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

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Presentation on theme: "1 Hypodontia Supernumerary Teeth Lecture 4 Ingrid Reed DDS, MS Department of Orthodontics and Dentofacial Orthopedics 1/12/2014."— Presentation transcript:

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

2 2 Glossary Hyperdontia Anodontia Oligodontia Hypodontia 1/12/2014

3 3 Hypodontia Absence of one to five teeth Incidence Etiology If primary tooth missing – cant have permanent tooth 1/12/2014

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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 births 1/12/2014

8 8 Hypodontia Usually affects the last tooth in a series Lateral incisors Second premolars Third molars 1/12/2014

9 Treatment Maintain primary tooth Replacement Extraction of primary tooth 9 1/12/2014

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

11 11 Case 1

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14 Profile Change 1/12/201414

15 1/12/ Case 1

16 1/12/ Case 2 Missing 5s and 8s

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19 Profile Change 1/12/201419

20 20 Missing third molars Calcification of 8s starts at 8-14 years of age 1/12/2014

21 21 Hypodontia Missing maxillary lateral Treatment options: Maintain space Open space Close space 1/12/2014

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

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25 25 Canine substituion Malocclusion Class II with no mandibular crowding Class I with mandibular crowding – extract 2 mandibular teeth 1/12/2014

26 26 Canine Substitution Diagnostic wax –up critical Anterior tooth size excess may need to be reduced 1/12/2014

27 27 Canine substitution 1/12/2014

28 28 Profile Balanced Relatively straight profile Mildly convex profile may also be acceptable 1/12/2014

29 29 Canine Shape Color 1/12/2014

30 30 Crown width at CEJ 1/12/2014

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

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

33 33 Microdontia is an expression of hypodontia Bolton discrepancy Build up laterals 1/12/2014

34 Supernumerary Teeth 1/12/

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

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

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39 1/12/ years 8 months

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41 1/12/ months later

42 1/12/ Treatment time 1 year 9 months

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44 1/12/ Supernumerary

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46 46 Supernumerary teeth Third premolar 1/12/2014

47 47 Supernumerary teeth Fourth molar Also called distodens 1/12/2014

48 48 Supernumerary Teeth Cleidocranial Dysplasia 1/12/2014

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

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

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

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

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64 Reading 64 1/12/2014 Contemporary Orthodontics, 4th Edition William R. Proffit Henry W. Fields Jr. David M. Sarver Pages 87-88, , 243, ,


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