Showing posts with label missing teeth. Show all posts
Showing posts with label missing teeth. 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

Saturday 26 December 2015

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

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.

Sunday 6 September 2015

Baby teeth can be built up to function like adult teeth

The Leeds restorative dentistry group have published a review illustrating how 'baby' teeth can be efficiently built up with white filling material to function like adult teeth. This procedure doesn't require the need for anaesthesia or tooth drilling and can be delivered easily. 



Wednesday 2 September 2015

Patients with Hypodontia have different needs to other patients

The hypodontia team from the Eastman Dental Institute have published a review paper outlining the management needs of patients with hypodontia with specific reference to the dental, psycho-social, medical, functional, educational and financial implications that this diagnosis can bring. They identified the need for disease prevention as well as the management issues that can present during growth and development. The article can be accessed on the link below.

Thursday 16 July 2015

Why overcomplicate hypodontia treatment?


A recent research article in the International Journal of Dental Sciences and Research emphasised the importance of non-destructive restorative management of missing teeth. A good aesthetic outcome was achieved with bonded white composite fillings and resin bonded bridges (sticky bridges). After 4 years of fixed orthodontics, a good aesthetic result can be achieve with minimal intervention, non-tooth destructive restorative treatment in a relatively short period of time.

Click on the link below for the full article:

http://pubs.sciepub.com/ijdsr/3/2A/1/

This post was by Lakshmi Rasaratnam, StR in Restorative Dentistry, Kings College Hospital. l.rasaratnam@nhs.net

Monday 15 June 2015

Hypodontia is a common problem amongst Cleft lip palate patients

A recent dental review from Malaysia  has reminded dental professionals and informed patients that hypodontia is a common problem amongst patients who present with cleft lip and palate. Cleft lip and palate is a group of conditions that includes cleft lip (CL), cleft palate (CP), and both together. A cleft lip is an opening in the upper lip that may extend into the nose. The opening may be on one side, both sides, or in the middle. 

These disorders can result in feeding problems, speech problems, hearing problems, and frequent ear infections. Less than half the time the condition is associated with other disorders. One of the most significant problems is that of difficulties in eating due to the opening in the mouth and the routine absence of teeth near the opening. 


Click on the link to be taken to the article.



Sunday 7 June 2015

Scottish research shows how common hypodontia is !

Recent research from Aberdeen Dental School has shed new light on how common (incidence/prevalence) 
Hypodontia is. Approximately 6.5% of the worlds population has hypodontia but this can vary by continent. Hypodontia was most common in Africa: 13.4%, followed by Europe 7%, Asia 6.3% and Australia 6.3%with a lower prevalence in North America 5.0% CI: 4.1–5.9 and Latin America and Caribbean 4.4%. 

Click on the link below for the published paper. 

Saturday 23 May 2015

New research shows that resin bridges can last a very very long time without any problems !

New research from Bristol Dental Hospital illustrates that resin bonded bridges can last 15 years or more when delivered under the right circumstances to patients with missing teeth. A survival study was conducted on patients who have had resin bonded bridges and it was shown that patients who did not loose the bridge by 4 years could possibly have the bridge for life such were the excellent nature of the results. 

Click on the link below for the abstract.