Showing posts with label dentistry. Show all posts
Showing posts with label dentistry. Show all posts

Monday 9 January 2017

Do implants provide the best aesthetic outcome for patients with hypodontia ?


A study by Hvaring and colleagues has looked at the outcomes for patients with hypodontia and more specifically the treatment for missing teeth. They looked at a cohort of 50 patients with 6 missing teeth or more with a mean age of 26. These patients were examined clinically assessing mucosal discolouration, crown morphology, colour, and papilla index. 

Deciduous teeth showed good outcomes whereas implants had poorer results. Changes in gingiva colour was seen only for implants and occurred for all fixtures in the anterior mandible and the majority of those in the anterior maxilla. As you would expect papilla index scores were poorer for implants and conventional bridges when compared with orthodontic space closure.

A pubmed link to the paper is below 


Implants are a popular treatment modality in the management of patients with hypodontia as they provide tooth replacement without the need for adjacent tooth support or retention. Over time those working in the hospital services have seen case from 5 years or more return with either mechanical or biological complications. Patients with hypodontia may have adequate bone stock around the top of the ridge but this becomes more compromised higher in the alveolus. Over time the alveolus is likely to continue to resorb as illustrated in the above research resulting in mucosal discolouration due to the slow exposure implant threads. In such patients, who have such underdeveloped ridges, alternative tried and tested treatments maybe wiser to consider. Resin bonded bridges are predictable, efficient with good long term outcome data. Consideration for the patients long term maintenance-especially if treated in late adolescents-needs to be a significant consideration. 

Tuesday 26 July 2016

New evidence shows patients prefer closing spaces versus opening spaces when teeth are missing




Qadri and colleagues have surveyed lay members of the public to try and measure their perception of different types of orthodontic treatment and subsequent restorative treatment. Opening of lateral incisor spaces can be difficult to get right especially if there are other complicating factors. The closure of spaces obviously has its advantages. It removes the need for ongoing maintenance of a restoration such as a resin bonded bridge, this can be even more complicated and involved where implant restorations are planned in these sites which will potentially need grafting and long life maintenance...lets not mention the potential for complications ! 

Other issues to consider with space closure include the gingival profile of the canine, the depth of colour of the canine and its size and ability to be disguised with bleaching and bonding as a lateral incisor. In this research from a group in Sheffield (UK) they found that patients and laypeople preferred space closure from an aesthetic sense as opposed to having a restoration in the lateral incisor position.    


LINK TO ABSTRACT

Monday 21 September 2015

Hypodontia is ideally treated in a multidisciplinary setting- A case report

The purpose of this article is to describe a team approach to treatment of hypodontia in adolescent dentition. A case report of hypodontia with a microdontic lateral incisor in a Class I malocclusion illustrates the principles of case management. Multidisciplinary consultation during treatment planning and coordination and appropriate timing of subsequent interdisciplinary dental care enables the clinician to provide the optimum care. The scope of orthodontic and restorative management depends on the severity of the hypodontia.