Discussion
In this case the absence of six permanent teeth together with taurodontism of second molars was observed. Seow and Lai6 reported 34.8% of patients with hypodontia had at least one mandibular permanent molar with taurodontism.
The etiology of congenital absence of teeth is believed to be involved in heredity or developmental anomalies.2 Graber7 claimed the congenital absence of teeth was largely due to hereditary factors. The family history has to be considered in such cases as was done in the present case. It is also important to determine whether oligodontia is related to a syndrome or not. Patients with oligodontia as a part of a syndrome may have abnormalities in other parts of the body, such as the skin, ears, eyes, and skeleton.2 The patient in the present case had no problems associated to these symptoms.
Panoramic radiography is a useful diagnostic tool for the diagnosis of congenital missing teeth. These provide a global view of the jaws not only for diagnosing oligodontia but also for evaluating other anomalies of the teeth such as morphologic alterations, variations of tooth size, or tooth absence. Avcu et al.8 recommended a panoramic radiographic examination when a tooth was missing because it might be an ectopic impaction. In the present case a panoramic radiograph revealed no unerupted teeth except for third molars. The radiograph was essential for the detection of taurodontism of the maxillary and mandibular second molars while evaluating the image for possible abnormalities of the other teeth.
Treatment of patients with oligodontia generally requires a multidisciplinary approach. Some patients may require prerestorative orthodontics. Restoration with a removable partial denture, conventional fixed partial denture, an implant-retained prosthesis and adhesive restorative techniques, or a combination of these therapies are the treatment options.9 A number of factors must be taken into account for treatment planning. The age of the patient is the most important factor during treatment planning. Other conditions that must be evaluated include the number and condition of retained teeth, the number of missing teeth, presence of carious teeth, condition of supporting tissues, occlusion, and the interocclusal rest space.1
The age of the patient plays a significant role in selecting direct composite as the restorative material. Volchansky et al.10-11 have reported studies suggesting the maxillary and mandibular anterior teeth continued to undergo passive eruption beyond 20 years of age and the gingival architecture and papillary height were not stable in the late teens and early adulthood. With this in mind, the teeth were restored with direct composite because the patient was 16 years-old. Prognosis of the primary teeth determines the long-term prognosis of this treatment. Another option for this patient might have been extraction of the primary teeth followed by combining orthodontic therapy and rehabilition with dental implants. However, the expectations for treatment by the patient and his parents was to achieve an esthetic result at a low cost; a long-term treatment plan was rejected. Management with direct composite was the least-expensive treatment alternative for cosmetic reconstruction. In addition, this simple and noninvasive approach provided psychosocial comfort for the young patient.
An advantage of a more conservative treatment plan, in this case prosthetic rehabilition, remains as an alternative treatment option for the future.
