PROSTHODONTIC REHABILITATION OF A PATIENT WITH

UNUSUAL PARTIAL ANODONTIA A CLINICAL REPORT

Introduction

Congenital absence of one or more teeth, i.e., Partial or total anodontia

is a rare condition and is a debilitating one. This condition affects the

esthetics and functional capability of the patient. At the same time, it

has a devastating effect on the psychology of the patient.

Anodontia may be either total or partial.

a) Total anodontia is a condition in which all the teeth are missing and

usually involves both the deciduous and permanent dentition.

b) Partial anodontia is more common than total anodontia and it usually

involves certain teeth like the 3rd molars and the lateral incisors. In

severe cases, very few erupted teeth remain in the dental arches.

Partial anodontia can be both physically and emotionally devastating to

the young patients.

Complete or partial Anodontia can occur either singly or may be

associated with certain syndromes such as:

o Ectodermal dysplasia.

o Downs syndrome.

o Goltz syndrome (Focal dermal hypoplasia).

o Ellis van creveld syndrome.

o Orofacial digital syndrome.

1
 o Albright hereditary osteodystrophy.

o Cleft lip and cleft palate.

Comprehensive management of patients with complete or partial

anodontia poses a significant challenge to the clinician.

The remaining natural teeth provide support, stability and retention to

the prosthesis.

Treatment modalities for partial anodontia:

A multidisciplinary approach is recommended for optimal dental

management of partial anodontia.

As this condition has both functional and psychological implications, it

is important to provide early treatment. It must be remembered that any

prosthesis made for young patients must be closely monitored for

needed adjustments or for the replacement the entire prosthesis to

accommodate the growth and development of the patient.

Treatment modalities include fixed, removable or implant prosthesis,

either singly or in combination.

FPDs should be avoided in young actively growing patients because

they could interfere with the jaw growth. Hypoplastic teeth are

commonly associated with partial anodontia and they may require

composite restorations or crowns to restore the proper contours of the

teeth.

Implant-supported restorations can improve physiological and

psychological functions when compared with the complete dentures;

2
 but their placement in growing jaws leads to complications. When

implant treatment is considered in young patients, their dental and

skeletal maturity should be the determining factor.

However, removable prosthesis is the most frequently used treatment

modality for dental management of partial anodontia. Although

complete dentures are an acceptable form of treatment, over dentures

or RPDs supported by natural teeth are desirable for the preservation of

alveolar bone.

Clinical Report:

a) History of the patient:

A 15-year-old girl was referred to our Department from the Department of

Oral Medicine & Radiology.

The patient presented with the chief complaint of multiple missing teeth
associated with poor esthetics, mastication and difficulty in speech.

It was reported by the patients patents that she did not have a full set of

milk teeth when she was a child. By the age of 7 years, she only had a few

teeth in the upper and lower arches. There was neither any history of

exfoliation of these teeth nor of eruption of other teeth subsequently.

The general medical history of the patient was non-contributory.

The family history revealed that her 19-year old bother was having a

similar dental presentation and no other family members were affected by

this condition.

3
 The patient however, had not received comprehensive dental care because

of financial constraints.

b) Clinical Examination:

Extra oral:

- The extra oral examination revealed a prognathic mandible.

- Diminished lower facial height contributed to a senile facial

appearance.

- Patient presented with a thick everted lower lip.

Intraoral:

The intraoral examination revealed multiple missing teeth in the upper and

lower arches.

- Clinical examination revealed two malformed teeth in the

region of right and left maxillary lateral incisors and two

malformed teeth in the region of right and left mandibular first

molars.

- Underdeveloped upper and lower alveolar ridges with the

minimal height and width were seen.

- The palatal vault was shallow and there were no other clinically

noticeable abnormalities of oral mucous membrane.

- The tongue appeared to be large, but no signs of macroglossia

could be detected.

4
 - Loss of vertical dimension of occlusion and lack of alveolar

growth associated with an increase in the inter-occlusal distance

were also observed.

c) Radiographic Examination:

- A panoramic radiograph revealed complete absence of primary

or permanent teeth germs. Two teeth were present in the upper

anterior region and two teeth on the either side of the lower

arch.

- Because of the absence of teeth, there was only a thin layer of

bone separating the maxillary antra from alveolar ridges and

only basal bone was observed in the mandible.

- Intraoral periapical radiographs of the teeth that were present

revealed well defined pulp chambers and root canals.

Diagnosis:

A diagnosis of partial anodontia was arrived at after the clinical and

radiographic examination.

Prosthodontic treatment strategy:

Treatment of partial anodontia requires knowledge of growth and

development. Behavioural management is an integral part of the treatment

strategy.

- Considering the initial examination, the following treatment

modalities were recommended:

5
 1. Implant-retained restorations.

2. Removable partial or complete dentures.

3. Over-dentures.

- Implant-retained restoration was ruled out for this particular

patient due to the age of the patient, as continued dental and

skeletal growth could be expected.

- A treatment plan consisting of fabrication of maxillary and

mandibular over-dentures was discussed with the patient.

Restorative Procedure:

Preliminary impressions were made using stock metal trays and

irreversible hydrocolloid impression material (Imprint Dental

Products India Ltd.).

The impressions were poured in dental stone.

With the help of interocclusal record, the diagnostic mounting was

done.

The preliminary casts were surveyed and the desirable path of insertion

and removal was established. The necessary tooth modifications,

which included contouring of proximal and occlusal surfaces, were

carried out in the patients mouth.

Two layers of base plate relief wax (Modeling wax no. 2) were used to

cover the dentulous and edentulous areas on preliminary cast.

6
 Custom self-cured acrylic resin (DPI, Cold Cure Acrylic Resin) trays

were fabricated to make the final impressions.

Maxillary and mandibular resin trays were border molded with green

stick compound (DPI, Pinnacle, Dental Products India Ltd.).

Final impressions were made using vinyl polysiloxane elastomeric

impression material (Reprosil, Dentsply, Hydrophilic Vinyl

Polysiloxane medium viscosity).

Working casts were obtained using dental stone, on which maxillary

and mandibular occlusal rims were fabricated.

Vertical dimension of occlusion was established by assessing phonetics

and esthetics. Centric relation was recorded and teeth selection was

done.

Face bow transfer was made to mount the maxillary cast in a semi-

adjustable articulator.

Lingual aspects of artificial teeth in dentulous areas were adjusted to

allow the artificial teeth to be set over the existing teeth in order to

maintain proper occlusal and esthetic relationships.

Anterior edge-to-edge relation was established following neutro-

centric occlusion in the posterior teeth.

Following a satisfactory try-in with teeth setup, dentures were

processed in heat polymerizing acrylic resin (DPI Heat Cure Acrylic

Resin) according to the manufacturers instructions.

7
 The retrieved dentures were trimmed and polished. Denture insertion

was done with minor adjustments.

The tissue surface of mandibular denture was relined with GC soft

relining material (GC RelineTM Soft, GC Corporation, Tokyo Japan).

Recall visits of 24 hours and 1 week were scheduled and were carried

out accordingly.

DISCUSSION

Patients affected with congenital or developmental anomalies of the

oral or head and neck regions present the prosthodontist with a unique

esthetic and functional restorative challenge.

As the number of teeth is reduced, patients often present with problems

related to occlusal vertical dimension and esthetics, thus requiring

extensive restorative and prosthetic treatments to regain appropriate

function, esthetics and comfort. Such needs can create a challenging

treatment situation.

The options for definitive treatment plan include fixed, removable or

implant supported prosthesis, either singly or in combination.

Financial constraints and other priorities may restrict patients from

choosing the most desirable treatment.

The use of over-denture can significantly improve the function and

esthetics in an anodontia patient.

8
 The advantages include the remaining natural teeth provide improved

support and stability, improved proprioception and neuromuscular feed

back mechanism. Superior restoration of the oral functions such as

speech, chewing and swallowing with improved comfort to the patient

and preservation of alveolar bone can be attained.

Additional benefits include the preservation of the tooth structure and

psychological support for the patients.

SUMMARY:

Anodontia, either total or partial, should be referred to the

prosthodontic consultation at an early age.

The improved appearance that results from providing dental prosthesis

is of great psychological importance to patient.

The treatment rendered for this patient significantly improved the

esthetics, function and phonetics of the patient and established a more

favorable plane of occlusion.

REFERENCES

Ana Claudia Pavarina, Ana Lucia Machado, Carlos Eduardo Vergani,

and Eunice Teresinha Giampaolo Overlay removable partial dentures

for a patient with ectodermal dysplasia: A Clinical Report. J. Prosthet.

Dent. 2001; 86: 574-7.

Atilla Stephen, S. Burcak Cengiz The use of overdentures in the

management of severe hypodontia associated with microdontia: a case

report. J. Clin. Pediatr. Dent. 2003; 27: 219-222.

9
 Ekaterini Paschos, Karin Christine Huth, Reinhard Hickel Clinical

management of hyoigudrituc ectodermal dysplasia with anodontia:

case report. J. Clin. Pediatr. Dent. 27: 5-8, 2002.

Mark A. Pigno, Ronald B. Blackman, Robert J. Cronin and Edmund

Cavazos Prosthodontic management of ectodermal dysplasia: A

review of the literature. J. Prosthet. Dent. 1996; 76: 541-5.

Minaxi I. Patel Prosthodontic rehabilitation of a patient with partial

anodontia: A clinical report. J. Prosthet. Dent. 2002; 88: 132-4.

Thomas J. Vergo Prosthodontics for pediatric patients with

congenital / developmental orofacial anomalies: A long-term follow-

up. J. Prosthet. Dent. 2001; 86: 342-7.

10