Fig. 10.24 (a) A 14-year-old boy with severe amelogenesis imperfecta. Stainless-
steel crowns were placed on the first permanent molars at 9 years of age (lower arch).
(b) At 20 years of age a full mouth rehabilitation was completed (upper arch).
10.6 HYPODONTIA
Individuals with missing teeth may present at any age requesting replacement of their
missing teeth for both aesthetic and functional reasons. A detailed discussion on the
management of hypodontia is beyond the remit of this text, however, there are a few
principles that can be considered. During infancy and early school years there is rarely
a need for any active intervention. An exception may be infants with Ectodermal
Dysplasia who can have multiple teeth missing. In such cases the provision of
removable partial or even complete dentures can be highly successful. However, as
children move through the mixed and permanent dentition phases, aesthetics become
increasingly important. Replacing one or two teeth may be relatively straightforward
using either removable partial dentures or adhesively retained bridges (592HFig. 10.25 (a)-
(e)). However, those individuals with multiple missing teeth often have associated
skeletal and dentoalveolar discrepancies which demand a multidisciplinary approach
(593HFig. 10.26 (a)-(c)). The core to such a clinical team includes a paediatric dentist,
orthodontist, and prosthodontist. In addition a periodontist and a maxillofacial
surgeon may be required for implants, bone grafting, and/or orthognathic surgery in
later years. Finally, access to a geneticist with expertise in orofacial anomalies can be
beneficial as adolescents begin to contemplate the implications of their dental
anomaly on family planning.
Children with multiple missing teeth and their families should be referred early to a
multidisciplinary team for discussion and preliminary planning. Consideration needs
to be given to the number and position of the missing dental units, the age of the
child, their level of and attitude towards oral health, and importantly the wishes and
expectations of the individual and their family. The aim of orthodontic treatment is to
consolidate the spacing and place the existing teeth in the optimum position to support
the definitive restorations. However consideration also needs to be given to any
underlying skeletal discrepancy or dentoalveolar deficiency that may require a more
surgical approach. Interim restorative solutions, such as removable dentures,
composite veneer, or partial veneer restorations, can be placed during the mixed
dentition phase but will require maintenance throughout adolescence. Proactive
preventive strategies need to be supported in order to achieve optimum dental and
periodontal health. This is essential for the long-term success of definitive