Hi Yango,

I would wait until permanent teeth in the maxilla will develop a bit (it means..few years). There are still no upper second premolars. If they finally appear, there might be orthodontic indications for transplantation. In my opinion in this case, only half of the root length - just to be able to accommodate it within the atrophic alveolus in a semi-erupted position. It is the only chance to grow the bone, as far as I am aware:)

Let me know pls the follow-up the boy, whatever you decide. Very challenging case:) I wonder what was the reason of the teeth aplasia.

Best wishes,

Paweł

I agree with explanation given by Paweł Plakwicz

Hi, all,

thanks even if  there seems to be no short treatment option.

At the moment there seems to be a primary canine in the 4th qu, at least, and possibly a successor. Maybe I will recommend an orthodontic distalisation for that primary canine. Any problems with that???

Dear Yango Pohl

Thanks for sharing this interesting case. From the x-ray it is obvious that the hypodontia includes in  the 4th quadrant: primary canine, first primary molar, 2nd primary molar and their permanent successors beside the permanent molars. The lower incisors both primary and permanent  got hypodontia also. I can see like gemination in most probably right central incisor ..I guess also there is shift in the midline due to the unilateral absence of C/D. I don't think there is need for intervention for the meantime.

It is worthy to try to find the diagnosis also. 

Dear Hayfaa, (hope that is your first name, if not, please correct)

unfortunately, it is not my own patient, and thus I have to wait for more information also myself.

I do not agree with doing nothing.

I have the impression that there is an unilateral facial/muscular hypertrophy. As far as such a finding can be taken from the non-symmetric photograph.

At least there is a big chance that this hypertrophy will develop more pronounced, at least resulting in some mobbing from other children.

Additionally, as far as I know, there is a certain risk for the TMJ, and the alveolar process (width, height). And there is the risk of losing all the primary teeth, if they are kept in their original position...

Next week, I will try to discuss this case with a physiotherapist who is specialized in TMJ and CMD treatments. Will be back then.

Greets

Yango

Greetings

Yes this is my first name Mr. Pohl.

I meant doing nothing in the meantime regarding your suggestion of orthodontic treatment since there is no any permanent tooth has erupted yet.

Could you please check it again, I think it is an incisor not a canine as I have mentioned above.

Yes there are lots of problems will develop: atrophy, TMJ problems as you have mentioned, beside over eruption of opposing teeth & I think the big challenge is the midline shift.

As a suggestion; could you try doing  partial denture (bilateral) since the child is still 4 years & monitor the eruption of the left  6 then it can be changed & modified  to allow it's eruption, Hope the child will be cooperative. Yes please give us a feedback. thanks

Hi, Hayfaa,

(sry for using first name, could imagine that Hayfaa is female, but don't know for sure, thus trying to avoid Mr. or Mrs. + I prefer first name)

thanks again for your valuable comments.

Yes, maybe there is no permanent canine, the germ looks inddeed like an incisor. Since I don't want to judge from a radiograph, especially in the aplasia cases where there sometimes also the teeth show irregular appearance, I avoided to name the tooth. Nevertheless, I had a closer look onto the radiograph, and I think the primary canine 83 is also not what I thought (and or sure) but looks like an atypical primary incisor with some developmental coronal irregularities.

But - what would be the consequence for the treatment? Maybe, it is decisive in the long run, but I think these cases are much to rare to have any information whether there are better or worse results with a permanent canine. It is in my opninion most important to have as many natural teeth as possible.

That said, I think, I will propose the transplantation of the primary incisors to the 4th quadrant... Again, thank you for forcing me to rethink...

Dr.Yango Pohl  

Your question

Boy, 4y old, total aplasia in 4th quadrant. What to do? I would suggest a partial or total full upper denture  I would refer you to this article

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4549998/ the title of the article is

Contemp Clin Dent. 2015 Jul-Sep;6(3):414-7. doi: 10.4103/0976-237X.161907.

Dental management of hypohidrotic ectodermal dysplasia: A report of two cases.

Mittal M1, Srivastava D2, Kumar A1, Sharma P3.

As you can see from their publication  a partial denture can be constructed for your patient

Hope that helps in answering your question

Best wishes

Dr.K.A.Galil.Professor of Dentistry

DDS.,D.Oral & Maxillofacial Surgery,PH.D,FAGD.,FADI.,Cert.Periodontist (Royal College of dental surgeons )

,Developer of The patented first App in Oral Histology for i Pad,i Phone ,i Pod Touch

visit the web site

https://itunes.apple.com/us/app/dgohe+/id1015383607?mt=8

and down load a free demo ,look at the bottom of the page

see Dr.Galil listed as #17 on the  51 first researchers in the history of Western university and the only dentist to be included

http://www.uwo.ca/research/51_firsts/

https://www.uwo.ca/research/about/publications.html

Unfortunately Dr. Yango Pohl died in 2018.

Bad news.