Effective multidisciplinary approach for treatment of traumatized maxillary incisors and hypodontia

From Volume 13, Issue 1, January 2020 | Pages 6-9


Jonathan J O'Dwyer


Articles by Jonathan J O'Dwyer

Jonathan Sandler

BDS (Hons), MSc, PhD, MOrth RCS, FDS RCPS, BDS(Hons), MSc, PhD, FDSRCPS, MOrth RCS, Consultant Orthodontist, , DOrth RCS

Consultant Orthodontist, Chesterfield Royal Hospital, Chesterfield, UK

Articles by Jonathan Sandler

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Fractured and missing teeth within the aesthetic zone have always posed a clinical challenge for the dental team. Management and treatment requires the input from a number of dental specialists to guarantee a high quality result. A case report is presented to demonstrate an effective combined orthodontic/restorative approach that fully restored aesthetics and function. The report is of a 14-year-old girl who traumatized her maxillary central incisors, in a dentition that was already compromised as she had congenital absence of her maxillary left lateral incisor.

Using fixed orthodontic appliances, the fractured teeth were extruded to bring the fracture line above the level of the alveolar bone. This movement allowed an immediate aesthetic improvement, using stainless steel prefabricated posts and composite resin buildups, which also facilitated further orthodontic tooth movement. Teeth, that would otherwise have been extracted, were salvaged and, utilizing a multidisciplinary team approach, a reasonable long-term prognosis has resulted.

CPD/Clinical Relevance: This case report aims to demonstrate how a multidisciplinary team approach in Orthodontics can be utilized for management of severely handicapped dentitions that have sustained dental injury. It is not the aim of this case report to discuss the treatment of dental injuries but to demonstrate and provide an overview of the possible treatment modalities that can be effective in restoring function and aesthetics, with special consideration given to missing teeth and subgingival crown fractures within the aesthetic zone.


Trauma to the oral region occurs frequently and comprises 5% of all injuries for which people seek treatment.1 The incidence of traumatic dental injury is common, with between 6%–34% of children aged 8-15 years experiencing damage to their permanent teeth.2,3,4 Hypodontia is often defined as the developmental absence of one or more primary or secondary teeth, excluding third permanent molars,5 and is a relatively common condition affecting around 4% of the British population.6 Due to the fact that an increased proportion of children who have sustained dental trauma seek orthodontic treatment, orthodontists need to be aware of the long-term prognosis of traumatized teeth and the implications on orthodontic treatment planning.

A 14-year-old girl was referred to the orthodontic department presenting with a history of trauma to both maxillary permanent central incisors. She had recently been accidentally hit in the face with a golf club. Her main complaint was the grossly unaesthetic appearance of her upper front teeth (Figure 1). The patient had a symmetrical face with an average lip line, a Class II profile and an average Frankfort-mandibular planes angle. Intra-oral examination revealed the presence of fractured maxillary central incisors and the remaining roots had been incompletely root filled (Figures 1, 3a). The situation was further complicated by congenital absence of her maxillary left permanent lateral incisor, presence of a peg-shaped maxillary right lateral incisor crown and retained maxillary second deciduous molars. She also had a buccal crossbite on the right-hand side (Figure 1).

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