Congenitally Missing Anterior teeth in a 7 year old child ...

CASE REPORT

Congenitally Missing Anterior teeth in a 7 year old child:
Review and Case Report

Aayushi Bansal1, Kirti Asopa1, Anant Gopal Nigam2, Nikhil Marwah3

Abstract
Oligodontia is agenesis of numerous teeth (> 6), excluding the third molars. Its prevalence

in permanent teeth has been estimated to be 0.14%. It is one of the most common anomaly
affecting the permanent dentition but equally infrequent in the primary dentition. Presented here is
a case report of 7 year old child with congenitally missing 10 primary anteriors in both maxillary
and mandibular dental arches with subsequently missing 4 permanent anterior teeth in the
mandibular arch.

(Bansal A, Asopa K, Nigam AG and Marwah N. Congenitally Missing Anterior teeth in a 7 year old child :
Review and Case Report. www.journalofdentofacialsciences.com, 2014; 3(2): 1-4.

Key words: Oligodontia, Congenitally missing anteriors, missing canine

Introduction evolutionary trend is still believed to be
continuing.2
An edentulous smile might look appealing in
an infant but its persistence is a serious cause of Dental anomalies occur due to genetic or
concern for the parents and the child. According environmental factors which may result from
to Shapiro, congenital absence of teeth is most various formative defects. A tooth is said to be
common dental anomaly in human with more congenitally missing when there is no evidence of
prevalence in permanent dentition.1 The reduction its presence clinically and radiographically plus
in number of teeth has been directly related with no history of previous extraction exists.3
the reduction in the size of human jaw, this
Hypodontia is used to denote a condition with
1Postgraduate Student, 2Professor & Head, 3Professor agenesis of one or few teeth. Hypodontia has
Department of Pediatrics and Preventive Dentistry significant psychological, aesthetic and functional
Mahatma Gandhi Dental College and Hospital, Jaipur. consequences as it may result in dental mal
positioning, periodontal damage, stunted
Address for Correspondence: development of maxilla and mandible bone
Dr Ayushi Bansal height.
e-mail: [email protected]

2 Bansal et al.

According to Stewart, Oligodontia means Figure 1:
agenesis of numerous teeth (more than 6); Front profile of
excluding the third molars.4 Prevalence of
oligodontia in permanent teeth has been the child
estimated to be 0.14%.5 Difference in male and
female distribution is not significant, nor is the The child had mesomorphoric facial structure.
difference between right and left maxillary and Examination for any craniofacial abnormalities
mandibular arch. However, combining data from (Figure 1 and Figure 2) was negative since his hair,
various studies show higher frequency of skin, nails, eyebrows and eyelashes were all
oligodontia in females.6 The causes of oligodontia found to be normal. Bone deformities were
are hereditary, trauma, infection, radiation, absent.
metabolic disorders and idiopathic. It can occur
alone or in combination with syndrome like Figure 2: Lateral profile of the child
ectodermal dysplasia. Henceforth, resulting
clinical features are reduced lower facial height, Intra-oral examination (Figure 3) revealed
impaired growth of alveolar process, pseudo- presence of normal complement of teeth for his
prognathism, speech impairment and deep bite age except for primary mandibular incisors and
all of which have a physiological and canines along with primary maxillary incisors.
psychosocial impact over an individual. Oral hygiene was good with absence of stains,
debris or dental caries.
A classical study was conducted by Grahen in
1956 on parents and siblings of 171 hypodontia Figure 3: Intraoral in occlusion view of the child’s
patients, which concluded that, in majority of the dentition
cases, oligodontia is mainly determined by an
autosomal dominant gene pattern with variable Thin alveolar ridge and high lingual frenum
expressivity and an incomplete penetrance of the was also evident. Bulge was observed in the
trait.7 maxillary anterior region which was suspected to
be due to erupting permanent incisors. The finding
Case Report was later on affirmed by radiograph (Figure 4).
The teeth present were normal in morphology.
A 7½ years old male Indian patient was
brought by his grandfather to our department with
a complaint of missing lower and upper front teeth
since birth. The child was healthy, well nourished
with appropriate physical and mental growth for
his age. Patient did not have any adverse oral
hygiene habits; had sound sleep, incompetent lips
and a habit of mouth breathing. The peri-natal
history was unremarkable. The history of trauma
to the concerned region was absent. No other
person in the family reported with the same
condition.

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Bansal et al. 3

Figure 4: Orthopantamograph showing the missing Figure 5: Photograph showing the removable partial
primary teeth and Developing tooth buds of permanent denture after placement

teeth in both maxillary and mandibular arch Discussion

Panoramic radiograph (Figure 4) confirmed The prevalence of hypodontia is strongly
the absence of primary upper incisors and lower affected by race and ethnicity. It has been
incisors as well as canines. The permanent estimated to be between 2% and 10% in
mandibular central incisors were also missing. The permanent dentition and less than 1% in the
tooth buds of permanent maxillary central incisor primary dentition.4,5 There’s no significant male to
were present. female ratio difference with more predilection for
maxilla. The most common primary missing teeth
Considering the history, clinical and are maxillary lateral incisors and mandibular
radiographic findings diagnosis of Oligodontia central and lateral incisors, while the least
was concluded. Informed written consent was common missing teeth are canines.
obtained from his grandfather after which, with
the thought of promoting esthetics and Several mechanisms have been proposed to
psychological well being of the child a removable explain congenitally missing teeth. Butler’s Field
partial denture was planned. Teeth selection was theory states that the distal teeth within each
done under natural light. Impression of both morphological class are developmentally less
mandible and maxillary arches were made using stable.8 Therefore, canine stands alone in its own
alginate impression material. Then, the impression field displaying great stability and hence, is rarely
was poured with dental stone. The casts were congenitally missing. Sofaer et al. suggested that
mounted on articulator and jaw relation was greater variability seen in teeth that form later in
established. A wax pattern was made with c each morphological class may be a result of the
clasps on both the first primary molars followed interaction of tooth germs during development.9
by anterior teeth arrangement of the mandibular
arch, using central and lateral incisors. After the Inheritence pattern was first described by
satisfactory try in of the removable partial Gregor Mendel, 1805 and extensively studied in
denture, acrylisation was done using compression early part of the 20th century was extremely useful
moulding technique. On the subsequent in studying traits caused due to a single gene, it
appointment denture was delivered to the patient does not give an accurate description of traits
(Figure 5) after checking for proper occlusion and caused by multiple genes.
fit. Post operative instructions were given. After 1
month recall, patient was satisfied with the In cleft patients MSX1 is associated with
esthetics and functioning of the removable partial agenesis of first, second and third molars. Mice
denture. lacking MSX1 had cleft palate, deficient
mandibular or maxillary alveolar bones and
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4 Bansal et al.

failure of tooth development. Agenesis of only 1 or nature (example: Reiger’s syndrome, Marshall’s
2 teeth cannot be explained by MSX1 mutation.
syndrome, Lacrimo-auriculo-dento-digital
The importance of eruption of primary and
then permanent anterior teeth coupled with syndrome, Down’s syndrome and Ectodermal
concomitant growth of the alveolar ridge height
lies in receding the frenum at the mucogingival dysplasia). Thirdly, due to congenital absence of
junction.10
canines and lastly, radiographic evidence of this
Treatment of hypodontia is especially
important when several teeth are missing as it can case showed presence of maxillary permanent
affect the facial development as well as lead to
malocclusion. The treatment depends on the age central incisors tooth bud. Ranta and Maroto have
of patient. Conservative rigid or fixed prosthesis suggested a hereditary cause for oligodontia.11,12
may be used if growth is completed.
Comprehensive orthodontic tooth movement and Tooth agenesis is the most prevalent craniofacial
selective extraction of teeth can be done. The
patient will be monitored every six months to malformation in humans and 2nd pre molar most
determine the need to refit or remake his denture. common missing tooth.7 There’s a need for a
This will act as a transit period and further
development of dentofacial structures will be thorough diagnosis and efficient management to
evaluated.
last a life time.
Tooth agenesis is a matter of concern for
parents. Pedodontist might be the first one References
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7. Grahen HJ. Hypodontia in permanent dentition.
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8. Butler PM. Studies of the mammalian dentition.
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9. Sofaer JA, Chung CS, Niswander JD, Runck DW.
Developmental interaction, size and agenesis
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11. Ranta R. Hereditary agenesis of ten maxillary permanentes y de sus correspondented piezas
posterior teeth: a family history. J Dent Child 52: eciduas.Rev Act Estomatologica espanola
125–127, 1985. 1987;47: 39–42.

12. Maroto MR, Azcorra GV, Arellanos RO, Martin
MTB. Un caso de agenesia de incisivios

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