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Table of Contents
CASE REPORT
Year : 2020  |  Volume : 8  |  Issue : 3  |  Page : 60-62

Partial anodontia with macroglossia: An esthetic and functional challenge for a prosthodontist


1 Maharashtra Institute of Dental Sciences & Research Dental College, Latur, Maharashtra, India
2 Dental Unit in ARSMH, Pune, Maharashtra, India
3 Guru Teg Bahadur Hospital, Delhi, India
4 Theerthanker Mahaveer Dental College and Research Centre, Rampur, Uttar Pradesh, India
5 Guru Teg Bahadur Hospital, Dilshad Garden, Delhi, India

Date of Submission24-Jun-2020
Date of Acceptance24-Jul-2020
Date of Web Publication28-Sep-2020

Correspondence Address:
Dr. Ankit Agarwal
Guru Teg Bahadur Hospital, Dilshad Garden, Delhi.
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/INJO.INJO_25_20

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  Abstract 

Partial anodontia is considered as one of the most crucial developmental anomalies in the dentofacial region. In the permanent dentition, the prevalence rate of true partial exodontia is 3.5%–6.5%. The clinical situation in relation to this abnormality is very distressing for the patient; at the same time, it is a strenuous challenge for the clinician to bring it to the normal function and esthetics. This case report discusses the prosthodontic rehabilitation of a young girl with the partial anodontia that was treated with the tooth-supported over-denture using Ceka Preci precision attachments. The ultimate aim was to rehabilitate her prosthodontically to uplift her mental and esthetic status.

Keywords: Partial anodontia, precision attachment, prosthetic therapy, tooth-supported overdenture


How to cite this article:
Jadhav S, Sahu K, Khan M, Khan SM, Singh N, Agarwal A. Partial anodontia with macroglossia: An esthetic and functional challenge for a prosthodontist. Int J Oral Care Res 2020;8:60-2

How to cite this URL:
Jadhav S, Sahu K, Khan M, Khan SM, Singh N, Agarwal A. Partial anodontia with macroglossia: An esthetic and functional challenge for a prosthodontist. Int J Oral Care Res [serial online] 2020 [cited 2020 Oct 30];8:60-2. Available from: https://www.ijocr.org/text.asp?2020/8/3/60/296223




  Introduction Top


In general dentistry, anodontia, also referred as anodontia vera, is a rare genetic disorder which is characterized by the congenital absence of all primary or permanent teeth. It is associated with the group of skin and nerve syndromes called the ectodermal dysplasias. Congenital absence of permanent teeth can present as hypodontia with missing one or two permanent teeth, or oligodontia that is the congenital absence of more than six teeth. Anodontia is the congenital absence of some teeth (partial anodontia) or all teeth (hypodontia). It can involve two dentitions or only teeth of the permanent dentition (Dorland’s 1998). It has been reported that approximately 1% of the population suffers from oligodontia.[1] According to Graber, congenital absence of teeth is a hereditary phenomenon that is probably passed to each generation by an autosomal dominant pattern with incomplete peneterance.[2],[3],[4],[5] The prosthodontic rehabilitation of patients suffering from partial anodontia with macroglossia depends on the number of teeth present. In complete anodontia, the treatment would be conventional or implant-supported complete dentures. In patients with partial anodontia, removable or fixed partial dentures or tooth-supported overdentures using precision or semiprecision attachments may be considered with depending on number of present teeth. In the present case, tooth-supported overdenture with ceka presi–precision attachment system was planned. Being a female youngster, the patient had high comfort level and aesthetic demands, care was taken to fulfill them and upgrade her psychologically.[6]


  Case Report Top


A 17-year-old female patient reported to the department of prosthodontics with a complaint of missing teeth. According to her parents, since infancy she suffered from missing teeth; the parents also gave the history of intermittent fever throughout infancy and childhood. There was no family history of missing teeth. The girl was moderately built and well nourished. She was intellectually disabled which may be syndromic. Other clinical features included scanty scalp hair and brittle nails. An intraoral examination revealed a relatively normal mucosa with macroglossia. Totally, there were six permanent teeth present in mouth (maxilla: central incisors and first molar on the right side; and mandible: canine on the left and first molar on the right side) along with some badly carious deciduous teeth. [Figure 1]
Figure 1: Preoperative OPG

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Treatment phases

Phase I

Extraction of all the overretained deciduous teeth was planned to be done in the special care center of the hospital under the antibiotic cover for 7 days. The patient’s parents were given the postoperative instructions and the recall was scheduled as per the requirements.

Phase 2

The patient was attended again after 4 months and the complete healing was confirmed in the extraction areas. An intentional endodontic treatment was planned for the permanent teeth present in the oral cavity which were used as abutments for the overly dentures. After the endodontic treatment, the abutment teeth were prepared dome shaped with maintained ferrule effect to provide the retention to the metal copings. Metal copings were cemented with glass ionomer luting cement (GC Corporation Tokyo, Japan).

Phase 3

A complete denture was fabricated by the conventional technique. The patient presented a Class III jaw relationship and macroglossia thus it was decided to use criss-cross posterior teeth arrangement. The dentures were kept ready for insertion.

Phase 4

The precision attachment system, that is, Ceka Attachments Preci-Line (PRECI-CLIXRTI POST), was used in maxillary central incisors and mandibular canine. The abutment teeth were prepared with the post space by using the drills provided in the kit by the manufacture.

Phase 5

Varnish (Copal-F PREVEST) is applied over prepared teeth to prevent it from caries.

Phase 6

Metal housing was placed in the intaglio surface of the denture at the appropriate points replicated by the pressure, indicating that pastes and were fixed with autopolymerizing acrylic resin. Nylon caps, that is, female component were placed in metal housings with the help of the mount that was provided in the kit. These female components are available in three different colors, that is, white (less retention), yellow (normal retention), and red (Increased retention).[7],[8] The dentures were inserted and stabilized in place by making the patient occlude in centric, so that the nylon caps with the metal casing gets transferred to the dentures [Figure 2]A and [B].
Figure 2: (A and B) Metal housing with nylon caps assembly on place

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  Discussion Top


Treatment of mentally challenged patients is a challenge in itself even for the routine dental procedures. It becomes more arduous as involves extensive treatment procedures where the patient and clinician both need to work with patience. The clinician must plan the treatment and follow the protocol to get favorable functional and aesthetic results. Special care is required to be taken while treating the young patients as, the differential treatment plan depends on the age, degree of malformation of teeth, the growth and development of the stomatognathic system. It is important to provide early prosthodontic treatment to replace missing teeth and to restore the vertical dimension of occlusion. Because of early-age intervention and the need to easily modify the intraoral prosthesis during rapid-growth periods a removable partial denture or complete denture prosthesis is indicated. This treatment protocol affords the partial anodontia patient an easy, affordable, and satisfactory method of dental rehabilitation.


  Conclusion Top


Partial anodontia is an autosomal developmental anomalies in the dentofacial region. Prosthodontic rehabilitation of an intellectually challenged adolescent with ectodermal dysplasia poses multiple difficulties while treating the same. In the present case, overlay dentures were fabricated by using CEKA ATTACHMENTS PRECI-LINE(PRECI-CLIXRTI POST). The treatment was based on the philosophy of preserving the remaining residual ridge and to restore the esthetic and function of the missing structure.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.



 
  References Top

1.
Hickey AJ, Vergo TJ Jr. Prosthetic treatments for patients with ectodermal dysplasia. J Prosthet Dent 2001;86:364-8.  Back to cited text no. 1
    
2.
Jorgenson RJ Clinician’s view of hypodontia. J Am Dent Assoc 1980;101:283-6.  Back to cited text no. 2
    
3.
Rajendran R Diseases of skin. In: Rajendran R, Sivapathasundaram B. editors. Shafer’s Textbook of Oral Pathology. 5th ed. Elsevier; 2006. p. 1099-162.  Back to cited text no. 3
    
4.
Graber LW Congenital absence of teeth: A review with emphasis on inheritance patterns. J Am Dent Assoc 1978;96:266-75.  Back to cited text no. 4
    
5.
Agarwal SK, Madan R, Praveen G, Tandon R Prosthodontic rehabilitation of a patient with true partial anodontia––a case report. J Indian Prosthodont Soc 2010;10:75-7.  Back to cited text no. 5
    
6.
Madalli P, Amasi U, Bhushan K, Mankani N, Nagaraj E Overdenture with access post system of an ectodermal dysplasia: A case report. IOSR J Dent Med Sci 2015;14: 65-7.  Back to cited text no. 6
    
7.
Khajuria RR, Singh R, Priyanka . Overdenture with ceka preci-clix attachments a case report. Ann Dent Specialty 2014;2: 108-9.  Back to cited text no. 7
    
8.
Ceka Attachment Preci-Line Technique Manual. Waregem, Germany; 2007.  Back to cited text no. 8
    


    Figures

  [Figure 1], [Figure 2]



 

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