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Authors: Dr. Arjun Jawahar Sharma, Dr. Manesh Lahori


Oral diseases are the most common of the chronic diseases and are important public health problems because of their prevalence, their impact on individuals and society in many parts of the world. The rapidly changing disease patterns throughout the world are closely linked to changing lifestyles, which include diets rich in sugars, widespread use of tobacco, and increased consumption of alcohol.

Oral diseases qualify as major public health problems owing to their high prevalence and incidence in all regions of the world, and as for all diseases, the greatest burden of oral diseases is on disadvantaged and socially marginalized populations. The severe impact in terms of pain and suffering, impairment of function and effect on quality of life must also be considered.1,2 The common clinical anomalies seen in the dental practice are micrognathia, macrognathia, microdontia, macrodontia,anodontia, hypodontia or oligodontia and environmental enamel hypoplasia’s (nutritional deficiency, birth injuries, local infections/trauma or florides) which are due to developmental disturbances in size, shape, number, and structure of the teeth or due to eruption of teeth.
Due to regressive alterations of the teeth some more common pathologies can be observed like attrition, abrasion, erosion, and abfraction.3 In this case series we will be portraying the common clinical oral anomalies and there prosthodonticrehabilitaion which were examined and treated in K.D Dental college and Hospital,Mathura.
Before treatment
After treatment

Case Report 1

A 45 year old female patient reported to Department of Prosthodontics, K.D dental college and hospital,Mathura. The chief complaint of missing teeth in upper right and left regions with less number of teeth since birth, difficulty in chewing and having gap in between front upper two teeth since childhood.

The patient was thoroughly examinedintraorallyand it was found that teeth present were 11,12,15,16 in first quadrant 21,22,25 in second quadrant 32,33,34,35,36 in third quadrant and 42,43,44,45,46 anda deciduous central incisor in fourth quadrant. (FDI Notation) 13,14,17,23,24,27,31,41 were congenitally missing which refers to true partial anodontia. The patient hadmicrognathia, microdontia, true partial anodontia and collapsed bite with a diastema in upper central incisors. An orthopantogram was done to rule out any impacted teeth and to see the condition of the teeth and the bone.

Patient were told about all treatment options available as removable partial dentures, fixed tooth supported partial dentures and implant supported teeth. Fixed tooth supported partial denture was opted as a definitive treatment plan. Bite was raised by giving acrylic full maxillary arch temporary prosthesis till the desired bite was raised for 6 weeks. The permanent prosthesis were given i.r.t 11,12,13,14,15,16 & 21,22,23,24,25,26 and in 31,41,42. (FDI notation system)
Fig-3.Before Treatment
Before Treatment
Fig-4.Tooth Preparation for Ceramic Laminate Veneers i.r.t 11,12,13,21,22,23.
Tooth Preparation for Ceramic Laminate Veneers i.r.t 11,12,13,21,22,23.
Fig-5.Ceramic laminate Veneers i.r.t 11,12,13,21,22,23.
Ceramic laminate Veneers i.r.t 11,12,13,21,22,23.

Case Report 2

A 22 years old female patient reported to Department of Prosthodontics, K.D dental college and hospital, Mathura.Patients chief complaint was of discolored upper and lower teeth since few years. The patient gave history of having some unknown medicines after which the teeth had brownish stains few years back. Intraoral examination revealed patient had mottled enamel and brownish stainswhich could be environmental or congenital.The provisional diagnosis formulated was environmental enamel hypoplasia due to high fluoride levels and idiopathic factors.

Patient was explained about the treatment options of having composite or ceramic laminate veneers with their advantages and disadvantages. Ceramic laminate veneers was decided as definitive treatment plan.
Fig-6.Intraoral view : Before Treatment
Intraoral view : Before Treatment
Fig-7.Intraoral View : After Treatment
Ceramic laminate Veneers i.r.t 11,12,13,21,22,23.
Fig-8.Before and After
Ceramic laminate Veneers i.r.t 11,12,13,21,22,23.

Case Report 3

A 20 year old female patient reported to the department of Prosthodontics in K.D dental college and Hospital,Mathura.The patient reported chief complaint of multiple missing permanent teeth in upper and lower arch since birth. Her past medical history was non-contributory and family history revealed that she was born to non-consanguineous marriage with normal delivery and no one in her family have congenitally missing teeth. The patient had no history of trauma or extractions. Extra oral examination revealed a face with normal facial profile but assymetrical smile. During clinical examination,

Maxillary arch had
lateral incisors 12 (FDI system) presented with conical shape,
both maxillary canines (13 and 23) were rotated,
first maxillary molar (16) were present.
And the mandibular arch
Lack of development of maxillary and mandibular alveolar bone height and reduced lower facial height and variation in tooth morphology was also observed. only had a distally tilted canine (43) and a first molar (46).
  • A provisional diagnosis of non syndromicoligodontia was given with differential diagnosis of Ectodermal Dysplasia; Rieger syndrome and Van der Woude syndrome.
  • Complete set of investigations were done which included routine examination of blood including serum calcium, alkaline phosphate, TSH, T3, T4. The findings of these investigations were normal.
  • During physical examination, hair were not thin and sparse, nails were not brittle and no difficulty in perspiration was seen which ruled out ectodemaldysplsia;
  • On occular examination, no signs of glaucoma was seen ruling out Rieger syndrome and lastly Van Der Woude syndrome was left out as there was no cleft palate or any mucosal cysts in lower lip.
  • On the basis of above findings non syndromicOligodontia was diagnosed as the final diagnosis.

Tooth preparation were done in maxillary archi.r.t 12,13,16 and 23.Temporary Prosthesis were given from right first molar 16 to left first premolar 24(cantilever).Implants with 3.0 mm D and 11.5 mm L at canine regions (B & D region) were placed for mandibular implant supported overdenture. And after three months of osteointegration mandibular overdentures were attached to the implants and fixed partial prosthesis were given from right first molar 16 to left first premolar 24.

Oligodontia is the term used most commonly in describing the phenomenon of congenitally missing teeth. Oligodontia has been classified as isolated or non-syndromic and syndromichypodontia. Although oligodontia can occur over with 60 different syndromes, these anomalies can occur without any syndrome or systemic disease. However, oligodontia is seen more common in non-syndromic or familial form than syndromic form. The biologic basis for the congenital absence of permanent teeth is partially explained by the failure of the lingual or distal proliferation of the tooth bud cells from the dental lamina. The causes of hypodontia are attributed to environmental factors such as irradiation, tumours, trauma, hormonal influences, rubella, and thalidomide or to hereditary genetic dominant factors, or to both.

MSX1 and PAX9 genes play a key role in early tooth development. PAX9 is a paired domain transcription factor that plays a critical role in odontogenesis. All mutations of PAX9 identified to date have been associated with nonsyndromic form of tooth agenesis.4 Oligodontia condition should not be neglected as it may result in various disturbances like abnormal occlusion, altered facial appearance which may cause psychological distress, difficulty in mastication and speech. Treatment depends on extent of hypodontia and should consist of interdisciplinary approach. Therefore early diagnosis is important in such conditions. Case of tooth agenesis should be recorded with complete clinical history including medical and radiological investigations to rule out any syndrome .

The patient’s speech and masticatory function improved greatly. She was also pleased with better facial esthetics. Observed temporomandibular joint dysfunction also ameliorated after the treatment.Dental clinicians should keep in mind that there are good possibilities with conventional prosthodontic techniques to help patients with dental anomalies. Treatment not only improved speech and masticatory function but also has psychological implications that greatly helped in regaining self-confidence.4

Case Report 4

A 23 year old male patient reported to the department of Prosthodontics in K.D dental college and Hospital,Mathura.The patient reported chief complaint of discoloration of the front teeth since 2 years. On examination the patient gave history of trauma in the front region. On readiographic examination patient had Ellis class IV fractures in the 11,12,21,22, 23 and discoloration in maxillary central incisorsi.e 11,21 seen intraorally (FDI notation). Root canal treatment were done in 11,12,21,22,23. Tooth preparation were done for all the anterior teeth from right lateral incisor to left canine. Individual porcelain fused to metal crowmswere given to the patients with excellent esthetics.
Fig-9.Intraloral View, Tooth Preperations 11,21,21,22,23 and Rubber base Impression
Intraloral View, Tooth Preperations 11,21,21,22,23 and Rubber base Impression
Fig-10.Temporary Prosthesis and Permanent Prosthesis
Temporary Prosthesis and Permanent Prosthesis
Fig-11.Before Treatment and After Treatment
Before Treatment and After Treatment


A 21 year old female patient reported to the department of Prosthodontics in K.D dental college and Hospital, Mathura. The patient reported chief complaint of discoloration and broken front teeth since birth.The patient gave history of fracture teeth due to trauma and had a very low socioeconomin status. On examination, the patient had Ellis class II fracture in 11,21 mottled enamel with brownish grey stains on all the upper and lower teeth which were since childhood. The patient only wanted the upper front teeth to be treated so the composite laminate veneers were planned as definitive treatment looking at the patient preferences of getting treatment only on upper teeth and socioeconomical status.
Fig-12.Before Treatment
Before Treatment
Fig-13.After Treatment
After Treatment

Conclusion :

By the early detection of the dental problem, alternative treatment modalities can be planned and performed with a multidisciplinary team approach, in order to establish an aesthetic and functional dentition in the future and to minimize the complications.Congenital absence of teeth is a hereditary phenomenon passed through generations by an autosomal dominant pattern. Such a patient often presents with poor esthetics, mastication and disturbed social behavior.

The prevalence of enamel defects in children born prematurely was clearly higher than in those born normally, in primary (78% versus 20%) and permanent (83% versus 36%) dentitions. In a study conducted in the United States, the occurrence of enamel hypoplasia was found to affect 5% to 17.9% of the population, but in Saudi Arabia, it was noticed in only 2.8% of 5581 patients. Therefore, as seen above, this pathology has a heterogeneous distribution all over the world.With the evolution of restorative materials and techniques, several types of treatment have been reported, each one related to the degree of enamel structure damage.

Tooth bleaching and microabrasion represent a first and minimally noninvasive step in achieving acceptable results in the removal of enamel stains and minor surface defects. When there is loss of tooth structure associated with the defects, the use of composite resins produces excellent esthetic results and stable clinical longevity.In severe cases, porcelain veneers represent an excellent and viable restorative option, which result in great esthetic success and considerable longevity. Besides these, the anomalies like attrition, erosion, abrasion and abfraction can be treated by formulating the prosthodontic and restorative definitive treatment plans.2,3

References :
  1. Z Kırzıog˘ lu, T Ko¨ seler S¸ entut, MS O ¨ zayErtu¨ rk, H Karayılmaz ; Clinical features of hypodontia and associated dental anomalies: a retrospective study. Oral Diseases (2005) 11, 399–404. doi:10.1111/j.1601-0825.2005.01138.
  2. BuketAkalinEvren, DDS,aSelcukBasa, DDS, PhD,bYasarOzkan, DDS, PhD,cHakkiTanyeri, DDS, PhD,d and Yasemin Kulak Ozkan, DDS, PhD.Prosthodontic rehabilitation after traumatic tooth and bone loss:A clinical report. J Prosthet Dent2006;95:22-5.
  3. Carlos Jose Soares, et al ;Esthetic Rehabilitation of Anterior Teeth Affectedby Enamel Hypoplasia: A Case Report. J EsthetRestor Dent 14:340-348,2002.
  4. Hosur MB, Puranik RS, Vanaki SS. Oligodontia: A Case Report and Review of Literature. World Journal of Dentistry. 2011;2:259–262.

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