Treatment of a Patient with Oligodontia:

A Case Report

Abstract
Aim: The aim of this report is to describe the management of a 16-year-old patient with oligodontia including six
permanent teeth.

Background: Oligodontia is agenesis of six teeth or more, excluding third molars. The etiology of congenital
absence of teeth is believed to be involved in heredity or developmental anomalies. It can be isolated or as part
of a syndrome. There are a number of options available to restore space generated by missing teeth. Dental
treatment can vary depending on the severity of the disease and generally requires a multidisciplinary approach.
Treatment options include orthodontic therapy, implants, adhesive techniques, and removable prostheses.

Report: A 16-year-old male patient with oligodontia affecting six permanent teeth received conservative care
that met his and his parent’s expectations. The existing primary teeth were restored to resemble permanent
teeth in order to achieve a favorable esthetic result using direct composite resin. The restorative treatment
was provided for the psychosocial comfort of the young patient. The loss of teeth in young patients can cause
esthetic, functional, and psychological problems particularly if the teeth of the anterior region are involved.

Summary: Adhesive techniques and new restorative materials represent current options in the management of
the dental rehabilitation of young patients with oligodontia.

Keywords: Tooth abnormalities, oligodontia, tooth agenesis, taurodontism

Citation: Akkaya N, Kiremitçi A, Kansu Ö. Treatment of a Patient with Oligodontia: A Case Report. J Contemp
Dent Pract 2008 March; (9)3:121-127.

© Seer Publishing
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The Journal of Contemporary Dental Practice, Volume 9, No. 3, March 1, 2008
Introduction
Oligodontia is defined as the developmental The teeth were not mobile. There was evidence
absence of six teeth or more, excluding third of caries on the distal aspects of the primary
molars.1,2 It can be isolated (Oligodontia-I) or lateral incisors as well as on the mesial and
as a part of a syndrome (Oligodontia-S) such distal aspects of primary canine teeth which were
as in ectodermal dysplasia.3 Oligodontia in the asymptomatic (Figure 1). The third molars were
permanent dentition occurs in 0.3 % of the not erupted.
population.1 Congenital absence of teeth most
commonly occurs with the maxillary lateral A panoramic radiograph confirmed the bilateral
incisors, second premolars, and mandibular absence of all permanent teeth which were not
central incisors. It may be either unilateral or present clinically (Figure 2). There was evidence
bilateral.4 The absence of maxillary central of minimal root resorption of the primary canines,
incisors, maxillary and mandibular canines, or first and the maxillary and mandibular second molars
molars is rare and mostly occurs in patients with were taurodont. The other permanent teeth were
oligodontia.1 Radiography is used for confirmation normal. A radiopaque appearance was detected in
of congenitally missing teeth.4 the periradicular region of maxillary left premolar.

Existing primary teeth in patients with oligodontia This region was examined on periapical
should be restored because of esthetic, phonetic, radiograph, and it was diagnosed as
and nutritional problems.5 Treatment can osteosclerosis or enostosis (Figure 3).
include space closure or space opening before
restorative procedures with orthodontic therapy, Radiographically all third molars were unerupted
removable or fixed partial dentures, implant- and there was evidence of caries on distal aspect
retained prosthesis, or a combination of these of mandibular left first molar.
treatment strategies.1
Treatment
This report describes the management of a During treatment planning the patient’s age
patient with oligodontia including bilateral missing was considered along with oral hygiene status,
maxillary lateral incisors, canines and mandibular socioeconomic background, and his treatment
central incisors together with taurodontism of the expectations. The patient and his parents
maxillary and mandibular second molars as well were informed about the existing condition and
as the patient’s restorative treatment. the objectives of treatment. Dental treatment
consisted of preventive and restorative phases.
Case Report The preventive phase was done first which
included a professional cleaning to remove dental
Diagnosis
A 16-year-old male was referred to the
Department of Oral Diagnosis and Radiology with
a chief complaint of missing permanent teeth and
an unaesthetic appearance. His medical history
was noncontributory. There was no history of
previous extractions. The family history revealed
his father, his sister, and brother were also
afflicted with hypodontia. Extraoral examination
revealed the patient had no abnormalities so
no additional laboratory tests were needed to
investigate any systemic condition that may have
contributed to the problem.
Figure 1. Intraoral examination showing
Intraoral examination revealed the presence of bilaterally missing permanent maxillary
maxillary left and right primary lateral incisors, lateral incisors, canines, and mandibular
canines, and mandibular primary central incisors. central incisors.

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 Figure 2. Panoramic radiograph showing agenesis of six permanent teeth and
taurodontism of second molars.

Figure 4. After the restorative treatment

of primary teeth by using direct composite
resin.
Figure 3. Periapical radiograph
showing sclerotic changes of
periradicular region of maxillary
Discussion
left premolar. In this case the absence of six permanent teeth
together with taurodontism of second molars
was observed. Seow and Lai6 reported 34.8%
stain and oral hygiene instructions. Restorative of patients with hypodontia had at least one
treatment using direct composite resin mandibular permanent molar with taurodontism.
restorations was the most appropriate approach
for this patient since the maxillary and mandibular The etiology of congenital absence of teeth
anterior teeth would continue to undergo passive is believed to be involved in heredity or
eruption for more than 20 years. The primary developmental anomalies.2 Graber7 claimed the
teeth were restored with Miris hybrid composite congenital absence of teeth was largely due to
resin (Coltène Whaledent, Altstätten, Switzerland) hereditary factors. The family history has to be
to resemble the permanent teeth (Figure 4). One considered in such cases as was done in the
year later, the patient declined a follow-up visit present case. It is also important to determine
because he stated he no complaints about his whether oligodontia is related to a syndrome
teeth at that time. or not. Patients with oligodontia as a part of a

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syndrome may have abnormalities in other parts The age of the patient plays a significant role
of the body, such as the skin, ears, eyes, and in selecting direct composite as the restorative
skeleton.2 The patient in the present case had no material. Volchansky et al.10-11 have reported
problems associated to these symptoms. studies suggesting the maxillary and mandibular
anterior teeth continued to undergo passive
Panoramic radiography is a useful diagnostic eruption beyond 20 years of age and the gingival
tool for the diagnosis of congenital missing architecture and papillary height were not stable
teeth. These provide a global view of the jaws in the late teens and early adulthood. With this
not only for diagnosing oligodontia but also for in mind, the teeth were restored with direct
evaluating other anomalies of the teeth such as composite because the patient was 16 years-old.
morphologic alterations, variations of tooth size, Prognosis of the primary teeth determines the
or tooth absence. Avcu et al.8 recommended a long-term prognosis of this treatment. Another
panoramic radiographic examination when a option for this patient might have been extraction
tooth was missing because it might be an ectopic of the primary teeth followed by combining
impaction. In the present case a panoramic orthodontic therapy and rehabilition with
radiograph revealed no unerupted teeth except dental implants. However, the expectations for
for third molars. The radiograph was essential for treatment by the patient and his parents was to
the detection of taurodontism of the maxillary and achieve an esthetic result at a low cost; a long-
mandibular second molars while evaluating the term treatment plan was rejected. Management
image for possible abnormalities of the other teeth. with direct composite was the least-expensive
treatment alternative for cosmetic reconstruction.
Treatment of patients with oligodontia generally In addition, this simple and noninvasive
requires a multidisciplinary approach. Some approach provided psychosocial comfort for the
patients may require prerestorative orthodontics. young patient.
Restoration with a removable partial denture,
conventional fixed partial denture, an implant- An advantage of a more conservative treatment
retained prosthesis and adhesive restorative plan, in this case prosthetic rehabilition, remains
techniques, or a combination of these therapies as an alternative treatment option for the future.
are the treatment options.9 A number of factors
must be taken into account for treatment planning. Summary
The age of the patient is the most important Adhesive techniques and new restorative
factor during treatment planning. Other conditions materials represent current options in the
that must be evaluated include the number and management of the dental rehabilitation of young
condition of retained teeth, the number of missing patients with oligodontia. Restorative treatment
teeth, presence of carious teeth, condition of was provided for the psychosocial comfort of the
supporting tissues, occlusion, and the interocclusal young patient in this case.
rest space.1

Refernces
1. Dhanrajani PJ. Hypodontia: etiology, clinical features, and management. Quintessence Int 2002;
33:294–302.
2. Schalk-van der Weide Y, Beemer FA. Symtomatology of patients with oligodontia. J Oral Rehabil
1994; 21:247–261.
3. Schalk-Van Der Weide Y, Bosman F. Tooth size in relatives of individuals with oligodontia. Arch Oral
Biol 1996; 41:469–472.
4. Goaz PW, White SC. Dental Anomalies. In: Goaz PW, White SC, eds. Oral Radiology Principles and
Interpretation. 3rd ed. St. Louis: Mosby; 1994: 340–368.
5. Eronat N, Ertugrul F. An unusual case of hypodontia with extensive caries: A multidisciplinary
treatment approach. J Clin Pediatr Dent 1991; 15:199–201.
6. Seow WK, Lai PY. Association of taurodontism with hypodontia. Pediatr Dent 1989; 11:214–219.
7. Graber LW. Congenital absence of teeth: a review with emphasis on inheritance patterns. J Am Dent
Assoc 1978; 96:266–275.

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8. Avcu N, Buyukkopru D, Kansu O, Dural S. Severe hypodontia and asymptomatic bilaterally ectopic
impacted teeth in the coronoid processes: A case report. Quintessence Int 2004; 35:582–583.
9. Wagenberg BD, Spitzer DA. Therapy for patient with oligodontia: case report. J Periodontol 2000;
71:510–516.
10. Volchansky A, Cleaton-Jones P. The position of the gingival margin as expressed by clinical crown
height in children aged 6–16 years. J Dent 1976; 4:116–122.
11. Volchansky A, Cleaton-Jones P, Fatti LP. A 3-year longitudinal study of the position of the gingival
margin in man. J Clin Periodontol 1979; 6:231–237.

About the Authors

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