A multidisciplinary approach for the management of hypodontia: case\nreport
A 17-year-old male patient in the final stage of orthodontic treatment presented with\nthe primary second molars in position for space maintenance. Hypodontia had been\npreviously diagnosed by the orthodontic team (), and the patient was referred to the Oral Rehabilitation Clinic (FOB/USP)\nfor extraction of those teeth and rehabilitation of the area. Analyses of the occlusal\ncondition revealed the presence of both canine and protrusive guidance achieved by\northodontic therapy and that the deciduous second molars were in infraocclusion (). The patient did not present with any\nsystemic or genetic disorder that could be associated with hypodontia, and the oral\nhygiene status was satisfactory.\nSeveral treatment options were considered, including adhesive or conventional fixed\nbridges and implants, because there were radiographic signs of root resorption in the\nprimary teeth. Considering the consecutive cephalometric analyses, which demonstrated\nthat the patient had reached physical maturity, the bone availability, the absence of\nmedical contraindications, and the patient consent, the treatment comprised the\nextraction of primary teeth and placement of immediate load implants. However, the\nmesiodistal dimensions of the primary teeth were larger than that required to restore\nthe anatomy of the mandibular second premolar but insufficient to restore the dimensions\nof a mandibular first molar. Thus, the only option was to reduce the mesiodistal\ndistance by orthodontic therapy before implant placement. To plan the prosthetic space\nand at the same time to guide the orthodontic movement, the occlusal surfaces of the\nprimary teeth were marked according to the mesiodistal dimension of a mandibular second\npremolar (), and the distal surfaces were\nreduced without changing the infraosseous anatomy to acquire space to fabricate the\nprovisional crowns with anatomic characteristics of mandibular second premolars (). This step of prosthetic planning was\nfundamental to the accomplishment of the orthodontic treatment.\nAfter the planned space closure (), the\nteeth were extracted, and external hex implants with a 4.1 mm rectangular platform were\nimmediately placed (Master Porous Grip, Conexão Sistemas de Implante, São Paulo, SP,\nBrazil) with immediate load (). The\nCeraone abutment was selected (Conexão Sistemas de Implante) and placed at a torque of\n32 N. The provisional crown was then adapted, cemented with temporary cement (RelyX\nTemp; 3M ESPE, St. Paul, MN, USA) and maintained in infra-occlusion for 4 months. During\nthis period, the orthodontic appliance was maintained for retention of the\northodontically moved mandibular molars. The implants were considered clinically\nacceptable after clinical (absence of pain, infection, mobility, or any other signal of\npathology into the soft tissues) and radiographic (no signs of periimplant radiolucency)\nexaminations.\nAn impression of the Ceraone abutment was taken with the emergence profile customization\ntechnique with silicone (Optosil® and Optosil Xantopren®; Heraeus\nKulzer GmbH & Co. KG, Germany). The metal-ceramic crowns were cemented with\nglass-ionomer cement (Relay X Luting 2; 3M ESPE). The patient was given maintenance\ntherapy every 6 months during a 2-year period.\nThe final outcome reflected the care taken, especially during the planning of the\nprosthetic space to be restored (). The\n2-year follow-up revealed maintenance of orthodontic treatment, occlusal plane and oral\nhygiene, esthetics ( and ), and the stability of the bone level (). No mechanical (ceramic fracture, screw\nloosening, and loss of retention) and/or biological complications (periimplantitis) were\nrecorded.