J PROSTHODONTICS

Rehabilitation of Non-Syndromic
I
D Oligodontia in a young adult: A Case
A Report Sharad Gupta1 Puneet Batra2 Shweta Batra3

Abstract
Brief Background
Congenital or developmental agenesis of teeth impacts
not only complete dentition but also the aesthetics. The
paper presents a case of hypodontia and diastema and
their management.

Materials and Methods

Clinical and radiographic examinations revealed over-
retained deciduous teeth and midline diastema following
which orthodontic correction and prosthodontic
rehabilitation were proposed.

Discussion
Aspects such as differential need for replacement,
treatment objectives concerning maintenance of facial
profile and aesthetics, masticatory efficiency and speech,
1 MDS,FICD,FICOI,FAAMP preservation and restoration of alveolar bone, need for
Professor, Department of Prosthodontics multi-disciplinary approach, considerations that govern
ITS-CDSR, Muradnagar, treatment modalities were the subject of discussion.
Ghaziabad, Uttar Pradesh
Summary and Conclusions
Email: sharadssv@gmail.com
There are prosthetic options galore for restorations which
2 MDS, MOrth RCS (Edin), FFD Orth RCS (Ire), DNB naturally should aim at caries free dentition, longer
Professor and HOD, Department of Orthodontics preservation of primary teeth in the event of missing
Institute of Dental Studies and Technologies permanent successor and preservation of the deficient
Modinagar, Uttar Pradesh alveolar bone.

3 BDS, PGDHHM, PGDMLS Key Words

Consulting Dental Surgeon Hypodontia, diastema, deciduous dentition, aesthetics,
New Delhi rehabilitation.

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 Introduction
Congenital or developmental agenesis of teeth can affect
a single tooth or the complete dentition. Hypodontia refers
to the developmental absence of one but less than six
teeth1. Oligodontia signifies more than six missing teeth1.
Complete absence of all teeth is termed as anodontia2.
In approximately 80 % of reported cases of hypodontia,
only 1 or 2 teeth are missing, in 10 %, 4 or more, while in
1% of cases 6 or more teeth are absent3.
Congenitally missing teeth affect both deciduous (0.08-
1.55%)4 and permanent dentition (2.3 % - 11.3 % )3. The
prevalence of hypodontia is 3.5-6.5 % in most populations
excluding third molar5. According to Brook6 variation in
prevalence may be due to criteria and technique used for
establishing the anomaly (variations in age, gender, ethnic
and racial background).
Hypodontia of permanent teeth has equal frequency in
both jaws. It is more common in females as compared to
males (3:2).3 The prevalence of third molar hypodontia
is about (9-37%).1 The prevalence of Incisor-Premolar
hypodontia ranges from 5-10%7. Amongst the
congenitally missing teeth mandibular second premolars
are (40-50%) followed by the maxillary lateral incisors
(25%), maxillary second premolars (20%), and mandibular
central incisor (6.5% ) as the most common missing teeth
with the exception of third molars5,8.
The aetiology of hypodontia is unclear and many theories
regarding the occurrence of hypodontia have been
proposed by different workers.9,10,11,12,13,14,15 Hypodontia
could be due to environmental factors, genetic/familial
trend or associated with some syndrome. Among the
environmental factors, role of peripheral nerve has been
found to be associated with tooth agenesis 9. According
to Inger Kjaer (et al) 9 (1994) tooth agenesis may be
based upon disturbances in nerve tissue, oral mucosa,
and supporting tissue related to tooth development.
According to Nasman et al11 (1997) malignant
chemotherapy and radiation therapy in early childhood,
have also been found to be associated with hypodontia.10
Drugs like Thalidomide (N-phthaloylglutamimide)
during pregnancy11, dental trauma, fractures, surgical
procedures are also found to be related to arrested tooth
development12.
Hypodontia has a greater genetic basis than
environmental factors. Hypodontia is more common
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among individuals related to hypodontia patients than in
general population13. Familial hypodontia is inherited as
autosomal dominant trait with incomplete penetration
and exhibits variable expressivity7. Some cases are found to
also exhibit sex linked and polygenic /multifactorial model
of inheritance14. Dental manifestations are a common
finding in various syndromes. According to the London
dysmorphology database (LDDB) hypodontia is associated
with around more than 150 syndromes15. Hypodontia
may occur in association with ectodermal dysplasia17,
Down’s syndrome17, Ellis Van Crevald syndrome17,
Incontinentia Pigmenti17 (Bloch- Sulzberger syndrome),
Cleft lip and Palate18, Pierre-Robin syndrome19,Vander-
Woude syndrome20, to name a few important ones.
Also, it is found to be present in association with other
dental findings like microdontia, macrodontia and
supernumerary teeth. The incidence of supernumerary
teeth is greater in males, with greater association
between hyperdontia and macrodontia. The association is
seen between impaction of permanent canines, maxillary
canine-first premolar transposition and taurodontism.16
Congenitally missing teeth are associated with various
clinical findings.1,5 The severity of hypodontia or the
number of teeth missing would be the influencing factor
on the dental outcome which could be in the form of mal-
positioning, periodontal damage, lack of development
of alveolar bone height resulting in increase in freeway
space. Severe hypodontia may be associated with small,
malformed, conical or tapering teeth, over-retained
deciduous teeth, prognathic appearance with mandibular
protrusion and lip eversion on occlusion. Abnormal
change in tooth number and shape can lead to reduced
masticatory ability, social and psychological disturbances
besides aesthetics and functional limitations.
Tooth size and number are important for planning
orthodontic treatment. It helps in determining whether
the dentition is spaced, well aligned or crowded. The final
occlusion, buccal inter-digitation, overbite, overjet and
midline discrepancies will be influenced by tooth size21.
The establishment/recognition of the most suitable age
for correct diagnosis of hypodontia is of great clinical
importance. Orthopantomograms, are found to be an
adequate diagnostic aid for establishing hypodontia22.
According to Borghild & Bjorn Ogaard5, in a longitudinal
radiographic study of 9 year old Norwegian children,
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 the diagnosis of hypodontia (second premolar) in boys
Fig 2a
when registered at the age of 9 years, 11.2 % showed
late mineralization upto 12 years. On the contrary only
2.9 % girls showed late mineralization after the age of 9
years. It is recommended that the radiographic diagnosis
of hypodontia should not be established before the age
of 8-9 years.
We present here a case report of congenitally missing teeth
(Oligodontia) and their multidisciplinary rehabilitation is
discussed.

Case Report Fig 2b

A 19-year old girl reported to our dental clinic with a chief
complaint of “gaps’’ between her front teeth. Her general
medical history was non-significant.

The patient had silver amalgam fillings done in all her

molars for treatment of caries. There was no history of
any tooth extraction or any familial history of any oral and
dental anomaly. Her extra-oral appearance revealed well
balanced face with normal facial profile (Fig.1). Her intra-
oral examination revealed over-retained deciduous teeth:

Fig 2(a,b): Picture showing maxillary occlusal view with over-

retained 55, 65 and 63

Fig 3: OPG showing missing: 15, 12, 22, 24, 25 and 35

55, 65, 63 and 75 (Fig. 2) and midline diastema. Her

radiographic examination (OPG) confirmed missing: 15,
12, 22, 24, 25 and 35 (Fig. 3). Radiographic examination
(Cephalometric) revealed a skeletal Class II profile.
Investigations, which included X-ray chest and bilateral
both limbs (full body skeletal survey) for determining any
skeletal involvement, were inconclusive.

It was decided to treat the patient with inter-disciplinary

orthodontic and prosthodontic rehabilitation. Orthodontic
Fig 1: Pre-Treatment extra oral picture showing normal appearance correction (Fixed 0.22 Roth mechanotherapy) included

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Fig 4: Rehabilitated and final outcome
closures of spaces posteriorly following extraction of over-
retained deciduous molars, creation of space for lateral
incisor and closure of midline diastema. In the lower arch,
retained 75 was extracted and spaces closed. Permanent
direct bonded retainers were given in the lower arch.
After completion of the orthodontic treatment the spaces
created for the lateral incisors 12 and 22 were closed by
designing fixed porcelain fused to metal bridges with
13, 11 and 21, 23 as abutments (Fig. 4). Satisfactory
aesthetics and function were achieved by combined
orthodontic and prosthodontic procedures.
Discussion
The patients having missing teeth will have differential
need for replacement depending upon the number of
teeth missing.1,23,24,25 Whether it is a single missing tooth
or many, management of hypodontia is best possible only
through multidisciplinary approach.
The main objective of treating hypodontia should be
restoration of the aesthetics, establishment of masticatory
efficiency and speech, preservation and restoration of
missing alveolar bone, besides psychosocial reasons.
Rehabilitation of hypodontia involves a close association
between orthodontic and prosthodontic treatments.
Orthodontic considerations should aim to correct
malpositioning of teeth, discrepancies related to tooth
References
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JI DA - Jou rn al of I n dian D ental Asso ciatio n - Vo l 7 - Issue 7 - July 2013
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Conflict of Interest: None
Source of Support: Nil
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