Help! Treatment planning hypodontia case
A child that I diagnosed with Hypodontia 12 years ago and referred to a pedodontist returned last week.
He is a senior in high school now, and would like to be able to smile confidently.
Aside from being too young for implants, the lack of permanent teeth never allowed the ridge to widen so extensive grafting would be necessary for any implants to be placed.
I am thinking of opening his bite with some overlays on the primary molars. Then single wing MD bridges on 8 and 9 to replace 7 and 10. I don't want to do anything irreversible to the incisors until implants are an option. On the Mandibular incisors, I was thinking of trying some Veneer / crowns . The just some composite bonding to correct some of the other areas.
Any thoughts are appreciated
Thanks
Wow Paul... that is a lot to sort through. FGTP wants all the photos and radiographs to look at this, what's possible now, where it might need to go in the future, and how to possibly stage this over the long haul... opportunities to deal with bite issue's with milled overlays, and bonded retainers is a good thought ballon to start out, but he devil's in the details. Would like to do this at least as an exercise, but you def have your hands full. Do you have more facial photos?
Mark
He is coming in again this week for more discussion. I will take some facial pictures then .
One other thought from my study club was some type of removable transitional partial. But what kid wants to go to college with a flipper?
How about a snap on smile for a short term fix? I havent used them but this seems like the type of case it might work.
Not that it makes a great deal of difference, but I'm guessing the patient has been identified as having Ectodermal Dysplasia.
I have a couple of similar patients who fortunately for me I didn't need to deal with this difficult phase, as they came to me as adults.
If you're posting again would you mind showing some cross sections to show how deficient the bone is in its bucco-palatal dimension? I'd just be interested to see for comparison.
Really tough to get him through the next few years.
One thing I would try is to identify is which primary teeth you would want to extract in order to place implant (bridges) eventually and maybe be a little judicious in not overloading those as single teeth and causing premature loss.
Even keeping the upper laterals underneath whatever goes over them might be beneficial.
Do you think he would tolerate wearing an overdenture type appliance for the upper anterior 6/8 teeth?
Just bonding all the lower primaries into a resin bridge, preferably milled such as telio.
Damian, here are some cross sections
I have never used a snap on smile, but I assume it has to "snap" over something, These teeth have no undercuts
?? Create undercut with some bonding maybe.
Looks like he has the foundations for a good longerterm result.
Might just be the section, but the cortical bone in the area above the primary lateral looks odd. Only looking on a phone though.
One poor lady I treated had to wait until she was nearly 50 before we intervened. Nibody knew quite what to do for her. They're tough cases for sure.
Tough case.
Short to medium-term: Bonded or cemented long-term temps sites #3-14 and sites #20-29 to open the bite for proper occlusion and esthetics. Don't worry about prepping any teeth if you have to as the majority will have to be extracted later on anyway probably.
Long-term: Most likely scenario will be an All-on-6 zirconia hybrid in the Maxilla and an All-on-4 zirconia hybrid sites #20-29 keeping #19 and #30 if possible.
Farhad
Finished this case, all teeth are Cerasmart except for 8 and 9 which are Vita Mark II
The posterior teeth are Crownlays. The maxillary cuspids and laterals are splinted, and the lower centrals are splinted
The anterior esthetics are not ideal mainly due to the tooth position of the worn primary teeth, However the patient and his parents are thrilled with the results.
Hopefully this will get him through college and beyond, and then he can get implants and long term restorations
Wow Paul.
You absolutely changed this young mans life. Given the initial photos and circumstances, I never would have imagined the result you achieved.
Life changing Paul.... just life changing. A lot of dentists would not have tacked this.... NICE! 
Mark
Wax up and Biocopy and 4.2.5 makes it possible.
He is a great patient, which made it that much more fun
