NON SYNDROMIC FAMILIAL HYPODONTIA- A CASE SERIES
Case Report
Figure 9. Orthopantomogram, father. Figure 10. Orthopantomogram, AA.
visit with no chief complaints. Her medical history was unremarkable with no systemic conditions or syndromes. Dental History: An extra-oral examination revealed a convex profile with an increased over-jet( 5 mm) and the patient ' s skin and hair were found to be normal in texture and appearance. The intraoral examination showed the child to be in the mixed dentition stage( Fig. 1-5). Multiple teeth, namely 55, 54, 53, 63, 64, 65, 73, 84( FDI Notation system) had proximal carious lesions which were detected clinically and confirmed by the initial bitewing radiographs( Fig. 6, 7). Tooth 74 was noted to be non-restorable. A comprehensive dental treatment plan was formulated and discussed with the parent, which included restoration of the carious teeth with composite restorations and extraction of tooth 74. The patient however did not return back for any treatment for almost one year, despite repeated attempts to contact them. Upon the child’ s return for treatment at 9 years of age, a new dental assessment was conducted which included an orthodontic consultation due to the Class II malocclusion with the increased over-jet. A routine panoramic radiograph was thus taken which revealed agenesis of teeth 13, 12, 22, 23 and 32( Fig. 8). The corresponding primary teeth( 53, 52, 62, 63) were retained with no radiographic evidence of tooth resorption or mobility. Tooth 72 had exfoliated and teeth 31, 41 and 42 were present. Based on the history and clinical findings, a diagnosis of non-syndromic hypodontia was made. A comprehensive treatment plan using a multidisciplinary approach was formulated in order to restore both esthetics and function and discussed with the father. The short-term plan included restoration of the carious teeth and maintaining the retained primary teeth( 53, 52, 62 63) until they showed clinical or radiographic signs of exfoliation on routine follow up appointments. The long term orthodontic plan would then be initiated which would involve extraction of all the retained primary teeth, moving the maxillary premolar teeth( 14 and 24) into the respective canine spaces and reshaping them to resemble the maxillary canines( 13 and 23). The space for the missing maxillary lateral teeth would be preserved. Once orthodontic treatment was completed, a resin retained bridge would be fabricated to replace 12 and 22 as a temporary measure until implants could be placed once the child turns 18 years of age. Due to the diagnosis of the hypodontia, a detailed medical history was obtained from the parent which revealed a non-consanguineous marriage, with no history of genetic conditions in both parents. The child was the third oldest among four children. The
Figure 11. Intraoral frontal view post-op, AA.
Figure 12. Upper occlusal view post-op, AA.
Figure 13. Lower occlusal view post-op, AA.
father agreed to a panoramic radiographic evaluation of himself and was advised to bring in the remaining children for a thorough dental evaluation to detect familial hypodontia. The father’ s radiograph showed spacing in the upper arch, no congenitally missing teeth and a history of extraction of tooth 26( Fig. 9). The two older children( Cases 2 and 3) however had congenitally missing teeth. The youngest child was 2
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Stoma Edu J. 2018; 5( 1): 52-57 http:// www. stomaeduj. com