Journal
of Dentistry,
7, No. 2, 1979,
pp. 115-l
16. Printed
The oral rehabilitation of partial anodontia P. M. H. Dummer,
in Great Britain
of a severe case
BDS
Department of Conservative Dentistry, Dental School, Cardiff
ABSTRACT A severe case of partial anodontia is reported which has been successfully and conservatively treated with full upper and lower overlay dentures. Aesthetics, speech and masticatory function have been improved with no deterioration in oral health.
INTRODUCTION presenting with severe partial anodontia and associated ‘overclosure’ are a difficult restorative problem. Extraction of the sound remaining teeth results in progressive loss of alveolar bone and subsequent problems with full denture stability. Conventional removable partial dentures may partly restore aesthetics but cannot fully restore masticatory function. Advanced bridgework can be attempted (Bennett, 1965; Wootliff, 1966; Short, 1969), but tooth size, position and alignment are not always ideal and such treatment may demand lengthy orthodontic therapy or surgical intervention. A high degree of success, however, can be obtained by providing such patients with complete upper and lower overlay dentures (Brewer and Fenton, 1973). All the aims of treatment can be fulfilled in a simple way and since the existing teeth are not altered, the procedure is completely reversible. Patients
CASE REPORT A man, aged 22 years, presented for treatment complaining of a poor dental appearance, difficulty in chewing and impairment of speech. His previous dental treatment had been confined to filings, no extractions having been carried out. There was no relevant medical history. The family history revealed that the patient’s mother and some maternal relations had small numbers of congenitally missing teeth. On examination the patient displayed a lack of lip support and gross overclosure. Intra-orally the soft tissues were healthy but the only teeth present were 7 E DC 1 1 C 4 E 7 (Fig. I). B was carious 7+7 and E were mobile. + AB All the permanent teeth were small. The occlusion was poor with marked overclosure, bilateral posterior crossbites and anterior crossbite. The dental base relationship was Class III. Radiographs showed no evidence of unerupted teeth in the jaws. Treatment
consisted of the extraction
of
E and the construction of full upper and lower overlay AB + dentures to restore the correct vertical dimension, improve aesthetics and reestablish the occlusion (Fig. 2). The remaining teeth were not crowned. Retention was greatly improved by using a semi-permanent soft lining (Flexibase, Flexico, London). The patient was given intensive oral hygiene instruction and told to remove the dentures at night. After 2 years there has been no deterioration in oral health and only slight loss of the soft lining (Fig 3). In addition the dentures have remained functional and comfortable.
116
Journal of Dentistry, Vol. ~/NO. 2
Fig. 3. View of fitting surfaces showing slight loss of soft lining (2 years after construction).
DISCUSSION With this form of treatment it is essential that the patient is trained in oral hygiene procedures. Plaque control is mandatory and the patient must be made to realize that this is his responsibility. Recall visits must be used to apply topical fluoride and reinforce oral hygiene instruction. With these safeguards overlay dentures can be worn by such patients for years with no deterioration in oral health (Brewer, 1975). REFERENCES Bennett D. T. (1965) Occlusal rehabilitation of a case exhibiting marked attrition, partial anodontia, and excessive mandibular overclosure. J. Prosthet. Dent. 15, 867-872. Brewer A. A. (1975) Overdentures for congenital and acquired defects. In: Brewer A. A. and Morrow R. M. (ed.). Overdentures. St Louis, Mosby, pp. 77-87. Brewer A. A. and Fenton A. H. (1973) The overdenture. Dent. Clin. North Am. 17, 723-747. Short F. E. (1969) Treatment of oligodontia. J. Can. Dent. Assoc. 35,540-544. Wootliff G. (1966) Oral rehabilitation of a partial anodontia patient. Dent. Msg. Oral Top. 83,160-161.
of Dentistry,
7, No. 2, 1979,
pp. 115-l
16. Printed
The oral rehabilitation of partial anodontia P. M. H. Dummer,
in Great Britain
of a severe case
BDS
Department of Conservative Dentistry, Dental School, Cardiff
ABSTRACT A severe case of partial anodontia is reported which has been successfully and conservatively treated with full upper and lower overlay dentures. Aesthetics, speech and masticatory function have been improved with no deterioration in oral health.
INTRODUCTION presenting with severe partial anodontia and associated ‘overclosure’ are a difficult restorative problem. Extraction of the sound remaining teeth results in progressive loss of alveolar bone and subsequent problems with full denture stability. Conventional removable partial dentures may partly restore aesthetics but cannot fully restore masticatory function. Advanced bridgework can be attempted (Bennett, 1965; Wootliff, 1966; Short, 1969), but tooth size, position and alignment are not always ideal and such treatment may demand lengthy orthodontic therapy or surgical intervention. A high degree of success, however, can be obtained by providing such patients with complete upper and lower overlay dentures (Brewer and Fenton, 1973). All the aims of treatment can be fulfilled in a simple way and since the existing teeth are not altered, the procedure is completely reversible. Patients
CASE REPORT A man, aged 22 years, presented for treatment complaining of a poor dental appearance, difficulty in chewing and impairment of speech. His previous dental treatment had been confined to filings, no extractions having been carried out. There was no relevant medical history. The family history revealed that the patient’s mother and some maternal relations had small numbers of congenitally missing teeth. On examination the patient displayed a lack of lip support and gross overclosure. Intra-orally the soft tissues were healthy but the only teeth present were 7 E DC 1 1 C 4 E 7 (Fig. I). B was carious 7+7 and E were mobile. + AB All the permanent teeth were small. The occlusion was poor with marked overclosure, bilateral posterior crossbites and anterior crossbite. The dental base relationship was Class III. Radiographs showed no evidence of unerupted teeth in the jaws. Treatment
consisted of the extraction
of
E and the construction of full upper and lower overlay AB + dentures to restore the correct vertical dimension, improve aesthetics and reestablish the occlusion (Fig. 2). The remaining teeth were not crowned. Retention was greatly improved by using a semi-permanent soft lining (Flexibase, Flexico, London). The patient was given intensive oral hygiene instruction and told to remove the dentures at night. After 2 years there has been no deterioration in oral health and only slight loss of the soft lining (Fig 3). In addition the dentures have remained functional and comfortable.
116
Journal of Dentistry, Vol. ~/NO. 2
Fig. 3. View of fitting surfaces showing slight loss of soft lining (2 years after construction).
DISCUSSION With this form of treatment it is essential that the patient is trained in oral hygiene procedures. Plaque control is mandatory and the patient must be made to realize that this is his responsibility. Recall visits must be used to apply topical fluoride and reinforce oral hygiene instruction. With these safeguards overlay dentures can be worn by such patients for years with no deterioration in oral health (Brewer, 1975). REFERENCES Bennett D. T. (1965) Occlusal rehabilitation of a case exhibiting marked attrition, partial anodontia, and excessive mandibular overclosure. J. Prosthet. Dent. 15, 867-872. Brewer A. A. (1975) Overdentures for congenital and acquired defects. In: Brewer A. A. and Morrow R. M. (ed.). Overdentures. St Louis, Mosby, pp. 77-87. Brewer A. A. and Fenton A. H. (1973) The overdenture. Dent. Clin. North Am. 17, 723-747. Short F. E. (1969) Treatment of oligodontia. J. Can. Dent. Assoc. 35,540-544. Wootliff G. (1966) Oral rehabilitation of a partial anodontia patient. Dent. Msg. Oral Top. 83,160-161.
