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BDS4 CDS Ortho > Hypodontia > Flashcards

Hypodontia Flashcards

1
Q

hypodontia

A

congential abscnes of one or more teeth

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2
Q

anodontia

A

complete absence of teeth (none at all)

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3
Q

severe hypodontia

A

6 or more congenitally absent teeth

(excluding 8s)

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4
Q

describe

A

Missing lower central and upper lateral, retained lower \a

Pt likely bothered by diastema and missing upper laterals

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5
Q

prevalance of hypodontia

A

Prevalence approx. 6% (excl. 8’s)
* 6.3% F, 4.6% M in European population

0.9% primary dentition (less than permanent)

Most affected
* (8’s), L5’s, U2’s, U5’s, lower incisors

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6
Q

prevalance of missing upper lateral incisors

A

Approx. 20% of all missing teeth

Associated with ectopic canines

Most hypodontia cases will have missing U2’s

Greatest effect on aesthetics
* Most concerned

Often dealing with 2 problems at once (ectopic 3s and/or micro)
* Missing guiding root theory possible

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7
Q

prevalance vs incidence

A

Prevalence and incidence are different measures of a disease’s occurrence.
* “prevalence” of a condition means the number of people who currently have the condition, whereas “incidence” refers to the annual number of people who have a case of the condition.

A chronic incurable disease like diabetes can have a low incidence but high prevalence, because the prevalence is the cumulative sum of past year incidence rates.
A short-duration curable condition such as the common cold can have a high incidence but low prevalence, because many people get a cold each year, but few people actually have a cold at any given time (so prevalence is low and is not a very useful statistic).

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8
Q

aeriology of hypodontia can be either

3

A

non-syndromic
or
syndromic
or
environmental

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9
Q

non-syndromic aetiology of hypodontia

3

A
  • Mutations in at least 3 genes associated with missing teeth in non-syndromic hypodontia
  • Familial – quite common
  • Sporadic a.k.a de novo
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10
Q

syndromic aetiology of hypodontia

examples

A

> 100 craniofacial syndromes assoc. with hypdontia

e.g.
Cleft lip and palate

Anhydrotic etodermal dysplasia
* ecto dermal tisues not develop fully
* Teeth are apart of this

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11
Q

environmental aetiology of hypodontia

A

not true hypodontia (as not developmental anomaly)

trauma or radio/chemotherapy

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12
Q

presentation options for hypodontia

4

A
  • Delayed or asymmetric eruption
  • Retained or infra-occluded deciduous teeth
  • Absent deciduous tooth
  • Tooth form

*No primary tooth guaranteed no permanent, As develop from primary tooth germ *

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13
Q

describe the tell tale signs of hypodontia in this case

4

A

Present early on, there’s tell tale signs
* Large midline diastema
* No lateral to stop the central drifting distally
* D infraoccluded absent successor
* Tooth from - tapered and small teeth hand in hand with hypodontia

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14
Q

10 associated dental problems with hypodontia

A

Microdontia
* Spacing caused by absence of permanent tooth exacerbated by small tooth

Malformation of other teeth

Short root anomaly

Impaction (common for upper 3s (or ectopic))

Delayed formation and/or delayed eruption other teeth

Crowding and/or malposition of other teeth

Maxillary canine/first premolar transposition

Taurodontism
* Enlarged pulp chambers

Enamel hypoplasia

Altered craniofacial growth

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15
Q

occlusion difficulty in hypodontia

A

often reduced vertical dimension and increased OB

making management challenging

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16
Q

potential orthodontic problems in hypodontia cases

5

A

spacing
drifting
over-eruption
aesthetic impairment
functional problems

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17
Q

hypodontia care pathway

A

GDP recognition

Referral to specialist orthodontist

In GDH
* Initial assessment in orthodontics and allocate when appropriate to Hyodontia Clinic (orthodontic and restorative input)

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18
Q

you are GDP and take this OPT

what should you do

common exam Q

A

refer to specialist as hypodontia case

with full radiographic report

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19
Q

tx for this hypodontia pt

4 stages

A
  1. Extraction URb, ULb (no2s)
  2. Sectional fixed appliance to close space between UR1, UL1 (midline diastema)
  3. Allows eruption UR3, UL3

Bonded retainers on back to prevent relapse

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20
Q

4 keys to successful management of hypodontia pts

A
  • Inter-disciplinary team
  • Joint assessment and treatment planning with precise aims
  • Joint collaboration at transitional stages of treatment
  • Follow up of treated cases
    *How results last, not just when take off appliance
    *
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21
Q

assessment and planning stages

7

A

History

Extra-oral examination

Intra-oral examination
* Orthodontic aspects
* Restorative aspects

Investigations

Problem list

Definitive Plan

Retention / maintenance
* How easy for pt to retain, longevity of restorative solutions

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22
Q

investigations for hypodontia pts

5

A

Study Models

Planning models
* Kesling, diagnostic

Radiographs
* OPT likely to account for all absent teeth, Root morph, neral dent health

Photographs
* see where you at and to compare

Conebeam CT

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23
Q

what can be an aid to ortho-restorative tx planning

A

diagnostic set up

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24
Q

tad =

A

temporary anchorage device

like a mini bone screw

25
IOTN 4h
absence of 1 tooth in a quadrant
26
IOTN 5h
absence of at least 2 teeth in 2 quadrants
27
pt concern re hypodontia
Dental health small impact * caries, perio - if anything easier to clean Reduction in tooth substance to chew - not really Mainly don’t like gaps
28
tx options for missing upper lateral incisors | 4
* accept * restorative alone * orthodontics alone * combined orthodontics and restorative tx
29
examples of
Restorative-only solution to missing upper laterals achieve partial closure of diastema Supplemental premolar?
30
describe this case
Absent UR2, with shift of upper centreline, but low treatment need due to acceptable aesthetics and function Likely complain cross over centrals, centre line to right Likely not notice hypodontia
31
2 pathway options for combined orthodontic and restorative tx | missing upper lateral incisor
open space close space * simple * space closure plus
32
restorative options after opening space with ortho for missing lateral incisor cases | 5
*** RBB * Implant ** * conventional bridgework * autotransplantation * partial denture
33
3 things about the tx plan of choice
1. Satisfies expected aesthetic objectives 2. Least invasive 3. Satisfies expected functional objectives * Immediate * Long term (65 years+) | Informed consent needed for these aspects
34
pro of acrylic partial denture after opening space
good OH maintained as can remove and clean easily
35
describe tx here
Absent upper 5 with retained es Resin-Bonded Bridges replacing absent upper lateral incisors. Bonded retainer wire in place to prevent relapse of diastema *Lends to space opening rather than closure Need upper fixed to redistribute space between central and 3- to make correct space for pros replace Cantilever RBB and Bonded retainer wire to keep diastema close*
36
role of TAD
keep posteriors in place whilst retracting canines
37
bridges in canine region
fail often due to occlusal force on them
38
what has happened here
labial rotation of lateral incisor cantilever pontics due to mesial replapse of canines (not wearing retainer) cause displeasing appearance
38
what has happened here
labial rotation of lateral incisor cantilever pontics due to mesial replapse of canines (not wearing retainer) cause displeasing appearance
39
RBB design for hypodonita
better success rate with cantilever design ideal abutment is canine technique sensitive
40
RBB for hypodontia adv | 5
Relatively simple Do when young (complete treatment) (unlike implants as vertical growth can occur till 20/21) Non-destructive Can look good Place on semi-permanent basis Can be until growth complete, or longer term
41
RBB disadv for hypodontia | 3
Failure rate * Bonding * Chipping/prosthesis part Appearance sometimes not good, (easy to try again, new materials) Orthodontic retention needs are high (relapse risk)
42
space needed for implant
approx 7mm at gingival level pt needs to wear retainer with tooth in it
43
describe tx needed here
Planned extraction of retained ULC to allow retraction of UL3 and space creation for prosthetic replacement of UL2. *Canines next to upper central C distal to it Primary C extract, distalise 3 - **challenge need anchorage right TAD** *
44
why need radiographs or CBCT for implants
confirm root separation CBCT allows more accurate assessment of root positions, bone width and volume in implant planning * gold standard
45
implants give the most predictable aesthetics??
no * Recession of gingival margin on labial of implant, leaving metalwork visible * Can be hard to fix metal work showing Warn pt and inc in informed consent * Complex * Can be excellent
46
7 key differences between RBB and implant
* Can’t do implant till about 18-19 (or later?) * Need minimum 7mm space * Root separation! * Often need bone graft * Technically very demanding in aesthetic zone * Significant extra time to do * Significant cost | can be hard to achieve space
47
7 key differences between RBB and implant
* Can’t do implant till about 18-19 (or later?) * Need minimum 7mm space * Root separation! * Often need bone graft * Technically very demanding in aesthetic zone * Significant extra time to do * Significant cost | can be hard to achieve space
48
simple space closure
minimal invasive procedure after closure (e.g. small composute bondings)
49
when assessing for simple space closure assess
When deciding take into account these factors * Tooth shape/size * Tooth colour - canine can be more yellow than lateral * Gingival architecture Gingival margin levels of central incisor and canine need to be assessed when planning space closure approach * normal is up down up (1, 2, 3) so if Missing upper laterals without large amount of space to close Favourable gingival margins - Canines below central incisor margin
50
3 ways to make a canine look like a lateral
* Individualised extrusion of canine re gingival contour height relative to U1 (gingiva follows tooth movement) * Significant reshape U3 reshape low hanging cusp * Bleaching U3 (tray for them only, also acts as a retainer - fits over bonded wire)
51
how to make a first premolar look like a canine | 3
* Intrude U4 to give correct gingival architecture * Rotate to take up more space * Composite build up or veneer U4 to restore vertical height and ‘caninise’ the U4
52
3 adv of space closure plus
* No prosthesis – relatively low maintenance * Good aesthetics with appropriate orthodontic and restorative techniques * Can be done at an early age
53
autotransplantation
when upper 5 blocked out due to loss of E (space closed) can be autotransplanted into site of missing lateral - rare
54
what tx has this hypodontia pt had
space closure plus (build ups)
55
what tx has this hypodontia pt had
implants
56
what tx has this hypodontia pt had
RBB upper left lateral
57
successful management of hypodontia pt needs | 4
* Inter-disciplinary team (joint appointment) * Joint assessment and treatment planning with precise aims * Joint collaboration at transitional stages of treatment * Follow up of treated cases

BDS4 CDS Ortho (9 decks)

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