1 Hypodontia Supernumerary Teeth Lecture 4 Ingrid Reed DDS, MS Department of Orthodontics and Dentofacial Orthopedics 1/12/2014

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1 Hypodontia Supernumerary Teeth Lecture 4 Ingrid Reed DDS, MS Department of Orthodontics and Dentofacial Orthopedics 1/12/2014 Slide 2 2 Glossary Hyperdontia Anodontia Oligodontia Hypodontia 1/12/2014 Slide 3 3 Hypodontia Absence of one to five teeth Incidence Etiology If primary tooth missing cant have permanent tooth 1/12/2014 Slide 4 4 Slide 5 5 Slide 6 6 Slide 7 7 Hypodontia Random no other associations Hypothyroidism: thyroid, pituitary, hypothalamus abnormalities Down Syndrome: trisomy 21 Ectodermal dysplasia: group of syndromes, missing or peg shaped teeth. Thin sparse hair Absence of sweat glands Cleft palate : one in 600-800 births 1/12/2014 Slide 8 8 Hypodontia Usually affects the last tooth in a series Lateral incisors Second premolars Third molars 1/12/2014 Slide 9 Treatment Maintain primary tooth Replacement Extraction of primary tooth 9 1/12/2014 Slide 10 10 Missing second premolars No crowding retain and build-up remove & implant Mild crowding remove after 2s erupt to encourage space closure Severe crowding leave and remove later 1/12/2014 Slide 11 11 Case 1 Slide 12 1/12/201412 Slide 13 1/12/201413 Slide 14 Profile Change 1/12/201414 Slide 15 1/12/201415 Case 1 Slide 16 1/12/201416 Case 2 Missing 5s and 8s Slide 17 1/12/201417 Slide 18 1/12/201418 Slide 19 Profile Change 1/12/201419 Slide 20 20 Missing third molars Calcification of 8s starts at 8-14 years of age 1/12/2014 Slide 21 21 Hypodontia Missing maxillary lateral Treatment options: Maintain space Open space Close space 1/12/2014 Slide 22 22 Color, size, shape & inclination of canine Vertical skeletal relationships Occlusion of the buccal segments Anteroposterior Skeletal relationship Whether arches are crowded or spaced Patients attitude towards treatment TREATMENT DECISION MISSING MAXILLARY LATERAL INCISORS MAINTAIN OPEN SPACE CLOSE SPACE Slide 23 1/12/201423 Slide 24 1/12/201424 Slide 25 25 Canine substituion Malocclusion Class II with no mandibular crowding Class I with mandibular crowding extract 2 mandibular teeth 1/12/2014 Slide 26 26 Canine Substitution Diagnostic wax up critical Anterior tooth size excess may need to be reduced 1/12/2014 Slide 27 27 Canine substitution 1/12/2014 Slide 28 28 Profile Balanced Relatively straight profile Mildly convex profile may also be acceptable 1/12/2014 Slide 29 29 Canine Shape Color 1/12/2014 Slide 30 30 Crown width at CEJ 1/12/2014 Slide 31 31 Canine substitution - ideal Canine same color as central incisor Narrow at the CEJ Relatively flat labial surface Narrow mid-crown width (buccolingually) 1/12/2014 Slide 32 32 Lip Level If the patient has an excessive gingiva to lip distance on smiling, the gingival levels will be more visible The gingival margin of the natural canine should be positioned slightly incisal to the central incisor gingival margin 1/12/2014 Slide 33 33 Microdontia is an expression of hypodontia Bolton discrepancy Build up laterals 1/12/2014 Slide 34 Supernumerary Teeth 1/12/2014 34 Slide 35 35 Supernumerary teeth Maxillary midline = most common location called a mesiodens 85% are in anterior part of maxilla Laterals, premolars and 4 th molars can also appear 1/12/2014 Slide 36 36 Supernumerary teeth Mesiodens Often exist singularly, but sometimes in combo Most common cause of unerupted upper central incisor Can deflect tooth 1/12/2014 Slide 37 37 Slide 38 1/12/201438 Slide 39 1/12/201439 12 years 8 months Slide 40 1/12/201440 Slide 41 1/12/201441 8 months later Slide 42 1/12/201442 Treatment time 1 year 9 months Slide 43 1/12/201443 Slide 44 1/12/201444 Supernumerary Slide 45 1/12/201445 Slide 46 46 Supernumerary teeth Third premolar 1/12/2014 Slide 47 47 Supernumerary teeth Fourth molar Also called distodens 1/12/2014 Slide 48 48 Supernumerary Teeth Cleidocranial Dysplasia 1/12/2014 Slide 49 49 Supernumerary teeth Treatment aimed at extraction before problems arise, or minimizing effect on other teeth General rule: more supernumeraries, more abnormal, higher their position, harder to manage 1/12/2014 Slide 50 50 Conical supernumerary teeth Remove If it erupts Inverted Displacing adjacent teeth Producing diastema Delaying eruption of permanent tooth Dont remove If well above the apices of the permanent tooth Observe 1/12/2014 Slide 51 51 Tubercle supernumerary teeth Unlikely to erupt remove supernumerary and retained deciduous tooth in the area Prepare for orthodontic eruption if permanent tooth doesnt erupt on its own 1/12/2014 Slide 52 52 Supplemental teeth Resembles a normal tooth in morphology & commonly produces crowding or displacement Extract the tooth most dissimilar to the contralateral tooth, unless it is severely displaced 1/12/2014 Slide 53 53 Slide 54 54 1 23 4 5 1/12/2014 Slide 55 55 1/12/2014 Slide 56 56 12 2 3 4 5 6 7 1/12/2014 Slide 57 57 Slide 58 1/12/201458 Slide 59 1/12/201459 Slide 60 Slide 61 Slide 62 1/12/201462 Slide 63 1/12/201463 Slide 64 Reading 64 1/12/2014 Contemporary Orthodontics, 4th Edition William R. Proffit Henry W. Fields Jr. David M. Sarver Pages 87-88, 138-139, 243, 449-453,