J Dent Rehabil Appl Sci.  2020 Dec;36(4):272-281. 10.14368/jdras.2020.36.4.272.

Temporary replacement of congenital missing incisors on mandible using temporary anchorage devices in growing patient: 2-year follow-up

• Choi Yk
• Kwon EY
• Jung KH
• Choi NR
• Park SB
• Kim Ss
• Kim Yi

• KMID: 2512122
• DOI: http://doi.org/10.14368/jdras.2020.36.4.272

Abstract

Agenesis of permanent tooth in adolescent patients can be treated either by orthodontic treatment for space closure or by main-taining the space until implant restoration can be carried out in adult. However, gradual atrophy of alveolar bone width makes it dif-ficult to restore the prosthesis in the future or may cause unaesthetic results. Therefore, maintaining of not only the missing space but also the alveolar bone width should be considered. This case is a treatment whereby a temporary replacement of missing 2 mandibular incisors in adolescent patient was carried out using 2 temporary anchorage devices (TADs). Two TADs were placed hori-zontally 2 - 3 mm below the top of alveolar ridge, and fixed with artificial teeth by stainless steel wires extended. During the 2 year follow-up, neither gingival inflammation nor loss of the TADs have occurred. In the radiographic evaluation, the growth of the adja-cent alveolar bone was not inhibited, and the width of the alveolar bone was maintained.

Keyword

alveolar bone loss; tooth agenesis; dental implants; temporary restoration; adolescent

Figure

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  Fig. 1 Clinical pictures (A - C) of a patient suffering from agenesis of both mandibular second premolars and buccal open bite on left side. (A) Both mandibular second primary molars were ankylosed and infraocclusion. (B) Extraction of ankylosed primary molars. And 1 month later, temporary anchorage devices (TADs) was inserted on left side for using as an anchorage for inter-maxillary elastics. (C) After 1 year, the width and height of the alveolar bone were better retained with TADs than without TADs (yellow arrows).

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  Fig. 2 Pre-treatment intraoral (A) and extraoral (B) photographs. (A) 2 Mandibular anterior teeth were congenitally missing. (B) Prominent chin and concave profile.

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  Fig. 3 Pre-treatment panoramic (A) and CBCT (B, C) radiographs. (A) Panoramic radiograph. (B) Cone-beam computed tomograph (axial view) : Alveolar bone width (most narrow area) was 7.11 mm. (C) Inferior borders of the second, third and fourth vertebra’s bodys were concave and body’s shapes were rectangular (yellow arrows). Therefore, she was estimated on CVM stage 4 (after growth peak period).

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  Fig. 4 Temporary anchorage devices (TADs) were placed at 2 - 3 mm under the alveolar crest and temporary artificial teeth with loop were placed.

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  Fig. 5 Intraoral photographs of 2-year follow-up. No inflammation of the soft tissues around the TADs was detected.

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  Fig. 6 Superimpositions of pre-treatment and post-treatment CBCTs. Chin and symphysis of mandible excluding teeth (yellow arrows, dotted rectangles) were used as a stabilizing structure for superimposition.

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  Fig. 7 Comparisons of pre-treatment (A, C) and post-treatment (B, D). Alveolar bone width (most narrow area, CBCT axial view): (A) 7.11 mm, (B) 6.96 mm. Alveolar bone height (CBCT sagittal view): (C) 27.17 mm, (D) 27.13 mm. No significant changes were observed.

Reference

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