Treatment of dental agenesis

Treatment of dental agenesis

1.Introduction

In his daily practice, the orthodontist is regularly called upon to treat patients in whom one or more teeth are missing.

Indeed, it places the orthodontist at the center of the treatment, but it is characterized above all by the multidisciplinarity implemented: orthodontics, by the potential development of malocclusions, periodontology, prosthetics, implantology, as well as genetics due to the significant polymorphism that dental agenesis constitutes.

2.Definition

From its Greek etymology meaning “absence of generation” (“a”: privative and “genesis”: without generation),
Dental agenesis is “an anomaly of number corresponding to the absence of a dental unit, in relation to the absence of the corresponding germ” (BASSIGNY)
“A tooth is defined as congenitally absent if it has not erupted into the oral cavity and is not visible on X-ray and has neither been extracted nor accidentally avulsed” (GONZALES-ALLO).
It is a dental anomaly of number by reduction, which can be isolated concerning only one germ, or multiple, distinguishing three types:

3.Frequency

Ana GONZALEZ-ALLO et al published in April 2012 a study on the prevalence of dental agenesis in a Portuguese population. Out of a total of 2888 patients followed from 2005 to 2009, the results are as follows:
- Total of 2888 subjects, 175 have agenesis or 6.1%
- Of these, 56.6% are female and 43.4% are male.
- The teeth most affected by this anomaly are, in decreasing order:
  - 2nd lower ^premolar : 39.3%
  - Upper lateral incisor: 25.5%
  - 2nd upper ^premolar : 14.4%
  - Lower incisor: 6.7%
The rate of agenesis was particularly high in brachyfacial type patients

4. Therapeutic attitude

The practitioner must find a treatment that satisfies both aesthetics and function:

Therapeutic abstention;
Opening or maintaining spaces for missing teeth;
Closing spaces in missing teeth.

In order to choose between these three alternatives, he must take into account the different factors influencing the therapeutic choice:

4.1. Factors influencing the therapeutic choice

Orthodontic factors :
Profile: closing spaces for convex profiles and opening spaces for concave profiles.
Facial typology:

Long face, do not distalize the molars, and prefer extractions (space closure);
Short face, do not mesialize the molars and avoid extractions (opening of space).

Periodontal context : height of attached gingiva, level of alveolar bone
Occlusal function: in the event of cracking, pain in the TMJ, spasms of the masticatory muscles or a predisposition to rheumatoid disorders, the canines must be placed in cl I.
Smile and dental morphology: The coronal morphology of the pointed or rounded canines and the thick or thin upper incisors, normal or rice-shaped lateral incisor and the color of the canines (very yellow).
Non-orthodontic factors:

Age
Motivation
Socio-economic factors: the cost of the prosthetic element can be high.

4.2. Treatment of agenesis of the upper lateral incisors:

4.2 . 1. Treatment of bilateral agenesis:

The incisors are located in a strategic aesthetic and functional sector, the therapeutic decision will be taken after an aesthetic, functional and economic analysis; which requires close orthodontic-prosthetic collaboration.

4.2.1.1. Therapeutic abstention:

It should be reserved for cases where the temporary lateral incisor is in place and in good condition, with the canine evolving in its usual place.

It arises from contraindications to orthodontic or prosthetic treatment, these being most frequently linked to a lack of motivation or the socio-economic context.

4.2.1 2. Treatment by opening space: (solution 1)

This technique consists of increasing or preserving the space of the agenesis with a view to a prosthetic or implant restoration in order to re-establish the continuity of the arch.

Treatment of dental agenesis

Consequences: Class I relationship of molars and canines

with canine function, laterally.

In patients during the growth period, it is necessary to maintain the space of the missing laterals at the end of orthodontic treatment by non-invasive means until the definitive restoration at the end of growth.

4.2.1.3. Space closure treatment:

Step 1: Closure of the agenesis spaces

Treatment of dental agenesis

Step 2: Positioning and transformation of the canine into a lateral one $C:\Users\ASPIRE\Desktop\agenesie\Untitled.png$ $C:\Users\ASPIRE\Desktop\agenesie\jdhlsk.png$ $C:\Users\ASPIRE\Desktop\agenesie\tr.png$

Step 3: Positioning and transformation of the first premolar into a canine

To better resemble the canine it replaces, the first premolar should have a slight mesiopalatal rotation (Fig. 3) in order to move its cusp mesially. This rotation will mainly help to hide the flat mesial face of the premolar and thus avoid an unpleasant appearance when smiling (Fig. 2).

If the canine is placed in the lateral incisor position, several solutions are possible depending on the initial conditions:

Solution 2: relationship of canine cl II and molar cl II without extraction.
Solution 3: relationship of canine cl II and molar cl I (extraction of the 02 lower premolars 35/45).
Solution 4: relationship of cl I canines and cl I molars (extraction of 42 and 32 or 41 and 31).
Solution 5: relationship of cl II canines and cl I molars (move the agenesis space posteriorly with placement of a prosthetic restoration between 3 and 4 or 4 and 5 or 5 and 6).

Treatment of dental agenesis

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Treatment of dental agenesis

Solution 2 Solution 3 Solution 4 Solution 5

4.2 . 2 Treatment of unilateral agenesis:

In case of microdontia of the lateral incisor present, extract the dwarf tooth early. We will find ourselves in the previous situation.
If the lateral incisor is present on the arch and of usual size, the therapeutic solution will depend on the initial molar relationships and symmetry problems.

Case of class I without DDM:

Keep space for the missing tooth and place a crown;
Or place the canine in the lateral incisor position (unilateral solution 2 or unilateral solution 4).

Case of cl I with DDM:

Extraction of the present lateral incisor and the lower 1st premolars: solution 3 or 4 bilateral.

Class II case:

Extraction of the lateral incisor (bilateral solution 2.)

Class III case:

The space closure solution retracts the anterior sector and hollows out the profile

Therefore, preservation of the remaining incisor (unilateral solution 1 or 5).

4.3. Treatment of agenesis of the lower second premolars:

4.3 . 1. Treatment of bilateral agenesis:

Treatment of dental agenesis

Extraction of the 2nd ^temporary molars:

Early:

Indicated at Open Bite without orthodontic abnormality ; after extraction, spontaneous mesialization of the lower 1st ^molars ;
Germectomy of the 2nd upper ^premolars , ensure the presence of DDS germs;
Treatment in multi-attachment fixed technique for axis correction and space closure.
Late:

Indicated at Deep Bite, extraction of the 2nd ^temporary molars does not allow spontaneous mesialization.
Extraction of the temporary tooth and treatment should be postponed until the young adult dentition to avoid subsidence of the VD.
4.3.2 Unilateral agenesis of the lower second premolar:

Unilateral solution: class I case without DDM,
Extraction of the second upper premolar on the same side.
Bilateral solution: DDM in case of class I
Extraction of the second premolar and the 75.85.

5. Conclusion

The multiplicity of treatment of agenesis, the monitoring as well as the implementation of the adequate therapy during growth will allow to prepare the oral cavity for the definitive treatment.

Opening will most often be the most functional solution, however it will always result in very long replacement techniques, but implant treatment appears to be the ideal solution given its advantages.

Orthodontic closure proves attractive to the patient both in terms of aesthetic benefits and treatment time and cost.

Finally, despite the practitioner’s attraction to certain techniques, he should not neglect any of the possibilities, always keeping in mind that he is not treating agenesis, but patients with agenesis.

Good oral hygiene is essential to prevent cavities and gum disease.

Regular scaling at the dentist helps remove plaque and maintain a healthy mouth.

Dental implant placement is a long-term solution to replace a missing tooth.

Dental X-rays help diagnose problems that are invisible to the naked eye, such as tooth decay.

Teeth whitening is an aesthetic procedure that lightens the shade of teeth while respecting their health.

A consultation with the dentist every six months is recommended for preventive and personalized monitoring.

The dentist uses local anesthesia to minimize pain during dental treatment.