PROSTHETIC

REHABILITATION OF
HYPODONTIA PATIENT
Supervised by Dr Chu
(Azril, Nasrul, Amin, Amira, Aishah, Fathiah)
Introduction Prosthodontic Seminar
Prevalence
Clinical manifestation
Block 3 (Year 5)
Impact and consideration
Treatment option
Case report
 INTRODUCTION
Hypodontia is defined as the developmental absence of one
tooth or more which can affect both primary and permanent
dentition
• Hypodontia -condition where there is absence of one or a
few teeth only.
• Oligodontia -usually used to describe large numbers of
missing teeth, six or more.
• Anodontia -complete absence of teeth
• Classified into 3 severity groups:
1) Mild: 1–2 missing teeth
2) Moderate: 3–5 missing teeth
3) Severe: 6 or more missing teeth
• Aetiology of hypodontia is multifactorial
• May be genetic in origin or environmental insult during
development.
Genetic factors – mutations in MSX1 and PAX9
Environmental factors – eg use of chemotherapy in
early infancy for childhood malignancy & the presence
of a cleft palate.
• It may occur as a feature of ectodermal dysplasia and
Down’s syndrome.
 PREVALENCE
• Prevalence of hypodontia : 0.1-0.9% in primary dentition
and 3.5-6.5% in permanent dentition
• Hypodontia in primary dentition no significant sex
predilection while for permanent dentition occur mostly
in female than male
• The prevalence of hypodontia in the maxillary arch is
higher than in mandibular arch
• Lower 2nd premolar is the most commonly affected
tooth (2.91–3.22%),
 followed by the upper lateral incisor (1.55–1.78%)
and
 then upper second premolar (1.39–1.61%)
• Most frequent no of teeth missing :
-1-2 teeth 80%
-4 or > 10%
-6 or > (oligodontia) 1%
• There does appear to be a strong relationship
between missing primary teeth and permanent
successors
 CLINICAL MANIFESTATION

Dental finding
1. Microdontic/macrodontic, conical/tapered
2. Eruption of permanent teeth may be delayed or
abnormal
3. If the maxillary lateral incisors are microdontic or
absent, the maxillary canines may follow an ectopic
path
4. Retained primary teeth may be infraoccluded which
results loss of space due to tilting of adjacent
permanent teeth. It usually ankylosed thus need to
consider surgical & orthodontic implications
 Dental finding
5. Usually associated with developmental failure of
alveolar bone→ atrophic ridge & lack of posterior
support.
6. Teeth associated with taurodontism
7. most of cases associated with maxillary sinuses
pneumatisation
8. structural problems : hypocalcification &
dentinogenesis imperfecta

Craniofacial finding
1. Retrognathic maxilla/ protrusive mandible
2. Reduced lower facial height with deep overbite and
increased freeway space
 CONSIDERATION FOR TREATMENT
1) Patients Factor
Oral Health And Motivation
• Depends on patient’s concern and expectation
• Complex tx requires a lenghty period, oral health
maintenance and repeat tx in future
• In general, severe hypodontia itself is not associated with a
heightened caries risk unless it is seen as part of a
syndrome such as ectodermal dysplasias, of which
xerostomia is a feature.
• Caries risk should be assessed. Previous caries experience
is the best indicator of future caries development
• Socioeconomic group, oral health motivation both of
patient and parents, dietary control and optimal uses of
fluoride should be considered
Age
• Dental team as part of a specialist paediatric dental unit
have crucial role to play in education of not only the
patient, but also the parents.
• Appropriate support and advice will lay foundations for
good oral health so that primary dentition is maintained as
long as possible
• When in MIXED DENTITION:
i. tx should be minimal and depends on patient’s
concern
ii. avoid restorative intervention at this stage
• But as grow older, compliance for extensive dental tx will
be improved as they will be more conscious of appearance
Dental implants
i. Should not be placed before cessation of craniofacial
growth. WHY? osseointergrated implants behave as
ankylosed teeth, become infra-occluded and result in non-fx
and poor aesthetic

ii. Edentulous patient (common in ED), absence of teeth

will not change the alveolar height.
• 2 implants placed on canine or lateral incisor regions may
allow successful early rehabilitation.
• Late growth and gingival maturation may continue into
adulthood and this affect esthetic appearance in adjacent
natural teeth
 2) Dental Factor
Reasons of teeth replacement:
i. Aesthetic reason iii. Occlusal stability
ii. Function iv. Oral comfort

It is not appropriate to restore all missing teeth and a

shortened dental arch can be considered

POSITION AND QUALITY OF TEETH PRESENT

• Retained primary teeth can be function with reasonable
aesthetics.
• Few permanent teeth are found to be in aberrant
positions, with small tooth size and unusual morphology
•Orthodontic is useful in :
i. redistributing space within the arches to create realistic
pontic spaces.
ii. Help realign ectopic or malposed teeth
iii. Close diastemas
iv. Level the occlusal plane
v. Establish a favourable inter-radicular space for possible
future implant placement

• Creation of more favourable interocclusal space and

incisor overjet and overbite can facilitate restorative tx
• However, placement of orthodontic brackets on microdont
teeth are very difficult and sufficient securing orthodontic
anchorage is challenging
• How to overcome?
i. By placing tad
ii. Build up with composite prior to ortho tx to
facilitate placement of brackets
iii. Recontour the conical/pointed teeth with rotary
instruments

• Unerupted, ectopic teeth may be best left in situ as

their surgical removal may threaten the longevity of
adjacent teeth or cause of alveolar destruction.
3) Anatomical Factor
Skeletal pattern and soft tissue profile
• Common to see reduced lower face height tendency to
have Class III skeletal pattern.
• Reduction in lip protrusion especially upper lip
• Consideration before tx planning:
i. The need to increase lower face height
ii. Reorganize the occlusal scheme
iii. Careful bucco-lingual positioning of the prosthetic
teeth relative to the alveolar ridges

• REMOVABLE PROSTHESIS often more effective and more

flexibility to position the prosthetic teeth and acrylic
flanges to achieve desired effects
BONY ANATOMY AND POSITION OF VITAL STRUCTURES
• Absence of permanent teeth restrict alveolar growth
• Insufficient bone for provision of dental implants even
primary teeth are retained and immediate implant
placement is possible, there is often concavity of alveolar
process beyond the root apices give an ‘hour glass’
ridge morphology
• Position of key anatomical features should be assessed
through imaging
• For example, in maxilla maxillary sinuses, floor of nose,
incisive canal in mandible submandibular fossa, mental
foramen ID canal
 TREATMENT OPTIONS
1) Fixed restoration (preferred treatment)
• resin-bonded bridge / conventional bridge
• implant supported prosthesis

2) Removable partial dentures

• options for restoring long spans & multiple missing
teeth
• their bulk and potential movement is functionally and
socially unacceptable because of their potential to harm
the remaining teeth
• patient should have high level of plaque control and
excellent denture hygiene as the denture increase the
risk of caries and gingival inflammation
Resin-bonded bridge
 restoration for one or two teeth
 improved survival when there is tooth preparation to
improve resistance form and maximise the bonding area.
E.g: grooves, rest, seats, guide plane & positive finishing line
 the construction not considered until completion of at
least 6 months full time orthodontic retention with fixed or
removable retainers.

Conventional bridge
 limited to the older patient
 in young patient, the necessary tooth reduction have the
risk of pulp exposure and subsequent periapical pathology
because of the large pulp.
Implant supported prosthesis
Advantages:
i) Ability to avoid using teeth as bridge abutment
ii) Have the capacity to maintain appropriate dental
spaces
iii) Can be used as anchorage point for orthodontic tooth
movement
iv) Can be used to support restoration
CASE REPORT
• 14 years old boy
• Medically fit and healthy
• No family hx of ectodermal dysplasia
• E/O : NAD
• I/O : mixed dentition, presence of torus palatinus,
retained roots of deciduous lateral incisors and
canines in all four quadrant. All the criteria mimic pt
with hypodontia and ectodermal dydplasia.
• Others : pt has undeveloped alveolar ridge and
reduced OVD
• Radiograph : OPG – no development of developing
teeth.
Management
1) Maxillary and mandibular impression were made by
using alginate
2) Study cast constructed plus special tray
3) Wax occlusal rims are made
4) Diagnostic jaw relation was recorded to assess free way
space
5) Facebow and interocclusal records used to mount cast
in centric relation on semi adjustable articulator
6) Diagnostic wax up was prepared to provide optimum
vertical dimension, plane of occlusion and esthetics.
7) Extraction of remaining retained roots
8) Reduced OVD was restored using direct composite
restoration on all permanent second molars to provide
stable intercuspation
9) Final impression using poly silicon
10) Final jaw relation recorded again in centric
relation and remounted the master cast.
11) Anterior teeth selected to meet both esthetics and
phonetics
12) Anatomic posterior teeth were arranged and tried in
after which the final processing was carried out
13) Dentures finished, polished and
delivered to the patient
Follow up
• Patient express satisfaction
with dentures, new OVD,
function and esthetics.
• Positive impact on social
confidence
• Importance of continuous
recall and maintenance of
the composite restoration
• Topical fluoride and
prophylaxis
 REFERENCE

1. Sadaqah NR, Tair JA. Management of Patient with

Hypodontia: Review of Literature and Case Report. Open
Journal of Stomatology. 2015 Dec 4;5(12):293.
2. Gill DS, Barker CS. The multidisciplinary management of
hypodontia: a team approach. British dental journal. 2015
Feb;218(3):143.
3. Lana A. Shinawi. Prosthetic Rehabilitation of Severe
Hypodontia: A Clinical Report . Journal of Medical Science.
2013; 20(2)