Dental Care Management Anomaly Microdontia on Children: Case Report  

Inne Suherna Sasmita
Staf Department of Pediatric Dentistry, Faculty of Dentistry, University of Padjadjaran, India
Author    Correspondence author
International Journal of Clinical Case Reports, 2015, Vol. 5, No. 29   doi: 10.5376/ijccr.2015.05.0029
Received: 24 Mar., 2015    Accepted: 11 Jun., 2015    Published: 03 Jul., 2015
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Inne Suherna Sasmita, 2015, Dental Care Management Anomaly Microdontia on Children: Case Report, International Journal of Clinical Case Reports, 5(29) 1-5 (doi: 10.5376/ijccr.2015.05.0027)

Abstract

One form of dental anomalies that occurred at the stage morfodiferensiasi teeth is microdontia, which occurs both in primary teeth or permanent teeth. Microdonsia is teeth with a size smaller than normal size, or beyond the limits of size variation in tooth and tooth shape with conical or tapered called conical teeth. Factors affecting microdontia is genetic and environmental factors.

The clinical examination microdontia was done by visual inspection, radiographic examination as well as a combination of both. Microdontia diagnosis should be done early to oversee and maintain the development of the teeth in order to avoid complications.

The treatment can be carried out with esthetic restorative treatment of anterior teeth, orthodontic treatment and a combination of both.

Keywords
Dental anomalies; Microdontia

The shape of deciduous teeth begins to develop at the age of 4 months in the womb. Growth and tooth development through several stages of initiation, proliferation, histodiferensiasi, morfodiferensiasi, apposition, calcification and eruption. At each stage can occur disorder that causes anomalies in the number of teeth, tooth size, tooth shape, tooth structure, the color of teeth and tooth eruption disturbances.

Microscopic tooth structure consist hard tissue (hard tissue) and soft tissue (soft tissue). Hard tissue is tissue containing limestone consisting of enamel, dentin and cementum, while the soft tissue is tissue contained in the pulp cavity through the apical foramen.
One form of dental anomalies that occurred at the stage morfodiferensiasi teeth is microdontia, which occurs both in primary teeth or permanent teeth. In microdontia, tooth size smaller than normal size. As with macrodontia, microdontia can involve all the teeth or limited to a single tooth or group of teeth. Usually the lateral incisors and third molars were smaller. Supernumerary teeth may also experience microdontia.
Microdontia defined as teeth with size smaller than normal size, or beyond the limit of the size of the gear variation (Shafer et al., 2009). Radiation in the jaw during tooth development can also cause microdontia in the area involved (Hanne and Ivar, 2009). Microdontia most common in the lateral teeth and the maxillary third molar. Frequency microdontia in maxillary lateral slightly less than 1% (Hanne and Ivar, 2009). There are three types of microdontia, namely:
1. True generalized microdontia (microdontia actually entirely).
2. Generalized relative microdontia.
3. Microdontia involving a single tooth (microdontia involving a single tooth).
Factors Affecting the Size of the Teeth
Variations in the size of the teeth caused by several factors, namely:
Genetic Factors (Heredity)
Hereditary factors can affect the size of the teeth, genetic factors are intended. Genetic factors have the greatest influence in determining the size of the tooth. Previous research expressed very strong influence of genetic factors is to estimate the morphological picture of the crown by 90%. In the twin brothers with their blood relations, found almost no variation in tooth size. According to Rakosi et al. (1993), based on current knowledge, the major networks that can undergo dentofacial deformities due to genetic effects of which have included the teeth which include size, shape, number, tooth mineralization, location and position of tooth germ eruption (Rakosi, 1993; Swasono, 2004).
Environmental Factors
Growth and tooth development is influenced also by environmental factors but not much change something that has been determined by heredity. The influence of environmental factors on the size of the tooth is about 20%. Research on american population in the united states, japan and china acquired americans born in the country compared with that was born in japan and china have different size mesiodistal tooth. Environmental factors are meant nutrients (Rakosi, 1993; Hong et al, 2008).
Case Reports
A 13-year-old girl came to a dental practice in london with a chief complaint of teeth 22 has a shape and size of the abnormal causing mild diastema and esthetic problem. History of patients in general good health.
Clinical Examination
Extra-oral examination shows that the patient has an advance flat profile, there are no abnormalities in the tmj, mouth and lips relations. Intra-oral examination showed grade 1 malocclusion with an overjet and overbite angle light. Microdontia on tooth 22 with mild rotation of the distal direction. Visual examination with radiographs showed microdontia on 22 teeth Figure 1 and 2.


Figure 1 Microdontia on teeth 22



Figure 2 Photo periapical radiography


Diagnosis
From the results of the examination was diagnosed that the patient is experiencing microdontia on the upper left lateral incisor tooth.
Case Management
Management of the patient's case is with composite restorations as temporary care and jacket crowns as permanent treatment. The treatment is carried out which treatment with composite resin. Care measures:
1. First drain and isolate the teeth with cotton.
2. Giving etching for 20 seconds to the entire surface of the tooth Figure 3.


Figure 3 Giving etching


3. Results etching seen that whiter teeth and microscopic form tag. Then proceed giving resin bonding and irradiation with light cure for 15-20 seconds Figure 4.
4. After irradiation on resin bonding, it would seem to be more opaque teeth. Dental composite fillings are ready made and polishing with a rubber polishing Figure 5.


Figure 4 Results etching



Figure 5 Resin aesthetic restoration


5. The results showed dental care 22 already has the same shape and size with 12 and no diastema Figure 6.


Figure 6 Results of treatment


Discussion
Microdonsia is an abnormality that occurs in the bud stage, and its etiology is hereditary factors in localized form, and endocrine dysfunction in the overall shape of the teeth involved (Mary balogh and Margaret, 2006) Figure 7.


Figure 7 The "peg-shaped" deformity in microdontia of a maxillary lateral incisor


Microdontia care divided by the number of teeth affected, namely treatments for generalized microdontia and for localized microdontia.
Generalized Treatment Microdontia
Generalized microdontia or thorough microdontia is a state of all teeth in the oral cavity having a size smaller than normal (Cameron, 1998). This condition causes a thorough and migration diastema tooth causing disharmony between the dental arch width and arch width. Thorough diastema found in patients with hypopituitarism (Cameron, 1998; Laskaris, 2000). Thorough diastema should not be treated as the influence of the pressure of the tongue and lips that often cause the teeth return to the starting position after treatment. One common type of treatment on overall diastema caused by microdontia thorough is the jacket crown thorough treatment (Moyers, 1988; Aschheim, 2001).
Localized Treatment Microdontia
Microdontia localized treatment can be done in various ways according to the microdontia conditions. There are some alternative treatments that can be done on microdontia that of one or more teeth: (Mcdonald, 2000; Pinkham, 2001).
First with diastema closure is done when the teeth are experiencing microdontia with mild diastema. Diastema can be closed with a simple orthodontic appliance. Advantages of the choice of this type of treatment are overjet and overbite patients experience minimal change (Pinkham, 1999). Orthodontic appliance that can be used is the labial bow and coil springs (Sim, 1977; Witt, 1988; Proffit, 2000) Figure 8.


Figure 8 Closing diastema simple light with tool orthodontics (Pinkham, 1999)


The second is a diastema closure is done by moving the lateral incisor tooth mesial direction until contact with the incisor teeth tops and leaves room in the distal region of the lateral incisor tooth. This action is generally not acceptable in terms of aesthetics, unless the rest of the small room (Pinkham, 2001). Orthodontic appliance that can be used is a coil spring, hawley appliance, proximal spring, spring proximal to the loop adjustment (Sim, 1977; Witt, 1988; Proffit, 2000) Figure 9.


Figure 9 Closing diastema with leaving regional space distal lateral incisor teeth (Pinkham, 1999)


The third is a combination treatment of orthodontic tooth movement with the tools and aesthetic restoration of anterior teeth. The lateral incisor is moved to its normal position with fixed orthodontic appliance that provided enough room for esthetic restorative treatment. This is the best treatment (Pinkham, 2001) Figure 10.


Figure 10 Treatment combinations between aesthetic orthodontic treatment and restoration (Welbury, 2001)


Esthetic restoration of anterior teeth is a restoration that requires a sense of art. There are several ways that can be used to change or cope with aesthetic problem (
Mount, 1998). The selection of appropriate materials for aesthetic anti-cariogenic properties were taken into account and durability (Bergen, 1989). In the case of localized microdontia, there are several ways to do aesthetic restoration, namely:
1. Restoration form of fillings with composite resin, which restore the tooth to its normal size in a simple way. How this is done to reshape the mesial and distal surfaces or cover the entire crown with composite (Wei, 1988; Ascheim, 2001). Composite resin restoration option is used for minor irregularities on the anterior teeth as the teeth conical lateral incisor. The advantages of the composite resin that is cheap and fast (Mount, 1998; Heasman, 2003) Figure 11.


Figure 11 Working model porcelain veneer


2. Porcelain laminates veneer. The restoration of the form of the crown gear casing used to keep young and incomplete root development and large pulp cavity because of the eruption that has not been perfect. Laminating produce aesthetic porcelain veneers and good abrasion resistance, does not cause changes in occlusion and can adjust to the surrounding tissue (Nakazawa, 1995; Mount, 1998) Figure 12.


Figure 12 Results of porcelain veneer restoration on lateral incisor (Welbury, 2001)


Conclusion
Microdontia treatment depends on the type of cases that experienced microdontia esthetic restorative treatment of anterior teeth, orthodontic treatment and a combination of both, depending on the condition of the teeth and mouth.
References
Aschheim K.W., and Dale B.G., 2001, Esthetic dentistry a clinical approach to techniques and materials, 2nd ed., St. Louis-Philadelphia-London- Sydney-Toronto: Mosby
Bergen S.F., 1989, The dental clinic of north America: Esthetic dentistry, Philadelphia-London-Toronto-Montreal-Sydney-Tokyo: W.B. Saunders Co.
Camero Widmer A.C., Richard P., 1998, Handbook of Pediatric Dentistry, London: Mosby
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