used
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to keep young and incomplete root development and large pulp cavity because of the
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eruption that has not been perfect. Laminating produce aesthetic porcelain veneers
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and good abrasion resistance, does not cause changes in occlusion and can adjust to
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the surrounding tissue (Nakazawa , 1995; Mount, 1998).
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Figure 11. Working model porcelain veneer
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Figure 12. Results of porcelain veneer restoration on lateral incisor (Welbury, 2001).
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Conclusion
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Microdontia treatment depends on the type of cases that experienced microdontia esthetic
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restorative treatment of anterior teeth, orthodontic treatment and a combination of both,
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depending on the condition of the teeth and mouth.
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