Case Report

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.

Intraoral examination revealed the presence of maxillary left and right primary lateral incisors, canines, and mandibular primary central incisors. The teeth were not mobile. There was evidence of caries on the distal aspects of the primary lateral incisors as well as on the mesial and distal aspects of primary canine teeth which were asymptomatic (Figure 1). The third molars were not erupted.

Figure 1. Intraoral examination showing bilaterally missing permanent maxillary lateral incisors, canines, and mandibular central incisors.

A panoramic radiograph confirmed the bilateral absence of all permanent teeth which were not present clinically (Figure 2). There was evidence of minimal root resorption of the primary canines, and the maxillary and mandibular second molars were taurodont. The other permanent teeth were normal. A radiopaque appearance was detected in the periradicular region of maxillary left premolar.

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

This region was examined on periapical radiograph, and it was diagnosed as osteosclerosis or enostosis (Figure 3).

Figure 3. Periapical radiograph showing sclerotic changes of periradicular region of maxillary left premolar.

Radiographically all third molars were unerupted and there was evidence of caries on distal aspect of mandibular left first molar.

Treatment

During treatment planning the patient’s age was considered along with oral hygiene status, socioeconomic background, and his treatment expectations. The patient and his parents were informed about the existing condition and the objectives of treatment. Dental treatment consisted of preventive and restorative phases. The preventive phase was done first which included a professional cleaning to remove dental stain and oral hygiene instructions. Restorative treatment using direct composite resin restorations was the most appropriate approach for this patient since the maxillary and mandibular anterior teeth would continue to undergo passive eruption for more than 20 years. The primary teeth were restored with Miris hybrid composite resin (Coltène Whaledent, Altstätten, Switzerland) to resemble the permanent teeth (Figure 4). One year later, the patient declined a follow-up visit because he stated he no complaints about his teeth at that time.

Figure 4. After the restorative treatment of primary teeth by using direct composite resin.