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 

Hvaring et al. 2016

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. 

What congenital anomalies do patients with Downs Syndrome present with ?

A low powered study from Brazil has illustrated some evidence for hypodontia being highly prevalent amongst patients with Downs Syndrome. In this study 96 individuals were clinically and radiographically examined. 

Hypodontia was found to be the most prevalent condition at 36%, followed by microdontia at 10%, conical teeth at 7%. Taurodontic teeth were rarer at 3% with other anomalies such as dens invaginatus 1% of cases. 

The authors concluded that the occurrence of hypodontia was high amongst this patient cohort and is likely to impact on their management not only in their interaction with orthodontics and paediatric dentistry but also with special care dentists managing them in adulthood. 

The link can be found below

http://www.stephenhancocks.com/download.php?op=view_article&article_id=395

What Are The Treatment Options in Patients with Unilateral Congenitally Missing Second Mandibular Premolars?

In this article by Gerassimos Angelopoulos, an orthodontist in Greece, the issue of missing second premolars and the management of the retained deciduous molar is discussed and the relative advantages and disadvantages of each are outlined but not entirely addressed. In my experience retention of the primary molar is a realistic option which obviously depends on the tooth's restorative status and how it relates to the occlusal plane. Where infraocclusion is significant enough to result in an increased chance of caries then extraction may need to be seriously considered. Where the tooth is at an acceptable level in the absence of ankylosis the occlusal surface can be restored to maintain contact with the opposing unit. If the deciduous tooth is extracted resin bonded bridges or implants may be an option if space closure is not possible.  Alternatively the patient may just be happy with having a space there with no further elective treatment ! Much a dentists head has been scratched on hypodontia clinics thinking about what the best option may be. 

Have a read of an orthodontists view. 

Angelopouos on the missing second mandibular premolar