Congenitally missing and malformed teeth are common manifestations of ED. The lack of teeth compromises not only esthetic appearance but also masticatory function and speech development. To address these functional and cosmetic issues and its consequent psychological implications, patients typically seek treatment early in life. Dental management of ED patients can be challenging and is best managed by a multidisciplinary approach. Treatment considerations include the patient's age, status of skeletal growth and severity of tooth agenesis and morphological abnormalities, and psychological status. Treatment options are removable dentures, toothsupported fixed partial dentures and implant supported prostheses.
Imaging plays an important role in planning and monitoring of the treatment. Given that many of these treatments are initiated in early childhood, prosthetic restoration is complicated by the ongoing skeletal growth and remodeling. For example, placement of implants early in life is complicated by the continual tooth eruption coupled with the growth and development of the jaws, which result in alterations in the vertical dimension and shifts in the occlusion. This may result in implant submergence or an open bite. Typically, growth of the anterior mandible is completed by approximately 10-12 years of age. Thus, implant placement in the anterior mandible at this age is an option. However, the mandibular body and ramus continue to grow until early adulthood. Skeletal growth assessment, as with hand-wrist radiographs is of importance to plan timing of implant placement. Furthermore, orthodontic tooth movement to optimally position the teeth for implant-supported prostheses or tooth-supported partial dentures is often required.
Cone beam CT provides crucial information on the height and width of the alveolar ridges, allows for assessment of bone quality at potential implant sites and evaluation of the need for possible bone augmentation procedures. Given the diagnostic task and the area to be imaged, this may be accomplished by limited- or medium-field of view CBCT. Additionally, patients with Xlinked hypohidrotic ED demonstrate increased mineralized of the trabecular bone, especially in the anterior mandible, and this may potentially compromise implant osseointegration.
The 2 cases shown here demonstrate the value of CBCT imaging in treatment planning of patients with oligodontia manifesting in ED.
Imaging plays an important role in planning and monitoring of the treatment. Given that many of these treatments are initiated in early childhood, prosthetic restoration is complicated by the ongoing skeletal growth and remodeling. For example, placement of implants early in life is complicated by the continual tooth eruption coupled with the growth and development of the jaws, which result in alterations in the vertical dimension and shifts in the occlusion. This may result in implant submergence or an open bite. Typically, growth of the anterior mandible is completed by approximately 10-12 years of age. Thus, implant placement in the anterior mandible at this age is an option. However, the mandibular body and ramus continue to grow until early adulthood. Skeletal growth assessment, as with hand-wrist radiographs is of importance to plan timing of implant placement. Furthermore, orthodontic tooth movement to optimally position the teeth for implant-supported prostheses or tooth-supported partial dentures is often required.
Cone beam CT provides crucial information on the height and width of the alveolar ridges, allows for assessment of bone quality at potential implant sites and evaluation of the need for possible bone augmentation procedures. Given the diagnostic task and the area to be imaged, this may be accomplished by limited- or medium-field of view CBCT. Additionally, patients with Xlinked hypohidrotic ED demonstrate increased mineralized of the trabecular bone, especially in the anterior mandible, and this may potentially compromise implant osseointegration.
The 2 cases shown here demonstrate the value of CBCT imaging in treatment planning of patients with oligodontia manifesting in ED.
Fig. 1: CBCT images of a 10-year-old male with ED. The examination was done to evaluate the jaws for implant-supported overdentures. Implant placement was planned in the mandibular canine regions. CBCT images were acquired in a 6-inch field of view.
A and B: 3D volume renderings demonstrate almost complete absence of the permanent dentition. Only the maxillary central incisors are present. Edentulous ridges of the maxilla and mandible are markedly atrophic.
C: Selected cross-sectional slices of the mandibular anterior and premolar region. Note atrophic, knife-edged ridge especially in the midline. Buccal and lingual plates are well corticated and the trabecular bone density appears adequate for implant placement.
A and B: 3D volume renderings demonstrate almost complete absence of the permanent dentition. Only the maxillary central incisors are present. Edentulous ridges of the maxilla and mandible are markedly atrophic.
C: Selected cross-sectional slices of the mandibular anterior and premolar region. Note atrophic, knife-edged ridge especially in the midline. Buccal and lingual plates are well corticated and the trabecular bone density appears adequate for implant placement.
Fig. 2: A 20-year old male patient with ED referred for CBCT imaging for orthodontic assessment and for potential implant treatment planning. The CBCT examination was done using a 12-inch field of view.
A: Panoramic reconstruction showing oligodontia. The maxillary right canine is impacted. Also note multiple conical-shaped crowns.
B: A maximum-intensity projection (MIP) demonstrating a hypoplastic maxilla and slightly prognathic mandible.
C: 3-D volume rendering
A: Panoramic reconstruction showing oligodontia. The maxillary right canine is impacted. Also note multiple conical-shaped crowns.
B: A maximum-intensity projection (MIP) demonstrating a hypoplastic maxilla and slightly prognathic mandible.
C: 3-D volume rendering
REFERENCES
White SC, Pharoah MJ. Oral radiology : principles and interpretation. 6th edn. St. Louis, Mo.: Mosby/ Elsevier, 2009. Pages 295-298.
Pub Med Health: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002440/
Pub Med Health: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002440/