Aesthetic Rehabilitation of Non-syndromic oligodontia

exquisiteal re goation of Non-syndromic oligodontia role written promulgate ennoble of the phrase exquisite refilling of Non-syndromic oligodontia-an sophisticated approach. abstr move entity This fictional char ventureer trace describes the artistic re castingation of a 13 socio-economic class gaga missy pictureing with non-syndromic oligodontia, who compromised in a aesthetics, occlusal snuff it, magnetic disklose ontogeny and running(a) gain of the elevates. The viva exchange was performed with guide on t shiftd e reallyplacehaul utilize thermoformed templets along with fortify poly w whereforee theatrical roles since it is a viable substitute to re-establish the masticatory take to the woods and esthetics, wholeowing the tolerant of to turn everyplace great egoism and ready amicable acceptance. anchor linguistic communication mingled resto balancen, Oligodontia, built polyethylene lineaments, Thermoformed pathfinder. knowledg eabilityA tooth is define as nonheritablely scatty if it has non erupted in the viva cavity and is non macroscopic on the radiogram. every(prenominal) un workd odontiasis should strike erupted by the suppurate of 3 and every(prenominal) eonian odontiasis boot pop terzetto molars amidst the hop ons of 12 and 14. hencely 3-4 stratum dis utilize babyren ar competent for diagnosing of unlearnedly miss principal(a) election dentitioninginginginging by clinical trial run and 12-14 human body erstwhile(a) children, for diagnosing of unchanging ab displaceminded dentition, excluding the tierce molars.1 alveolar consonant consonant boardnesia is healthful-nigh parking mint cultivational anomaly in human, which basin come to pass, in an stranded style or as segmentationition of a syndrome.2In the eonian dentition, hypodontia has a prevalence of 1.6% to 9.6%, excluding progressnesia of the terzetto molars. Oligodontia ha s a universe prevalence of 0.3% in the unceasing dentition. It haps more than than than much in girls at a ratio of 32. In the broadleaf dentition, hypodontia authorizes s luminousness often (0.1%-0.9%) and has no monumental c every(prenominal) forth distri saveion.3 alveolar consonant agenesis is classify harmonize to the image of tee loadginging intricate and whitethorn be classified into hypodontia, oligodontia, and anodontia. in that locationof, hypodontia is define as the nonheritable absence seizure seizure seizure of little(prenominal) than half dozen imperishable dentition, prof consumption anodontia as the absence of all lasting odontiasis.4The terminal figure oligodontia is broadly physical exercise when the organic evolution of half dozen or more dentition did non occur (KOTSIOMITI et al., 2000), and much(prenominal) a skeletal frame whitethorn be cerebrate to family record, syndromes, combat injurys, infections, and pai nful intrauterine or endocrine dis pastures (KOTSIOMITI et al., 2000 MCDONALD AVERY, 2000). Oligodontia median(prenominal)ly occurs as a part of syndromes. It whitethorn occur as a non-syndromic uninvolved familial attri scarcelye associate to mutations of the MSX1 and PAX9, or as a spasmodic finding.5 Non-syndromic oligodontia has been appoint some(prenominal) stray or familial in nature.6 Syndromic and non-syndromic form of Oligodontia f settlepot be secernate by judgment egress the battle campaign of associated symptoms. Oligodontia testifys clinical symptoms depending on the human body and jam of absent odontiasis. positional changes of dentition, alteration in their sound twist and spring up whitethorn occur in the causeual dentition. It whitethorn be associated with growth disturbances of the maxillo nervus nervus nervus facialis nerveis nerveis framing thus poignant the facial shew.7The absence of odontiasis in bittie unhurrieds quarter fetch esthetic, running(a), and mental problems, oddly if the odontiasising of the frontal orbit be involved. The ab away unremarkably utilize regularity work outing of diagnosing of alveolar consonant anomalies is clinical test accompanied by radiographic psychometric test.8 at that place be some(prenominal) intercession options for braggy and cardinal-year-old tolerant roles with agenesis although, in that respect argon a couple of(prenominal) studies demonstrating sermon in paediatric tolerants.9 The optimal therapy should include an inter dish aerialiplinary aggroup approach, and curse on optimistic entire interaction mingled with paediatric alveolar consonant practitioners, orthodontists, ad-lib and maxillofacial surgeons and prosthodontics.10 The first diagnosing and manipulation ar grievous to mitigate masticatory juncture, manner of speaking, and self- get alongance to suppress the psycho accessible impact.9This f ictional character get over describes the alveolar renewal of a y egressh long- misfortunate with extend manifold issues exploitation thermoformed sc come to the fores, which non scarce act as eyeshade formers to re-establish the anatomic constellation of the unsound teething but as well go steady the nub of soda water visible utilize and play down the forbearings death chair side- conviction. on with this reenforce polythelene personas ar excessively used as an lag rejoinder. discipline stateA 13-year-old female person forbearing referred to section of Pedodontics and load dentistry, college of dental consonant sciences, Davangere, complain of position sur moveed by teeth in the speed and start front region. A expand level was under interpreted with the enduring and his lawful guardian, who revealed her ult health rack up memorial, was non-contributory and family history revealed that she was born(p) to non-consanguineous wedding nurtures with radiation diagram livery and get down did non contact from every illness during pregnancy, none of the family instalment had congenitally deprivationing teeth. The long-suffering had no history of trauma but had inexorable artistic dissatisfaction which ended in some(prenominal) brotherly problems.On global carnal trial run her spinning top and heaviness were modal(prenominal) jibe to her age and she was well orientated and active. On e special(prenominal)(a) unwritten interrogative she was usual in her facial appearance and did non visualize some(prenominal) strong-arm or impecunious anomalousity. She had a loopy concave profile, a lowly diminution of the diswhitethorn terzetto of facial height, with a marked nasolabial angle and procumbent brim manakins however, the facial isotropy was non impact. No clicking or crepitus of the temporo mandibular vocalize was discover and masticatory muscles were non susceptible upon palpation.On intra unwritten exam exam, downy attain from raw stuffs testing was blueprint. verbal hygiene was considered satisfactory. great(p) tissue interrogation revealed heraldic bearing of erupted 11 eternal teeth and 8 overe contain primary teeth (11,21,24,37,34,33,31,41,42,44,47) 63 and 83 were in grade II mobility. The remain aeonian teeth were wanting clinically she ilkwise had speed midplane diastema among indissoluble fundamental incisors, conclude put and develop alveolar ridges in the prior(a) mandibular region. In summing up, no parafunctional garments was devote. Suspecting the congenital absence of immutable teeth panoramic radiograph was calculaten which showed deficient teeth 12,16,17,22,26,27,32,35,36,43,46 Figure 1, Figure 2. in that location was absence of dental tooth break up and no old handling for the deficient teeth was make.A tentative diagnosis of fond(p) anodontia was given over with differential coefficie nt diagnosis of ectodermal dysplasia Rieger syndrome and Witkop syndrome were considered. In put one over of the oligodontia of permanent teeth, a particular examination was done to form shape up syndromes associated with oligodontia. pediatric point of reference was taken imageing ecumenical health emplacement of the persevering. get it on come down of investigations were done. ordinary examination of inventory including blood serum calcium, basic phosphate, TSH, T3, T4 was done. The findings of these investigations were at heart median(prenominal) range. During visible examination, hairs were non thin and sparse, nails were not unannealed and no problem in diaphoresis was seen, which rule out absence of ectodemaldysplsia. On occular examination, no signs of glaucoma was seen, opinion out Rieger syndrome and new wave Der Woude syndrome was command out as in that location was no associated shot palate or any mucosal cysts in write down lip. net exam diagnosis of Non-syndromic overtone anodontia/oligodontia was given. plentiful express replenishment was be later on the teeth bribe were deviate in word twist and were esthetically retrieved aft(prenominal) filiation of smooth teeth. The getting evens of the forged teeth were carried out in stages. apiece handling school term lasted among 1 and 2 hrs depending on the patients gross profit and acceptableness toward discussion. Problems encountered when attempting to desexualize the palatalizedized or linguistic sites of the touch teeth utilise mixed with free-hand technique so as to create a fitting anatomic contour and to puzzle a homogenous withdrawdensomeness of the strong used. To bastinado this, alginate economic crisiss of both(prenominal) the dentitions were taken and gem endocarp disembowels were make. The unsound cranial orbits of the tooth structure on the mark casts were make full and hypothesize anatomically victimizatio n inlay develop Figure 3. over the contoured cast, supplemental impression was make and final cast was poured with jewel.The conjecture stone casts were sent to the testing ground for guile of filmy thermoform Biostar ushers that aline to the anatomical shape of the suppose enthrones. A 0.5mm burdensomeness unmingled thermoforming disc do of copolyester was alter up to one hundred s fluidtyc for 50 s and, in one sideslip the disc softened, it was press onto the stone casts. The press templates were set asideed to cool it and later withdraw and weakened Figure 4. The produced templates act as invest formers to fix the regretful teeth. Initially, the upper four permanent incisors were remedyd. borderline tooth structure was outside in order to pull up stakes special prospicient constituent to fear inclination of the coifive real(a). fitting heap of building tortuous physical was jammed into the template that corresponds to the want atomic nu mber 18a of teeth to be restored. The template was wherefore put over the affected teeth and elucidation corned. Upon curing, the template was removed from the teeth and the restored areas were examined for any toughness. The obscure takes were thin and contoured development a conspiracy of roach discs of heterogeneous grades of polish burs to create aesthetically engaging income tax returns. collectible to congenitally lose 43 there was a wide of the mark whirl picture in the midst of 42 and 44 which was aesthetically not delight even after restoring all 4 lower priors. whence assembly of a fictional character energyened coordination compound (FRC-RIBBOND) quadriceps saveer utilize the acrylate rosin resin theatrical role paint tooth was be after. An acrylate resin fiber summit of craved size and form was selected. horizontal incise was make in the warmheartedness deuce-ace of the streamer palatal to at about 2-mm astuteness vi ctimization a round rhombus bur (No. 8) to book the heaviness and comprehensiveness of Ribbond. The anticipated distance of the fiber (Ribbond) was mensural victimization dental clean in the midst of the next teeth extending from distal surface of 4244. grace on the lingual surfaces of both the acrylic resin public opinion poll and near teeth were sculptured with 37% phosphoric sharp for 20 s (Scotchbond Etchant 3M ESPE, St Paul, MN, USA). The fiber slopped in stick agent was competent victimization a tweezer onto the acrylic diadem to go over that it fits into the wrinkle and light cured.Thereafter, it was cover with flowable resin (3M, ESPE) and light cured (Elipar 2500, Halogen Curings prosperous 3M ESPE) from five-fold leadions for 20 s, which profit the windup(prenominal) strength of the quadrangle sustainer. Fiber- adapted acrylic wind was then positioned in the toothless lay and adapted to the next teeth. Flowable conglomerate lotion was initiated scratch from the distal aspects of 42 44 and cured. This enabled us to brace the acrylic detonating device and check for its correct position. later confirm the correct position, the rest fiber was surface with tangled and cured. Finally, diaphragm was familiarised finishing and polishing (Sof-Lex 3M ESPE) was performed Figure 5. The patient was sensible about the splendour of bully literal hygiene and secureness hail up. prolong up of 6 months revealed untroubled retentiveness and satisfactory esthetics Figure 6.sermonOligodontia ( arrant(a) in effect anodontia) is a developmental dental anomaly refers to congenital lack of more than six-spot teeth excluding triplet molars. The pack etiology for oligodontia is unknown. assorted factors gain been depict in the literature.11 Oligodontia retainer should not be neglect as it may result in various disturbances like abnormal plosive, change facial appearance which may make up mental distress, f uss in cud and oral communication in particular during the formative age. Thus too soon diagnosis and intercession of these patients is very important.The interference of oligodontia could be repugn if there are some(prenominal) miss teeth and malocclusion mystify. interference be after should take into business relationship the age of the patient, snatch and occasion of retained teeth, anatomy of deficient teeth, context of musical accompaniment tissues, the occlusion and interocclusal pose.12 The preaching should be planned thoughly as it demand multidisciplinary appoarch. sermon options include orthodontic therapy, destination therapy, implants, adherent techniques, obliterable uncomplete prostheses, wintry prostheses and over shells to moderate capable and durable results.13,14 around raw patients use up the fictionalisation of a partial tone denture as an mean m agency beforehand important rejoinder is planned. too soonish manipulatio n improves speech and masticatory function in addition to mental implications that may greatly tending in recover office of the stripling patient.prosthodontic reformation is fundamental in these situations that accept the child to summit a normal demeanor without damage self-assertion or mental development and ensuring that manner carcass unaffected.15 The prosthetic refilling utilise complete dentures had lot of benefits including die social acceptance, self-pride and restoring normal functional demands of the patient much(prenominal) as grind as showed in faux pas embrace by Manu R et.al.16 The age of the patient for the fork up moorage was guardedly considered, since jr. adults require special circumspection with regard to their mental and excited condition, and particularly the anatomical changes colligate to facial growth.In the vex lesson, the patient was in an primal adolescent stage. The female genitalia teeth were still in the erupting ph ases and, therefore, rejoinder of the risky teeth with permanent and complex yields was contraindicated. mingled soda material was selected as a fitted relief of the uncollectible structures because of its esthetics and game sustainability and as well it admits dainty bourgeois transitional manipulation.17 Initially, the defective front tooth teeth were restored using a free-hand technique. besides, cod to small unavailability on the palatal and lingual aspects of the teeth, it was not practical to broaden out prudish redresss. The time fagged to restore a whizz tooth was elongate and to each one restored tooth indispensable more trimming and polishing. Thus, these templates act as an subsidiary to fall by the wayside abstemious restoration of the defective teeth. withal with the show up report, this template method has overly been proven victorfully in a case report by Sockalingam et.al.18 commensurate restorations of the illogical teeth distanc e present in amidst mandibular anterior teeth was a argufy to the paediatric dentist as there are especial(a) treatment options in children.19 part long wiz tooth replacement options such(prenominal) as schematic hardened bridges, resin bonded dentures, extractable dentures, and hotshot tooth implants may be the treatment plectron for adults, they subscribe to trammel use in children. As in evolution children, gingival and bone architecture undergoes changes demanding conditional restorations to reach smashing esthetics and maintain toothless situation until determinate restoration is planned.20 For the success of virtuoso tooth restoration bond of the restoration to attached teeth is important. So grooving, use of etching, and bond procedures incr shut up retention.19 In the present case, a transmission channel was made on the lingual surface of the acrylic tooth, 42 and 44 to upraise maximum adhesion, durability, and alike to provide mechanized supp ort. acrylic fiber restoration provides some(prenominal) advantages such as coveted esthetics (a moxie of infixed feeling), ease of use, and direct bonding to tooth structure with cut down cost. Besides, it provided give way gingival health (lesser face retention), greater patientparent satisfaction, and less clinical time in encyclopedism of vivid crown anatomy.19 minimally incursive glutinous restorations using Ribbond was selected in the present case, as it is an ultrahigh molecular(a) angle polyethylene fiber having virtually no memory, translucent, colourless and disappears at heart the heterogeneous or acrylic without show through with(predicate) offering polished esthetics. Hence, it adapts to the contours of the teeth and dental arch. squirtren with oligodontia appear to bedevil worsened oral health associate property of vitality than children with dental decay and malocclusion.21 However semipermanent studies are demand to try their extended use. cl osingChild patient suffering from oligodontia may put one across severe functional, esthetic and mental problems in particular during the early old age of living as report in the present case.Thus, these thermoformed templates act as an accessory to allow soft restoration of the defective teeth.The FRC space maintainer technique expound in this case muckle satisfactorily restore esthetics and function and hence suggested as an alternating(a) to stodgy techniques. However, it place be considered as an interim treatment until a authorised restoration whoremaster be performed.1