Congenitally Missing Teeth:
Occasionally there are conditions that result in malformed or missing teeth. Some of these conditions are: congenital, meaning present from birth, and some are developmental, meaning they occur as a result of environmental factors during tooth development.
Adult teeth begin development as early as 6 months of age, starting with the front teeth, and continue to develop through the latter part of the teenage years, the wisdom teeth. Depending on the situation or condition the missing or malformed teeth may present in different locations of one’s mouth.
Some of the more common conditions are: congenitally missing teeth, congenitally missing laterals, impacted teeth, ectodermal dysplasia, amelogenesis imperfecta, and dentinogenesis imperfecta.
What is "congenitally missing teeth"?
Congenitally Missing Teeth/Tooth is dental terminology that describes the condition in which a person does not develop teeth. Some describe it as being “born without teeth” “I never developed the teeth” or “my kid is missing teeth.” The non-development of teeth can occur as missing single teeth or multiple teeth.
Why causes congenitally missing teeth?
Often the cause of non-development or “missing” teeth is unknown. However, there are some conditions or situations that do result in missing teeth. Some situations or conditions include: viral infection or high fevers as an infant, metabolic disorders, trauma, medications at a very early age, and genetic defects.
How common is it to not develop teeth?
In general it is very rare to not develop permanent/adult teeth. The most common congenitally missing teeth are the adult third molars or wisdom teeth. The second most common genitally missing teeth are the adult mandibular (lower jaw) second premolars and the third most common missing teeth are the adult maxillary (upper jaw) lateral incisors.
What should I do?
Once a diagnosis of congenitally missing teeth has been given one should seek treatment with the properly trained professionals. A great example of a properly trained team of qualified professionals may include a prosthodontist, a pediatric dentist, an implant surgeon, and possibly an orthodontist. All the specialist mentioned above have advanced training to help ensure the proper techniques and materials are used to ensure the most predictable long term result for your tooth replacement.
Missing Wisdom Tooth/Teeth
If you’re missing one or all your wisdom teeth you should be excited! You probably saved yourself a visit with an oral surgeon.
Missing Posterior (“Back”) Tooth/Teeth
There are some important key factors that must be considered when evaluating and deciding on the proper treatment method to replace a congenitally missing posterior tooth or teeth. Factors include: timing, growth and development, location of the missing tooth, condition of the remaining baby tooth or teeth, maintenance of proper tooth spacing, maintenance of jaw bone, and preservation of proper tooth alignment of the adjacent/neighboring teeth.
- Moving the adjacent teeth into the position of the missing tooth or teeth.
- Positioning the residual primary tooth into the proper position and maintaining it as long as possible. It is important to note that in general most residual baby teeth need to be remove or are lost aver 50% of the time.
- Dental Implant and Implant Crown:
- Dental implant therapy is the ideal treatment option in most scenarios. In order to ensure the best possible result is obtainable it is imperative to preserve jaw bone and maintain the proper spacing. Depending on the situation it may require different treatment options.
- Tooth Bridge:
- If a dental implant is not the proper treatment option a tooth retained bridge will be a the option of choice.
Missing Anterior (“Front”) Teeth/Tooth
Missing anterior (front) teeth is the most difficult and technique sensitive tooth replacement situation of any of the congenitally missing teeth scenarios. This is a situation in which it is essential to seek treatment from appropriately trained dental professionals. A treatment team should be a prosthodontist working in conjunction with a periodontist or oral surgeon and an orthodontist. The replacement of any of your front teeth is and will be visible to everyone that sees you. It is critical that the proper precautions and planning are utilized to ensure the an acceptable result is obtainable.
The most common situation is congenitally missing maxillary lateral incisors. This condition can be identified early on in life during your visits with a pediatric or general dentist. Once the situation is identified planning should begin immediately. It is critical to develop the proper treatment plan early on.
Congenitally Missing Lateral Incisors
Treatment options include:
- “Lateralization of the canine.”
- This terminology describes the process of orthodontically moving the canine teeth into the lateral position and adjusting the shape of the canine tooth to appear similar to a lateral incisor. This treatment option is acceptable if identified early on, the teeth shape and form are favorable, and the patient understands the inherent concerns and esthetic limitations of the process. Some of the limitations include: teeth that don’t posses ideal tooth form, gingival (“gums”) appearance that is not posses ideal esthetics, probable need for more extensive orthodontic tooth movement (which may result in a longer period of time in braces and increased risk of root resorption), and the likely need to reshape or restore the canine teeth as well as the adjacent teeth.
- Implants and Implant Crowns.
- When properly planned implant replacement of missing lateral incisors can be the best treatment options available.
- Proper planning includes: ensuring the correct space between the central incisors (two front teeth) and the canines is maintained or provided, maintain or provide the correct angulation of the canine teeth to allow adequate space between the roots of the front teeth and canines, evaluation of the jaw bone quantity, planning to provide adequate bone for implant placement, proper timing of implant treatment with respect to growth and development, evaluation of the gingiva (gums), evaluation of all esthetic components of the ones smile (teeth, gums, lips, shape, shade, etc.).
- Implant treatment should not be used until the patient is at the age at which their jaws are no longer growing. It is most common that females jaws stop growing by the ages of 17 to 19 and males by the ages of 19-21. If an implant is placed in ones jaw bone while their bone is still growing the implant location will not grow with the bone and will appear as though it is sinking into the jaw. This results in a longer unesthetic tooth appearance.
- Cantilevered Tooth or Bridge
- If dental implants are not indicated or affordable to replace the congenitally missing teeth there are two alternative options available. These options include:
- Bonded Pontic: is the most conservative option available. It involves preparing the the tongue side of one of the adjacent teeth and cementing a prosthetic tooth.
- Bridge: is a less conservative option. It involves preparing one of the adjacent teeth and cementing a crown with a prosthetic tooth replacement to replace the missing tooth.
What is the treatment sequence for implant replacement of congenitally missing laterals?
Early Phase: Usually begins with orthodontic maintenance of the missing tooth space. This is best accomplished with your restorative dentist (prosthodontist) coordinating with your orthodontist regarding the requirements of your future implant crown. After orthodontics has been completed and growth of the maxillary jaw bone has stopped it is time for implant planning.
Implant Phase: This should include a diagnostic wax up the proposed tooth replacement. The wax up should be approved by the patient and then replicated in a radio-opaque scan appliance that can be seen on a Conebeam CT radiograph. Using the images obtained from the Conebeam CT the bone quantity can be evaluated with respect to the ideal tooth location and form. In conjunction with a qualified implant surgeon implant placement can be planned and the need for any bone augmentation prior to or at the time of the implant surgery will be determined. In general an implant will require 3 to 5 months of healing prior to restoring with an implant crown. There are exceptions depending on the situation. Some exceptions include immediately restoring the implant with a temporary crown.
Implant Crown Phase: to help ensure the most esthetic result possible it is essential that the implants are restored initially with temporary crowns that possess the correct shape and contour the teeth they are replacing. This allows for proper development of the gingival (gums) tissue. Over a 6 to 8 week period of time the provisional crowns and the gingival esthetics evaluated and adjusted. When the best gingival tissue and tooth esthetics are obtained an impression is made, implant crowns are made in coordination with an excellent dental ceramist, and the crowns are delivered a couple weeks later.