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Year : 2021  |  Volume : 13  |  Issue : 6  |  Page : 1737-1740  

Esthetic and palliative management of congenitally missing anterior teeth using all ceramic fixed prosthesis: A clinical case report

1 Department of Prosthodontics, Faculty of Dentistry, Manipal University College Malaysia, Melaka, Malaysia
2 Department of Prosthodontics, Meghna Institute of Dental Sciences, Nizamabad, Telangana, India
3 Department of Prosthodontics, Rajiv Gandhi College of Dental Sciences and Hospital, Bengaluru, Karnataka, India

Date of Submission30-Mar-2021
Date of Decision16-Apr-2021
Date of Acceptance23-Apr-2021
Date of Web Publication10-Nov-2021

Correspondence Address:
Karthik Kannaiyan
Department of Prosthodontics, Faculty of Dentistry, Manipal University College Malaysia, Jalan Batu Hampar, Bukit Baru, Melaka 75150
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jpbs.jpbs_288_21

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Congenitally missing anterior teeth alters the patient's physiognomy and diction in a big way. Maxillary incisor agenesis, prominently the lateral incisor is the most common congenitally missing permanent tooth, in the anterior maxillary region, which is the esthetic zone, representing approximately 20% of all dental anomalies. Treatment planning is inclusive of; smile design, preparation, perception of the patients, and their expectations in relation to esthetics, interdisciplinary alliance that meets the functional, health, and esthetic needs. A critical factor for the overall success is that of choosing a suitable restorative recourse. The case report describes the esthetic rehabilitation for congenitally missing maxillary lateral incisor and early traumatic loss of central incisor using an all ceramic-fixed prosthesis.

Keywords: All ceramic-fixed prosthesis, congenitally missing teeth, esthetics

How to cite this article:
Kannaiyan K, Prasad V, Chander V B, Avinash R, Kouser A. Esthetic and palliative management of congenitally missing anterior teeth using all ceramic fixed prosthesis: A clinical case report. J Pharm Bioall Sci 2021;13, Suppl S2:1737-40

How to cite this URL:
Kannaiyan K, Prasad V, Chander V B, Avinash R, Kouser A. Esthetic and palliative management of congenitally missing anterior teeth using all ceramic fixed prosthesis: A clinical case report. J Pharm Bioall Sci [serial online] 2021 [cited 2022 Aug 16];13, Suppl S2:1737-40. Available from:

   Introduction Top

As Frush observes, “A smile can be attractive, a prime asset to a person's appearance, and it can be a powerful factor in the ego and desirable life experiences of a human being. It cannot be treated with indifference because of its deep emotional significance” (Goldstein, 2006). Hypodontia is a term used for defining the developmental absence of one or more teeth except third molars in both dentitions.[1] It is relatively common ranging from 4.5% to 7.4% of the population. The prevalence of dental agenesis is 1.37 times higher in women than that in men.[2],[3] Missing maxillary incisors compromise dental esthetics due to their eminent position in the smile.[4]

Patients with missing anterior teeth usually present with deviated midline, abnormal overlap, and overbite, reduced masticatory ability, and other functional problems.[5] The vulnerability of maxillary lateral incisors to dental agenesis has been correlated with their anatomical position in the maxillary arch and also the fact that they are the last teeth to evolve in their corresponding classes.[6] Traumatic loss of anterior teeth is also very prevalent among youngsters as the antecedent teeth take the brunt of all mishaps.

Various dental treatment protocols are available for conditions involving the anterior sextant where the esthetics is involved. Common treatment modalities for restoring anterior edentulous spaces include removable partial dentures, resin-bonded bridges, auto transplantation, and single-tooth implant. The clinical situation becomes dicey when rehabilitation has to be accomplished for more than one missing teeth with inadequate spacing. The treatment plan here would entail orthodontic intervention, followed by space maintenance with subsequent masking of the canine to resemble the congenitally missing lateral incisor. The case report describes the esthetic rehabilitation for congenitally missing maxillary lateral incisor and early traumatic loss of central incisor using all ceramic-fixed prosthesis.

   Case Report Top

A 21-year-old female patient reported to the Department of Prosthodontics, Sri Rajiv Gandhi College of Dental Sciences, Bangalore, India with a chief complaint of unattractive smile owing to missing teeth in the upper front teeth region. The patient had no relevant medical history. The patient had a history of an accidental fall 2 years back with loss of central incisor and also a congenitally missing lateral incisor.

Intraoral examination revealed Angle's class 1 malocclusion, with an insufficient mesiodistal width to replace 21 and 22. Endodontic treatment had been done in relation to 11 with noticeable discoloration. Due to the mesial migration of 11 and 23, the midline relationship was unsatisfactory and unesthetic. Orthodontic intervention was planned for space rectification in relation to 21 with subsequent use of interim prosthesis for space maintenance. Postorthodontic treatment, sufficient space was gained [Figure 1]. To harmonize the midline relationship and to conform with the issue of adequate space maintenance, an interim prosthesis was fabricated in relation to 21 [Figure 2].
Figure 1: Preoperative view after post orthodontic treatment missing teeth IRT 21, 22

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Figure 2: Midline assessment

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Alginate impressions were made with respect to upper and lower arches and poured with Dental stone. A temporary Maryland bridge was fabricated [Figure 3] in relation to 21 and cemented [Figure 4]. Although the initial treatment plan entailed the placement of an implant supported prosthesis in relation to 21, with subsequent crown on 11, the patient was hesitant in regard to the implant surgery. To subsist with the situation, an all-ceramic fixed prosthesis was planned in relation to 11, 21, and 23. To ameliorate with the absence of the lateral incisor, it was planned to mask the canine in the fixed prosthesis to propound as the lateral incisor and a minor amount of enameloplasty on the first premolar to impersonate the canine.
Figure 3: Interim prosthesis fabricated

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Figure 4: Temporary Maryland bridge cemented post orthodontic treatment

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Tooth preparation was carried out in relation to 11 and 23 [Figure 5]. Impressions were made with a two-step poly vinyl siloxane rubber base impression material [Figure 6] and poured with die stone. All ceramic prosthesis was fabricated in relation to 11, 21, and 23 with 23 made to conform with the shape of 22 [Figure 7]. The prosthesis was cemented with type 1 glass ionomer cement [Figure 8]. Enameloplasty was carried out in relation to 24 to create a semblance to canine. A perfect harmony was achieved, highlighting the naturalness and biomimetics of the restoration, while also achieving the expectations and wishes of the patient for a more esthetic smile [Figure 9] and [Figure 10].
Figure 5: All-ceramic tooth preparation done IRT 11, 23

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Figure 6: Impression made

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Figure 7: All ceramic FPD IRT 11, 21 and 23, for esthetic reasons was shaped into 22

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Figure 8: All ceramic Fpd cementation done

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Figure 9: Pre – Operative View

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Figure 10: Postoperative View

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   Discussion Top

Hypodontia is a typical dental anomaly amid Indian population, pursued closely by impacted teeth. Missing teeth in the anterior teeth region has a major repercussion on attitudinal well-being of patients affecting their self-respect and social credence.[7] Rehabilitation in such cases would depend on the factors such as measure of the edentulous span, calibration of the teeth in the arch, the scope of space present, the category of occlusion present, the skeletal correspondence, and if any shift in the midline. The other factors include the gradient of teeth present, the accessibility of primary abutments, the standard and total sum of the cardinal osseous topography; the outlook, affirmation and consent of the patient and the available proficiency and resources all play a deciding factor.[8]

The varying modalities of prosthetic rehabilitation spans from restoring esthetics with a transitional or interim removable partial denture, using a resin-bonded fixed dental prosthesis or rehabilitating with an implant supported prosthesis. In case where implant treatment is not a possibility then to ensure a plausible esthetic result orthodontic techniques like distalisation of the canine which helps retrieve adequate space in case of missing maxillary lateral incisors have been customarily recommended by various authors. This provides leeway for rectification and restoration of balance esthetically.[9],[10]

   Conclusion Top

Loss of anterior teeth accompanied by congenitally missing anterior teeth presents a challenging conquest in terms of prosthodontic rehabilitation. The solution for such a clinical situation depends on factors such as the malocclusion, the anterior relationship, specific space requirements, and the conditions of the adjacent teeth. A synchronized and unified effort to build optimum esthetics in the anterior section with prominence on reaching an equilibrium on satisfying the patients concerns, using the best treatment methods available and using the adroitness of the dentist to bring about a ternion of successful results is the need of the hour.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understand that name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

   References Top

Larmour CJ, Mossey PA, Thind BS, Forgie AH, Stirrups DR. Hypodontia – A retrospective review of prevalence and etiology. Part I. Quintessence Int 2005;36:263-70.  Back to cited text no. 1
Nordgarden H, Jensen JL, Storhaug K. Reported prevalence of congenitally missing teeth in two Norweigian countries. Community Dent Health 2002;19:258-61.  Back to cited text no. 2
Muller TP, Hill IN, Peterson AC, Blayney JR. A survey of congenitally missing permanent teeth. J Am Dent Assoc 1970;81:101-7.  Back to cited text no. 3
De Coster PJ, Marks LA, Martens LC, Huysseune A. Dental agenesis: Genetic and clinical perspectives. J Oral Pathol Med 2009;38:1-7.  Back to cited text no. 4
Rakhshan V. Congenitally missing teeth (hypodontia): A review of the literature concerning the etiology, prevalence, risk factors, patterns and treatment. Dent Res J (Isfahan) 2015;12:1-3.  Back to cited text no. 5
Abu-Hussein M, Abdulgani A, Watted N, Zahalka M. Congenitally missing lateral incisor with orthodontics, bone grafting and single-tooth implant: A case report. J Dent Med Sci 2015;14:124-30.  Back to cited text no. 6
Steele JG, Sanders AE, Slade GD, Allen PF, Lahti S, Nuttall N, et al. How do age and tooth loss affect oral health impacts and quality of life? A study comparing two national samples. Community Dent Oral Epidemiol 2004;32:107-14.  Back to cited text no. 7
Afroz S, Rathi S, Rajput G, Rahman SA. Dental esthetics and its impact on psycho-social well-being and dental self confidence: A campus based survey of north Indian university students. J Indian Prosthodont Soc 2013;13:455-60.  Back to cited text no. 8
Heymann HO, Hershey HG. Use of composite resin for restorative and orthodontic correction of anterior interdental spacing. J Prosthet Dent 1985;53:766-71.  Back to cited text no. 9
Kokich VO Jr. Congenitally missing teeth: Orthodontic management in the adolescent patient. Am J Orthod Dentofacial Orthop 2002;121:594-5.  Back to cited text no. 10


  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10]


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