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Introduction and Objective: Agenesis of one or more teeth is common among patients who are referred for orthodontic treatment. The most common treatments are orthodontic space closure (SC) and implant replacement (IR), which are widely studied, but the experiences of patients receiving these treatments have received little attention. The aim of this qualitative study is to explore how treatments to address missing maxillary lateral incisors (MMLIs) are experienced by individuals who are treated using either orthodontic SC or IR., Materials and Methods: This study is conducted in Sweden and based on semi-structured interviews with 13 individuals who have completed treatment, either orthodontic SC (n = 7) or IR (n = 6), to address the lack of one or two maxillary lateral incisors. Data were analysed in accordance with the grounded theory approach., Results: Findings were classified into the main category of being different during treatment and into three associated sub-categories. The first category, that is being different due to missing teeth, refers to when a person experiences being different because of the anterior spacing The second category, that is being different due to fixed appliance, refers to when the appliance itself makes a person different. The two first categories exemplify being different in terms of appearance. The third identified category, that is being different due to treatment appointments, refers to the need to spend time differently because of having appointments at the clinic for treatment., Conclusion: Patients MMLIs consider their treatment to start at the time of diagnosis. They experience feelings of being different irrespective of whether the type of treatment is orthodontic SC or IR. The experience of being different differs in timing and causes depending on the treatment method.

Patients: This case report presents a minimally invasive approach to replace a missing mandibular lateral incisor using a dual-injection molding technique with flowable composite resins. Integrated with a comprehensive digital workflow, this method achieves a structurally and esthetically biomimetic, bi-layered prosthetic solution. A 34-year-old woman with congenital absence of a mandibular lateral incisor was successfully rehabilitated using a direct composite resin-bonded fixed partial denture (RBFPD)., Discussion: Two specialized three-dimensional (3D)-printed flexible indices stabilized by a custom-designed 3D-printed rigid holder were employed to ensure the meticulous injection molding of flowable composite resins formulated to emulate the inherent chromatic gradations between dentin and enamel. The inherent flexibility of the indices, combined with the holder, facilitated accurate and seamless adaptation to the complex morphological features of the dental arch, thereby mitigating the challenges commonly associated with rigid 3D-printed resin indices., Conclusions: The bilayered direct composite RBFPD using 3D printed flexible indices prepared with a full digital workflow has several advantages over other dental prosthetic solutions, including noninvasiveness, cost-effectiveness, biomimetic esthetics, repairability, and shortened treatment times. Although the initial results are promising, further longitudinal studies with larger patient cohorts are required to confirm the long-term efficacy of this approach.

This clinical report describes the prosthodontic management of a 5-year-old boy with ectodermal dysplasia who had been followed for 31 years. During the first 15 years, several interim removable overdentures were fabricated and modified according to his skeletal growth. At age 20, after the completion of jaw development, 4 endosseous dental implants were inserted in the mandible with a nerve repositioning procedure. After a 6-month healing period, maxillary and mandibular double crown removable partial dentures (RPDs) using a gold electroforming system were delivered. In the 16 years since delivery, the implants and abutment teeth have shown no pathologic signs. The double crown RPDs supported by implants and natural teeth were found to be an effective, long-term stable treatment option for this patient with hypodontia. The authors are unaware of a longer follow-up period of dental rehabilitation in a patient with ectodermal dysplasia providing satisfactory functional and esthetic results., (Copyright © 2024 Editorial Council for The Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.)

Sotos syndrome is a genetic disorder characterized by distinct craniofacial features, overgrowth in childhood, and impaired intellectual development. We herein report the successful orthodontic treatment of a 14-year-old boy with Sotos syndrome caused by a heterozygous mutation in the NSD1 gene. He showed severe hypodontia, impaction of the maxillary second molars and a skeletal Class III jaw-base relationship. Orthodontic management, including space control by protraction of the maxillary first molars and traction of the impacted molars, was performed using fixed appliances and miniscrews. As a result, acceptable occlusion was obtained without any discernible relapse 18 months postretention., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Mandibular second premolar agenesis is a common problem in orthodontics and is often treated in conjunction with maxillary counterbalancing extractions. However, in cases without maxillary crowding or dental protrusion, space closure may pose challenges leading to compromised occlusal results or patient profile. Multiple techniques have been described to treat these patients; nevertheless, there is a paucity of data comparing effectiveness of space closure utilizing various anchorage techniques. The goal of this study is to assess the effectiveness of the Herbst device during mandibular molar protraction and compare it to the use of temporary anchorage device (TADs) in patients with mandibular second premolar agenesis., Materials and Methods: This retrospective study included 33 patients with mandibular premolar agenesis treated without maxillary extractions. Of these patients, 21 were treated with protraction Herbst devices and 12 with TADs. Changes in molar and incisor positions, skeletal base positions and occlusal plane angulations were assessed on pretreatment (T0) and post-treatment (T1) lateral cephalograms. Scans/photographs at T0 and T1 were used to evaluate canine relationship changes representing anchorage control. Space closure and breakage/failure rates were also compared. Data was analyzed with paired and unpaired t-tests at the significance level of 0.05., Results: Within the Herbst group, changes in mandibular central incisor uprighting and mandibular molar crown angulations were statistically significant. However, no significant differences were noted between the Herbst and TAD groups. Protraction rates as well as overall treatment times were comparable (0.77 mm/month vs. 0.55 mm/month and 3.02 years vs. 2.67 years, respectively). Canine relationships were maintained or improved toward a class I in 82.85% of the Herbst sample, compared to in 66.7% of the TAD sample. Emergency visits occurred in 80.1% of the Herbst group, with cementation failures or appliance breakages as the most common reasons., Conclusion: The Herbst device could be a viable modality in cases with missing mandibular premolars where maximum anterior anchorage is desired, or if patients/parents are resistant to TADs. Furthermore, they could be beneficial in skeletal class II patients with mandibular deficiency who also need molar protraction. However, the increased incidence of emergency visits must be considered when treatment is planned., (© 2024. The Author(s).)

This clinical paper provides an in-depth exploration of advanced techniques for bonding orthodontic attachments under special circumstances. Challenges arise when bonding brackets to non-enamel surfaces, such as dental restorations, and in conditions such as amelogenesis imperfecta, which affect enamel integrity. Distinct approaches required for bonding to different restorative materials, including glassy ceramics, zirconia, resin composites and metals, are outlined. Moreover, we describe strategies to manage bonding in conditions including amelogenesis imperfecta, hypodontia and microdontia in a multidisciplinary context., (© 2024. The Author(s).)

Missing maxillary lateral incisors can be treated either with orthodontic space closure or preservation of the edentulous space for tooth replacement. Orthodontic space closure coupled with non-invasive post-orthodontic cosmetic dentistry is a compelling option compatible with optimal function, favourable aesthetics, and periodontal health in the long-term. We present the rationale for space closure and detail contemporary clinical strategies underpinning interdisciplinary treatment planning and excellence in finishing., (© 2024. The Author(s), under exclusive licence to the British Dental Association.)

Congenital missing second premolars in growing patients should be accurately evaluated in order to establish a suitable treatment plan. Concerning the decision of whether to close or maintain spaces in the dental arches, it shall also be based on biomechanical aspects and the aesthetic traits of individual patients. Accordingly, the option of closing tooth spaces requires an adequate application of biomechanical principles aimed at avoiding detrimental effects on dental arches and facial profile. An effective use of titanium miniscrews for immediate loading, associated with efficient sliding mechanics, can represent an elective way to successfully treat such cases. Herein, the objective is to describe the procedure and underscore the advantages of the mentioned approach by presenting a clinical case along with long-term follow-up., (Copyright © 2024. Published by Elsevier Masson SAS.)

Managing orthodontic treatment for adults with missing permanent teeth can be intricate, especially when dealing with a posterior scissor bite and an impacted tooth. This case report presents successful treatment of a female patient with dental and skeletal Class II malocclusion, high mandibular plane angle, missing maxillary left lateral incisor and mandibular right first molar, as well as right posterior scissor bite, and a deeply impacted mandibular left second premolar. In the maxilla, the right second molar and right lateral incisor were strategically extracted to eliminate the scissor bite and enhance frontal esthetic balance. In the mandible, the edentulous space caused by early loss of the first molar was successfully closed and the impacted second premolar was guided into its proper position after surgical exposure. Finally, symmetric frontal esthetics, well-aligned dentition with ideal intercuspation and an improved profile were achieved, which remained stable in the 17 month follow-up., (© 2024 by The EH Angle Education and Research Foundation, Inc.)

In patients with cleft lip and palate the most common associated dental problem is lateral incisor agenesis, often associated with lack of support and definition of the nasal tip. In many cases, adhesions deriving from surgical procedures and skeletal discrepancy make orthognathic surgery and rhinoseptoplasty unavoidable. In the present case report a dental rehabilitation with canine substitution and prosthetic-implant treatment in a posterior area is described. The use, during rhinoseptoplasty, of a customized titanium prosthesis, which provides projection for the tip of the nose, is also introduced. The patient was administered two questionnaires in order to assess the psychological aspects related to the cleft outcomes and the influence that the treatment conveyed., Competing Interests: Declaration of competing interests None., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Objective: Agenesis of the maxillary permanent lateral incisors is a condition that requires treatment aimed at improving the esthetics, even at an early age. However, traditional therapeutic protocols are long, invasive and have limitations and contraindications imposed by the age of the patient., Clinical Considerations: Recent developments in restorative dentistry have provided a new approach to this clinical situation, in particular when the deciduous laterals are retained. We report two cases regarding the management of missing lateral incisors using Biologically Active Intrasulcular Restoration (BAIR) technique. The BAIR technique allows us to transform the shape of the deciduous lateral incisor into the permanent, acting both on the dental morphology and proportions, and on the appearance of the soft tissues and the gingival parables., Conclusions: The BAIR technique is a valid approach to cases of agenesis of the maxillary permanent lateral incisors, when the deciduous are retained. It does not require any preparation of the dental tissues, is reversible and minimally invasive. It is applicable to patients of all ages, and results are obtained in a single appointment., Clinical Significance: The BAIR technique allows a biomimetic conservative approach for the rehabilitation of congenitally missing permanent lateral incisors, when the deciduous are retained. It is a non-invasive protocol and effective in successfully restoring esthetics., (© 2024 Wiley Periodicals LLC.)

Background: Non-syndromic tooth agenesis (NSTA) is a type of ectodermal dysplasia (ED) in which patients with non-syndromic oligodontia may only affect teeth. No pathological findings were found in other tissues of the ectodermal. Herein, we report a case of a NSTA patient with severe dental anxiety and poor oral health., Case Presentation: A 5-year-old boy without systemic diseases presented as a patient with oligodontia, extensive caries, and periapical periodontitis. Molecular genetic analysis found a mutation in the Ectodysplasin A (EDA) gene, confirming the diagnosis of NSTA., Conclusion: Tooth agenesis (TA) is the most common ectodermal developmental abnormality in humans. Non-syndromic oligodontia patients often seek treatment in the department of stomatology. Because of their complex oral conditions, these patients should be provided with a systematic and personalized treatment plan., (© 2024. The Author(s).)

Congenital tooth agenesis is a type of craniofacial developmental anomaly with reduced number of teeth, which is caused by disturbances in tooth germ development. If the number of missing teeth is less than six (excluding the third molars), it is termed as hypodontia. The second premolars are most commonly affected. When the second premolars are missing, the second primary molars are more prone to suffer from retention, infraocclusion, caries, pulpitis, or periapical periodontitis. Without timely prevention and appropriate treatment, congenital loss of second premolars may cause adverse effects on the patients' tooth arrangement, occlusal function, craniofacial development, and even future prosthetic treatment. This review summarises the aetiological and diagnostic features of the agenesis of second premolars, and discusses the clinical considerations of retaining or extracting the second primary molars without permanent tooth germs, when the absence of permanent tooth germs is fully established or not, so as to provide references for dentists.

Introduction: The most common treatment approaches for patients missing maxillary lateral incisors are implant replacement (IT) and orthodontic space closure (SC). Treatment techniques change and improve over time, and it is of interest to know if improvements differ between the methods., Aim: To compare the aesthetic outcome and other clinical findings in patients with one or two missing maxillary lateral incisors who were treated with a 10-year difference in time, with either orthodontic space closure or implant replacement., Material and Methods: A total of 88 patients were included in the study. Forty-four patients treated between 2011 and 2018 were included as the latter cohort (LC). The LC was compared to the early cohort (EC; n = 44), treated between 2001 and 2008. A total of 132 teeth was analysed: 62 teeth in the EC (28 teeth in IT cases and 34 teeth in SC cases) and 70 teeth in the LC (34 teeth in IT cases and 36 teeth in SC cases). Long-term clinical and aesthetic outcomes were evaluated., Results: An improvement over time was found in crown length, BoP, papilla, the inclination of incisors, and overall appearance in IT cases and in crown colour and overbite in SC cases. A deterioration over time was found in crown length and BoP among the SC cases., Conclusion: Among the IT cases, an improvement in outcomes was noted over time. When comparing SC cases the colour of the crown and overbite had improved, while crown length and BoP had deteriorated over time., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Orthodontic Society.)

It is incumbent upon our profession to reevaluate our preference for routinely replacing a missing single maxillary incisor, especially a maxillary lateral incisor, with a dental implant in a young adult. The dental literature is replete with beautiful restorative results using implants in this area, but there is minimal discussion regarding the long-term consequences of this treatment. The maxillary lateral incisor is one of the most commonly missing teeth due to agenesis, and it is also one of the most common teeth to be lost due to trauma in the developing child.1 Therefore, the decision for replacement must be made with the long-term in mind, as these restorations are commonly placed between ages 18 and 21 and must serve the patient for many decades. There are several reasons that implants can be associated with complications or even fail, including the following: (1) Continued craniofacial growth, which has a predominant anterior and vertical component and has been shown to occur in the maxilla, resulting in the apparent submersion of the implant crown as the natural teeth move incisally in relation to the implant2,3-there is no evidence that this can be predicted, let alone how far into the future it may happen; (2) peri-implantitis, which has a patient-level prevalence estimate of nearly 25% according to the findings of a recent systematic review;4 (3) thinning and recession of the peri-implant mucosa due to poor implant placement, inadequate prosthetic management, and/or poor case selection, often resulting in compromised esthetics and a predisposition for the onset and progression of peri-implant diseases; and (4) mechanical failure of the implant, abutment screw, transmucosal abutment, and/or crown. Clinicians should also keep in mind that, once an implant is placed in the anterior maxilla, it precludes the possibility for palatal expansion in the adult patient because the space created by the expansion cannot be redistributed orthodontically. Canine substitution is one traditional method for replacement of the missing maxillary lateral incisor. It is still a viable option when the canine tooth has an acceptable shape and color, and the occlusion will not be compromised by the substitution.5 Additionally, the bonded single-wing zirconia bridge has become a primary treatment option.6 Zirconia has the strength of metal and beauty of porcelain, which makes it an ideal substrate for a bonded bridge. The literature has demonstrated the long-term success of this replacement option for the missing maxillary incisor.7 There are clearly many potential long-term disadvantages associated with replacing a single missing maxillary incisor with an implant in young adults. We should be prescribing the least-invasive treatment option for the replacement of these teeth. Therefore, when treatment-planning for a missing maxillary incisor in a young adult, alternatives to implant therapy-such as the bonded single-wing zirconia bridge and canine substitution-should be the primary treatment options. The implant should only be considered as a secondary treatment when the other options are not viable or have previously failed.

Introduction: This research aimed to evaluate the impact of orthodontic treatment on a young person's oral health-related quality of life, self-esteem, and esthetics concerning hypodontia., Methods: A prospective longitudinal hospital-based study recruited 97 participants with hypodontia, aged 11-18 years. Forty-one participants (42%) originally planned to have space closure and the remainder space opening, with subsequent prosthetic replacement. The following questionnaires were completed before and after orthodontic treatment: the child perception questionnaire, Bristol condition-specific questionnaire for hypodontia (BCSQ), the child health questionnaire, and the Oral Aesthetic Subjective Impact Scale (OASIS). The Wilcoxon and matched pairs t tests approach was applied to compare before and after orthodontic treatment for significant testing (P <0.05)., Results: Fifteen participants were lost to follow-up, resulting in 82 participants completing orthodontic treatment, with an average age of 13.8 ± 1.71 years. A total of 282 teeth were missing in the sample. Treatment resulted in significantly lower indexes (P <0.001) to overall BCSQ, OASIS, appearance, and how others would treat them. In comparing the 2 subgroups, those treated with space closure had significantly reduced functional limitations (child perception questionnaire), appearance concerns, self-esteem (child health questionnaire), OASIS, and overall BCSQ scores., Conclusions: Orthodontic treatment in participants with hypodontia appears to significantly impact a range of psychological and esthetic scales. In particular, space closure appears to significantly improve the quality of life of participants compared with those undergoing space opening., (Crown Copyright © 2023. Published by Elsevier Inc. All rights reserved.)

Resin-bonded bridges are one of the main options for replacing missing teeth for hypodontia patients. This technique offers several advantages for these patients, who are often young, have unrestored abutment teeth, and have had tooth positions optimised by orthodontic treatment. However, the replacement of missing teeth can be challenging due to tooth positions and anomalies of abutment tooth shape and size.These patients are often young adults at the time of restoration, making the minimally invasive nature and predictable long-term success of resin-bonded bridges advantageous over other treatment methods.This paper in the hypodontia themed issue discusses the importance of case selection and gives practical advice for the design and provision of resin-bonded bridges., (© 2023. The Author(s).)

The general dental practitioner (GDP) is usually the first person to suspect that a young patient is affected by hypodontia. The condition occurs rarely in the primary dentition but is relatively common in the permanent dentition. Between the ages of 7 and 12 years, failure of a permanent tooth to erupt as expected will lead the GDP to initiate and then contribute to the ideal management of the patient's condition. This ranges from reassurance and preventive measures to providing aspects of treatment in a long-term management plan, alongside a multidisciplinary specialist team and thereafter, delivery of life-long dental care., (© 2023. The Author(s), under exclusive licence to the British Dental Association.)

Hypodontia is a relatively common condition and patients will be seen by both general dental practitioners and specialist dental colleagues. Although hypodontia can be described as mild, moderate and severe, this does not directly correlate with the complexity of treatment required to provide an acceptable outcome. In addition, the complexity of treatment provided by one colleague in the multidisciplinary team may not be the same as for other colleagues.When treatment planning and delivering dental care for these patients, especially those with severe hypodontia, it is useful to recognise the factors that make their care complex and also to follow principles for multidisciplinary treatment planning., (© 2023. The Author(s).)

Involving young people and their parents in decisions about their health care is ethically and professionally the right thing to do. Good decision-making relies on informed, value-based deliberation. Providing the right treatment for people with hypodontia is complex, both technically, in terms of the range of options available, and from a communication perspective. Treatment decisions faced by young people with hypodontia can have lifelong implications and the weight of this is felt both by the patient, who may have limited experience of dental treatment and decision-making, and their parents, who act as advocates. It is important that clinicians understand how they can best share the available evidence and their expertise in a way that can be understood and applied. Clinicians also have an important role in facilitating young people to recognise and communicate their own values, expectations, and ultimately, preferences for treatment. This paper outlines the challenges of navigating information sharing and engaging in shared decision-making specific to hypodontia. A scoping review of the literature by the authors was conducted to identify evidence-based advice for discussing uncertainties, risks and increasing engagement in decision-making. This may be useful to both primary and secondary care practitioners involved in decision-making with people with hypodontia., (© 2023. The Author(s).)

This article aims to give an overview of the part orthodontics plays in the management of hypodontia cases. Severity of hypodontia varies and some cases can be managed by orthodontics alone. The more complex cases benefit from multidisciplinary care with a combination of orthodontics and restorative treatment. This article sub-divides orthodontic involvement in hypodontia cases into three distinct phases, while providing clinical examples to highlight the management of a variety of cases ranging from simple to complex., (© 2023. The Author(s), under exclusive licence to the British Dental Association.)

Most patients seeking treatment for hypodontia will require prosthetic replacement of their missing teeth. This will be in the form of dentures, bridges and implant restorations. As these are created by one or more dental technicians who supports the clinical team, a close working relationship between these colleagues is likely to improve the quality of treatment outcome. This interaction will usually occur towards the end of the patient's treatment process, when definitive restorations are prescribed. However, appropriately trained and experienced dental technicians should be involved throughout the patient's treatment process as an integral part of the multidisciplinary team approach to effectively manage these patients.This paper describes the contribution of dental technicians to patient care with particular focus on communication between the restorative dentistry clinical team and the dental technician to improve the quality of anterior restorations. As missing maxillary lateral incisor teeth are a common presentation for this patient group, further technical detail relating to planning resin-bonded bridges for replacement of these teeth is included., (© 2023. The Author(s).)

Hypodontia is a relatively common clinical condition and the second premolar tooth is the most common tooth that fails to develop (excluding third molars). For some patients, no treatment is required, as there is little, if any, consequence of the condition. For other patients, the missing teeth are part of a more complex dental presentation, requiring specialist dental management. This paper describes the clinical decision-making process and explores the options for managing this presentation of hypodontia., (© 2023. The Author(s), under exclusive licence to the British Dental Association.)

Peg-shaped and missing lateral incisor teeth are common features for patients affected by hypodontia. While improvements in dental appearance may be a strong motivating factor for these patients, providing dental treatment to improve the clinical condition and achieve an acceptable and stable outcome can be complex and lengthy.For patients affected by hypodontia, discussion and consideration of various approaches to their individual treatment are best achieved in a multidisciplinary team environment. This allows debate of options and joint agreement between at least orthodontic and restorative dentistry specialist colleagues, based largely on clinical factors, towards a treatment plan that is acceptable to the patient. As most patients with this lateral incisor form of hypodontia are initially treated as teenagers and young adults, there is also an understanding that treatment outcomes will have lifelong maintenance and resource implications to consider.This paper identifies and discusses the key clinical features that influence the treatment planning process for a patient with either missing or peg lateral incisor teeth. These will often involve consideration of whether to open or close the lateral incisor spaces and whether to restore or replace a peg lateral incisor tooth. The process should be patient-centred, evidence-based, and aim to minimise the lifelong treatment burden, retaining options for future maintenance and retreatment., (© 2023. The Author(s).)

Primary molar teeth that are retained beyond their exfoliation pose a clinical decision-making challenge for dental teams. The retention of these teeth may be due to absence of a permanent successor. As a result, careful planning is required to determine if retention or extraction is necessary. This article aims to discuss the prevalence of retained primary molars, assessment and treatment planning considerations, from both orthodontic and restorative perspectives., (© 2023. The Author(s), under exclusive licence to the British Dental Association.)

Introduction Patients with hypodontia can be seen by a multidisciplinary team clinic (MDT) for treatment planning at the University Dental Hospital of Manchester (UDHM). The MDT consists of orthodontics, restorative dentistry and oral surgery colleagues.Aims and methods A retrospective case-note analysis was conducted on 558 hypodontia patients seen on Manchester Hypodontia Clinic (MHC) between 2016-2022 to assess service utilisation and treatment planning outcomes.Results The average age of patients attending the MHC was 16 (range 8-50). The distribution of mild, moderate and severe hypodontia in the sample was 28%, 37% and 35%, respectively. Most common treatments proposed were fixed appliances, extractions, implants and resin-bonded bridges. Out of 558 patients seen for consultation on the MHC, 365 (65%) were accepted for treatment. The average number of visits for treatment was 15.5 (range: 1-55). The average number of did not attend/was not brought appointments, patient cancellations and hospital cancellations were 0.8, 1.4 and 1.8, respectively.Conclusion Hypodontia patients referred to UDHM are triaged by consultants in orthodontics or restorative dentistry, and if MDT planning is required, they are booked onto the MHC. There are sufficient patients with complex cases of moderate and severe hypodontia to justify a regular MDT hypodontia clinic., (© 2023. The Author(s).)

Introduction: The case in this study had moderate hypodontia, with both lower lateral incisors and the lower-left second premolar missing. A Class II division 2 relationship with severe crowding in the upper arch and a traumatic deep bite over a skeletal I base complicated the occlusion., Materials and Methods: The plan was to extract the upper first premolars to relieve upper arch crowding and the lower-left impacted second premolar to preserve the bilateral class I molar relationship. A class I occlusal relationship was achieved through space opening in the lower lateral incisors region and space closure in the upper and lower premolars regions., Results: The use of orthodontic screws for bite opening and anterior segment retraction, in conjunction with bi-metric slot size selection in bracket prescription, was effective in controlling incisor inclination and interincisal angle. The use of an implant fixture before beginning the finishing stage allowed for a reduction in total treatment time and facilitated the provision of the final prosthesis before debonding the case. As a result, the patient was able to receive a satisfactory occlusion on the day of debonding., Conclusion: This case of moderate hypodontia was successfully resolved by combining space closure and space opening effectively. To solve the arch problems in such Class II division 2 cases with severe crowding, extractions were required. To complete the case, this was combined with intrusive and retractive mechanics. In hypodontia cases, implants are an excellent choice for both aesthetics and functional restoration., (Copyright © 2023 CEO. Published by Elsevier Masson SAS. All rights reserved.)

Objectives: The aim of this study was to determine the quality, reliability and usability of information on the Internet regarding hypodontia., Method: A survey of patients with hypodontia revealed seven key search terms favoured by patients: Hypodontia; Congenitally missing teeth; Missing teeth; Gaps in teeth; Cure of missing teeth; Information on missing teeth; and Treatment of missing teeth. These were entered into four search engines: Google; Ask; Wikipedia; and NHS Choices. Relevant websites were assessed for their overall demographics, author type, country of origin and rank within the search engine. They were then analysed using five validated assessment tools. Intra-examiner reliability was assessed, and statistical analysis of the data was undertaken., Results: Good intra-examiner reliability was observed. A total of 48 websites were included for analysis from an initial 1718. There was no relationship between the ranking of a website on a search engine and the quality of information it contained. When medical search terminology was used, it resulted in websites of better quality than layperson search terms. Most websites were produced by general dental or specialist dental practices but the quality of these was poorer than those developed by private companies and medical organisations. The country of origin was primarily the USA and UK; however, this had no relationship to website quality. Overall, the majority of websites scored poorly for the validated tools and none scored well across multiple tools. A statistical analysis showed a positive relationship between the LIDA and DISCERN instruments but no other correlation between other validated tools was found., Conclusion: The quality and reliability of information on the Internet regarding hypodontia is generally poor. There is a need for a reliable online hypodontia resource that can be recommended for patient use.

Objective: Few studies within orthodontics present both economic and clinical findings. Missing maxillary lateral incisors is a frequently occurring anomaly. The treatment alternatives most used are orthodontic space closure and prosthetic replacement of the missing tooth. Our aim is to compare the total societal costs of orthodontic space closure (SC) and implant therapy (IT) in patients missing maxillary lateral incisors., Methods: Records of 32 patients treated with SC (n = 18) or IT (n = 14) due to missing maxillary lateral incisors were retrieved from the archives. Direct costs and indirect costs in the short- and long-term were analysed using a cost analysis with a societal perspective up of to 12 years post-treatment., Results: Comparing cases treated with SC and IT, the difference in direct short-term costs for treatment is €735.54, whereas SC is the least costly. There is no difference between SC and IT in short-term parent loss of productivity, long-term loss of productivity, costs for transportation, or direct long-term costs. A difference was found between SC and IT-in favour of SC-when comparing patients' loss of productivity (P = 0.007), short-term societal costs (P < 0.001), long-term societal costs (P = 0.037), and total societal costs (P < 0.001)., Limitations: There is a limited number of patient records. Local factors such as subsidies, urban versus rural areas, taxes, etc. can influence monetary variables, so the transferability to other settings may be limited., Conclusion: Patients treated with SC have a lower total societal cost compared to patients treated with IT. There was a difference in productivity loss for patients between SC and IT; however, concerning other indirect parameters and direct long-term costs, there was no difference between the two treatments., (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Orthodontic Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Background: Dental agenesis (DA) in the permanent dentition is one of the most common dental anomalies, with a prevalence up to 2-10%. Therefore, the aim of this retrospective study was to investigate the prevalence and therapeutic treatment of DA in healthy children (HC) compared to children with systemic disease or congenital malformation (SD/CM)., Methods: Out of 3407 patients treated at the Department of Paediatric Dentistry of the Justus Liebig University Giessen (Germany) between January 2015 and December 2020, a total of 1067 patients (594 female, 473 male) aged between 4.5 and 18 years were included in this study due to DA. Besides the patients' general medical history and therapeutic treatments, panoramic radiographs were analysed., Results: In contrast to the HC group with 9.7% DA, the SD/CM group showed a significantly higher prevalence of DA (19.8%; p < 0.05). The latter group was further classified into children with ectodermal dysplasia (4.4%), down syndrome (8.2%), cleft lip and palate (4.4%), intellectual disability/developmental delay (16.4%), and other genetic/organic diseases without intellectual disability (45.9%). Regarding therapeutic treatments, the HC group (59.5%) was significantly more often treated with an orthodontic gap opening compared to the SD/CM group (42.6%; p < 0.05), followed by orthodontic gap closing 36.5% in the HC group and 22.9% in the SD/CM group (p < 0.05), whereas no treatment was predominantly performed in the SD/CM group (37.7%) compared to the HC group (4%; p < 0.05). Furthermore, 50% in the SD/CM group required general anaesthesia for therapeutic treatment (vs. 8.1% in the HC group; p < 0.05)., Conclusions: Children with SD/CM suffered more often from DA compared to HC that underlines multi- and interdisciplinary treatment of utmost importance. Furthermore, due to intellectual disability, common treatment methods can be complicated by insufficient compliance. This fact underlines the importance of an early attempt to establish the necessary cooperation enabling children with SD/CM to receive therapy., (© 2023. The Author(s).)

Introduction: The most common chromosomal anomaly is Down syndrome/Trisomy 21, which can be associated with varying degrees of intellectual disability and physical malformation. Specific orofacial characteristics regarding orthodontic treatment options and features are described on the basis of a patient collective from the Witten/Herdecke University, Germany., Methods: Data of 20 patients (14 boys and 6 girls, mean age: 11.69 ± 3.94 years) who underwent orthodontic treatment between July 2011 and May 2022 were analyzed. Baseline skeletal and dental conditions were assessed, as well as the presence of hypodontia, displacements, and treatment-related root resorptions. The treatment need was evaluated based on the main findings according to the German KIG classification. In addition, treatment success was determined in relation to patient compliance., Results: The patient group was characterized predominantly by a class III relationship (ΔANB: -2.07 ± 3.90°; ΔWITS: -3.91 ± 4.33 mm) and a brachyfacial cranial configuration (ΔML-NL: -4.38 ± 7.05°, ΔArGoMe: - 8.45 ± 10.06°). The transversal discrepancy of the dental arch width from maxilla to mandible was -0.91 ± 3.44 mm anteriorly and -4.4 ± 4.12 mm posteriorly. Considering the orthodontic indication groups, the most frequent initial finding and treatment indication represented hypodontia (85%), followed by frontal (75%) and unilateral lateral (35%) crossbite. In 55% of the cases, the teeth had a regular shape, but in 35% a generalized and in 15% an isolated hypoplasia. Only 25% of the patients could be treated with a fixed multiband appliance due to sufficient cooperation. In each of these patients, varying degrees of root resorptions were detected during treatment, and 45% of all treatments had to be terminated prematurely due to a lack of cooperation by patients or parents., Conclusion: The extent of dental and skeletal malformations and the high rate of findings requiring treatment in patients with Down syndrome represent a significant indication for orthodontic therapy, which can be well illustrated by the KIG classification. However, this is in contrast to the eventually increased risk of root resorption, with significantly reduced patient cooperation. A compromised treatment outcome and process must be expected. Consequently, the orthodontic treatment must be simple and realistic to achieve fast and therapeutically satisfactory treatment result., (© 2023. The Author(s).)

Introduction: The alveolar bone is an essential consideration when planning treatment for patients with tooth agenesis. This study evaluated the changes in the alveolar bone and adjacent teeth in patients with a congenitally missing mandibular lateral incisor using cone-beam computed tomography., Methods: Twenty-three nonorthodontically treated adults with a unilateral congenitally missing mandibular lateral incisor were the missing group (M group). The control group (C group) consisted of 23 nonorthodontically treated adults with normal occlusion and no missing teeth. First, the difference in the arch perimeter between the groups was compared at the cementoenamel junction (CEJ) level and the root apex (RA) level. Next, the root divergence of the anterior teeth in the M group was observed. Finally, the alveolar bone thickness ratio was compared between the M and C groups at different vertical levels., Results: The arch perimeter was significantly decreased in the M group at the CEJ and RA levels (P <0.05). Root divergence was observed adjacent to the missing site (P <0.0001). There were a reduction in total and cancellous cortical alveolar bone thickness (ABT) ratios at the 3-, 6-, and 9-mm positions (P <0.05). The buccal cortical ABT ratios decreased at the 3-and 6-mm positions. The lingual ABT ratio increased at the 9-mm position (P <0.05)., Conclusions: The congenitally missing mandibular lateral incisor caused a reduction in the arch perimeter in the CEJ area and the RA area. The root divergences were observed in the teeth adjacent to the missing areas. A significant decrease in the buccal cortical bone and cancellous bone was observed in the missing area., (Copyright © 2022 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.)

Aim: As oral rehabilitation of tooth agenesis usually begins at a very young age, it is important to plan the therapy in advance in order to prepare the patient for the final treatment after the end of skeletal and dental growth. The diverse patterns of tooth agenesis require interdisciplinary oral rehabilitation adapted to individual factors like patient's age, number of missing teeth, and alveolar-bone development. The aim of the present high volume single-center study was to provide an overview of the management of patients with tooth agenesis, in terms of treatment approaches, associations, and long-term implant survival, over a period of 30 years., Methods: Descriptive analyses were performed to analyse treatment approaches and and how they reated to severity of agenesis as well as patients' gender and age. Kaplan-Meier survival curves and log-rank-tests were used to investigate implant survival over time., Conclusion: Treatment starts usually in childhood or adolescence; orthodontic therapy was the most common treatment. All treatment options showed similar high survival rates. External bone augmentation might be a risk-factor for implant loss.

Choosing hypodontia treatment requires young people and parents to consider a large amount of information, identify what is important to them, and make trade-offs between options. This study aimed to examine young people and parents' preferences for hypodontia treatment using discrete choice experiment (DCE). This was a cross-sectional survey of young people (12-16 y) with hypodontia of any severity, at any stage of treatment, and their parents. Participants were recruited from NHS Hospitals in England and Wales. A bespoke DCE questionnaire was developed to measure preferences for 6 attributes of hypodontia treatment (waiting time, treatment time, problems during treatment, discomfort during treatment, bite, appearance). The questionnaire was completed 1) online by young people and parents, individually or together, and 2) by child-parent dyads under observation. Preferences were analyzed using regression models. In total, 204 participants (122 young people, 56 parents, 26 dyads) completed the online questionnaire and 15 child-parent dyads completed the questionnaire under observation. The most important attribute in hypodontia treatment was improvement in appearance, but significant heterogeneity was found in preferences. Four distinct groups of participants were found: group 1 (39%): severe discomfort and problems were most important; group 2 (31%): most concerned about improvement in appearance of teeth and improvement in bite; group 3 (22%): appearance 3 times more important than any other attribute; and group 4 (9%): preferences difficult to interpret. There was variation in how child-parent dyads approached decision-making, with some negotiating joint preferences, while for others, one individual dominated. Making trade-offs in DCE tasks helped some people think about treatment and identify their preferences. Appearance is an important outcome from hypodontia treatment, but preferences vary and potential risks and functional outcome are also important to some people. There is a notable level of uncertainty in decision-making, which suggests further shared decision support would be valuable.

Background: Hypodontia is one of the most common anomalies in dentistry. Hypodontia has a negative impact on oral health-related quality of life with patients best seen in a multidisciplinary clinic to improve treatment outcomes., Aim: To investigate the prevalence of hypodontia and its association with other dental anomalies, as well as malocclusion, and to investigate the treatment planned for patients attending the clinic and whether the type of missing teeth affected the proposed treatment., Materials and Methods: Analysis of consecutive patients attending the hypodontia clinic at a dental hospital between February and November 2020. A total of 100 patients who met the inclusion criteria were identified. Data collected included the following: age/sex; number and type of missing teeth; pre-treatment occlusion; presence of other dental anomalies; and planned treatment., Results: A total of 100 patients (55% female; age range = 7-41 years; mean age = 18 years) were included. Of the cohort, 47% had a class I skeletal relationship and participants were significantly less likely to have a class III skeletal or incisor relationship; 45% had another dental anomaly with the most common being microdontia. Space opening was the preferred treatment option for those managed by orthodontic treatment with resin-bonded bridges most likely to be used for restoration of spaces, 86%., Conclusion: Lower second premolars were the most commonly missing teeth. Participants were significantly less likely to have a class III incisor or skeletal relationship than class I or II. Space opening was the favoured approach for orthodontic treatment, particularly for maxillary lateral incisors.

Objective: The aim was to evaluate the distribution of congenitally missing teeth and the treatment provided for congenitally missing lower second premolars in an eleven-year cohort of patients referred to a publicly funded source of specialist care., Material and Methods: This was a retrospective, register-based cohort study. Search for patients referred to a publicly funded source of specialist care based on ICD10 diagnosis code K00.00 (partial anodontia) and treatment codes EBA00, EBA05, EBA10, EBA12, EBB10 and EBB20 during the period 1.1.2009-27.10.2019 yielded 232 patients (151 females, 81 males), of whom 218, born in 1941-2009, were eligible. Data collected from medical files were presented in the form of descriptive statistics and analysed using Fisher's exact test., Results: The 218 subjects possessed 876 congenitally missing teeth (males 307, females 569) (third molars excluded). The most common missing teeth were upper second premolars and lateral incisors, and lower second premolars and central incisors. No difference in laterality was found. Statistically significant associations were found between the choice of treatment and both the patient's age at referral and the patient's year of birth. Most common treatment for adult patients (age 18-56 years) was placement of an implant (67%), while autotransplantation (11%) was the preferred option for children at the mixed dentition stage (age 9-15 years)., Conclusions: The congenitally missing teeth most commonly involved in referrals of patients to publicly funded specialist care were lower second premolars. The most frequent treatment was insertion of an implant for adults and autotransplantation at the mixed dentition stage.

Introduction: There are different possibilities of orthodontic planning for cases with congenital absence of maxillary lateral incisors. This subject divides the opinion of orthodontists and oral rehabilitation clinicians, due to the advantages and disadvantages of each treatment option, which may involve opening spaces for future implants and/or prosthetic restorations, or closing the spaces by positioning the maxillary canines in the place of lateral incisors. The correct diagnosis and careful evaluation of each patient allow to determine the best therapeutic approach. This paper discusses the main topics to be considered when planning these cases., Objectives: To evaluate the main aspects related to orthodontic treatment planning in cases of congenital absence of maxillary lateral incisors, to aid the decision-making, with clinical and scientific basis.

Aim: Despite the fact that ectodermal dysplasia (ED) is a rare disease, it is often seen in a tertiary clinic. ED affects ectodermal tissues such as skin, hair, teeth, nails, and sweat glands. Patients usually have sparse light hair, deformed nails, and dry skin. They suffer from dental abnormalities such as oligodontia (absence of 6 or more teeth) or complete anodontia; salivation can also be affected. The absence of teeth can be the overriding problem for both patients and their parents, and lead to substantial social ostracisation. This study aims to summarise the facts about the disease, especially dental treatment options based on data drawn from a representative Czech cohort., Materials: The present article summarises the facts about ectodermal dysplasia (ED) in a cohort of 13 patients, where the following were evaluated: clinical manifestations of ED, pathogenic variants detected in selected candidate genes and dental treatment options from child removable dentures to fixed crowns and implants insertion. Three cases are described in detail and demonstrate approaches for different age groups., Conclusion: Early diagnosis and active cooperation between the geneticist and dentist will facilitate cooperation with parents and patients and assure secondary prevention. It is preferable that the geneticist understands dental treatment options and can discuss these with patients/parents.

Background: The craniofacial developmental abnormality can significantly complicate the oral rehabilitation of patients with oligodontia. This case report describes an interdisciplinary approach that took 7 years to successfully treat a young patient with non-syndromic oligodontia and midface deficiency., Case Presentation: A 14-year-old patient with complex oral and maxillofacial conditions and diagnosis of oligodontia presented to our clinic. In addition to 4 retained deciduous teeth and congenitally missing 10 permanent teeth, dentofacial findings included maxillary and malar deficiency with a concave facial profile, Angle Class III malocclusion, and poor dental esthetics. The interdisciplinary treatment included pre-surgical orthodontic decompensation, high Le Fort I maxillary osteotomy, postsurgical orthodontic therapy, osseous ridge augmentation using recombinant human bone morphogenetic protein-2 (rhBMP-2), interim removable partial denture, dental implant installation, interim implant prostheses, and final prosthetic rehabilitation., Conclusions: The successful treatment of patients with oligodontia and complex dentofacial abnormalities requires the close and orderly collaboration among orthodontist, oral maxillofacial surgeon, and prosthodontist. Within the limitations of this case report, presented interdisciplinary approaches may optimize the oral rehabilitation outcome in patients with similar clinical challenges. A prospective clinical investigation is desired to verify the benefit of presented interdisciplinary approach., (© 2022. The Author(s).)

The developmental absence of permanent maxillary lateral incisors is a common developmental anomaly and presents clinical challenges. The maxillary lateral incisor is the second most common developmentally absent tooth after the mandibular second premolar, therefore can present frequently in practice. Patients with hypodontia of the maxillary lateral incisor present clinical challenges in relation to function and aesthetics. In part one of this two-part series, we focused on the assessment, diagnosis and management. In this part, we will discuss some of the frequently encountered challenges in canine camouflage cases and possible solutions., (© 2022. The Author(s), under exclusive licence to the British Dental Association.)