|Year : 2014 | Volume
| Issue : 3 | Page : 199-202
Nonsyndromic oligodontia associated with submerged primary molars: Clinical features and management protocols
Mahesh Ramakrishnan1, Kanimozhi Gandeeban2
1 Department of Pediatric Dentistry, Saveetha Dental College, Saveetha University, Chennai, Tamil Nadu, India
2 Department of Pediatric Dentistry, Sri Ramachandra University, Chennai, Tamil Nadu, India
|Date of Web Publication||14-Aug-2014|
Department of Pediatric Dentistry, Saveetha Dental College, Saveetha University, Chennai - 600 072, Tamil Nadu
Source of Support: None, Conflict of Interest: None
Tooth agenesis is the most common dental anomaly. The agenesis of permanent teeth can seriously affect children both physically and emotionally, especially during the years of transition into adolescence. This clinical report illustrates the oral rehabilitation of 12-year-old patient with multiple congenitally missing teeth using removable denture. The presented case reports an unusual occurrence of multiple missing teeth in a nonsyndromic patient and the treatment protocol for managing these conditions. This case is significant in three ways. First being a nonsyndromic case of missing 15 permanent teeth. Second a rare case of missing first maxillary permanent molars and third being the presence of bilateral submerged tooth.
Keywords: Congenital missing teeth, hypodontia, oligodontia, removable partial denture
|How to cite this article:|
Ramakrishnan M, Gandeeban K. Nonsyndromic oligodontia associated with submerged primary molars: Clinical features and management protocols. SRM J Res Dent Sci 2014;5:199-202
|How to cite this URL:|
Ramakrishnan M, Gandeeban K. Nonsyndromic oligodontia associated with submerged primary molars: Clinical features and management protocols. SRM J Res Dent Sci [serial online] 2014 [cited 2022 May 16];5:199-202. Available from: https://www.srmjrds.in/text.asp?2014/5/3/199/138760
| Introduction|| |
Human tooth agenesis may be caused by several independent defective genes, acting alone or in combination, leading to a specific phenotypic pattern.  It is the most common developmental anomaly, which occurs in an isolated fashion or as a part of a syndrome. , Various terminologies such as hypodontia, oligodontia, anodontia have been used to describe the agenesis of teeth in the primary or permanent dentition. 
Hypodontia is used to describe the agenesis of one or few teeth; oligodontia is used to describe agenesis of six or more teeth excluding the third molars. Anodontia is the extreme of oligodontia where there is the total absence of any dental structure. ,, Severe hypodontia is a rare condition that can occur in association with genetic syndromes, as a nonsyndromic isolated familial trait, or as a sporadic finding.  The most supported theory suggests a polygenic mode of inheritance, with epistatic genes and environmental factors exerting some influence on the phenotypic expression of the genes involved. 
Reports of the prevalence of hypodontia in the literature vary widely, ranging from 0.5% to 2.4% for the primary and from 2.6% to 11.3% for the permanent dentition.  It has got serious implications for the patient in terms of masticatory function, malocclusion, speech impairment, and psychological impact. As such, severe hypodontia can have a dramatic effect on a patient's (oral health-related) quality-of-life.  The management protocol in cases of multiple tooth agenesis involves a multidisciplinary approach mainly restoring the form and function.
The most common form of replacement in growing children with multiple missing teeth is by restoration of spaces with a removable partial denture. This is a relatively simple and cheaper form of restoration and could restore the occlusal and esthetic function. The disadvantages include patient compliance, its tendency to retain plaque and the need for periodic replacement. In patients with a single tooth missing, orthodontic closure of the space can eliminate the need for prosthesis. It is indicated only in patients with one or two missing tooth and cannot be carried out in patients with multiple missing teeth. Recontouring of the adjacent tooth after orthodontic alignment is also indicated in congenitally missing lateral incisors, where the canine is moved mesially and recontoured either using light cure composite or veneers.  Auto transplantation of any supplemental tooth into the area of congenitally missing tooth is also indicated as a form of restoration. Implants and fixed prostheses are contraindicated in growing children. These may interfere with the growth of the alveolar process; the implants are osseointegrated and would result in infra-occlusion. ,
The article describes a case involving a nonsyndromic oligodontia and the management protocols.
| Case report|| |
A 12-year-old male patient reported to the Department of Pediatric Dentistry with the chief complaint of unerupted lower front tooth. His past medical history and the family history were not significant. It was the patient's first visit to a dentist. Extra-oral examination revealed no abnormalities of the skin, hair, or nails. On intraoral examination, only 17 permanent teeth and the mandibular primary second molars (tooth 75 and 85) were retained, which is below the occlusal plane [Figure 1] and [Figure 2]. The upper maxillary first permanent molars were congenitally missing and the maxillary second permanent molars have erupted distal to maxillary second premolars. The orthopantomographic examination revealed agenesis of 15 permanent teeth including third molars [Figure 3]. The patient was diagnosed as a case of oligodontia since more than six permanent teeth were congenitally missing excluding the third molars, with associated submerged mandibular primary second molars. In view of the oligodontia of permanent teeth, the patient was referred to a pediatrician to rule out any associated syndromes and systemic disorders. A detailed examination was done to rule out abnormalities associated with the skull, chest, vertebrae and clavicles. Based on the above findings, the case was finally diagnosed as nonsyndromic oligodontia.
|Figure 1: Intra oral photograph of maxillary arch showing missing lateral incisors and permanent first molars|
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|Figure 2: Intra oral photograph of mandibular arch showing missing incisors and retained second primary molars|
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|Figure 3: Orthopantamograph showing the multiple missing permanent tooth and retained primary molars|
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The treatment protocol was discussed with the patient. A removable partial denture was fabricated for the mandibular arch as an intermediate procedure to restore esthetics and the masticatory function. The submerged mandibular primary second molars were restored using a stainless steel crown (3M ESPE St. Paul, Minn, USA) to the level of occlusion. The pit and fissure were sealed with Type VII GIC Sealent (FUGI Corp.) [Figure 4] and [Figure 5]. Orthodontic treatment was initiated to regain the space for replacement of maxillary lateral incisors and for de-rotation of maxillary second permanent molars. Once the space has been regained, it is maintained using removable partial denture until that patient attains growth completion for any permanent form of restoration such as implants.
| Discussion|| |
Prosthetic rehabilitation and maintenance care in individuals with multiple missing permanent teeth is often a comprehensive treatment plan that requires the involvement of different specialists. In an effort to minimize the number of missing teeth that need replacement, different methods can be used, and since the methods are ages dependent, an early diagnosis of which teeth are missing is crucial.
One of the key factors for the successful treatment of patients with hypodontia is the early intervention, which helps in treatment planning to achieve a stable occlusion. Multidisciplinary treatment is usually initiated upon the diagnosis of hypodontia. The definitive replacement of missing teeth should be delayed until the eruption of adjacent permanent teeth and/or any necessary tooth movement has been completed.  In case of young patients, the esthetic and functional demands can be met by the provision of composite additions, resin retained bridge such as the Maryland bridges or removable partial dentures. A removable partial denture can significantly improve the esthetic appearance and function in patients with oligodontia.
The tooth restoration using implants for severe tooth aplasia is considered the well accepted mode of definitive treatment, but placement of implants in young children is still controversial, and many authors/clinicians consider it to be delayed until skeletal growth is completed.  In most of the reported cases, the placement of implant-supported prosthesis is unlikely to be considered until clinical signs of growth cessation are present. 
Preservation of primary teeth until late teenage years is very critical for adequate bone for implant placement. The deciduous teeth should be retained in cases where they can fulfill both esthetic and functional demands of the young patient as long as possible.  They can also act as an ideal space maintainers that prevent the undesirable movement of adjacent teeth, which may cause difficulties in the placement of implants or fixed prosthesis.  Clinicians however should be aware of the risk of progressive infra-occlusion and careful monitoring of these teeth is essential. Clinically, a tooth is diagnosed as submerged if its intact marginal ridges are >0.5 mm below the intact marginal ridges of the adjacent normal teeth.  Since, they are below the occlusal plane, they can be restored using a stainless steel crown to restore the occlusal plane.
The maxillary lateral incisor is the second most common congenitally absent tooth. There are several treatment options for replacing the missing maxillary lateral incisor, including canine substitution, tooth-supported restoration, or single-tooth implant.  Selecting the appropriate treatment option depends on the malocclusion, the anterior relationship, specific space requirements, the degree of flattening of the facial profile, and the condition of the adjacent teeth.  Since in this case, there is excess space available in the arch, single-tooth implant would form an ideal treatment plan. Hence, orthodontic therapy is initiated to regain the space for the maxillary laterals and also to de-rotate the maxillary second molars.
The prosthetic rehabilitation of patient with the higher number of absent teeth as oligodontia is likely to become more comprehensive. Congenitally missing multiple permanent teeth are a rare entity and successful management necessitates the need for a sound understanding of the treatment modalities available and their indications.
| Conclusion|| |
The objectives of a hypodontia multidisciplinary team should be to provide improved esthetics, function, and occlusal stability. Various treatment options, which take considerations into account the growth and development of the dentition, can lead to a treatment plan that can produce acceptable interim results, which do not compromise any future definitive care.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]