Orthodontic considerations in restorative management of hypodontia patients with endosseous implants

The use of implant-supported restorations in patients with hypodontia remains challenging and requires a multistage treatment that begins in late mixed dentition and continues into late adolescence. The aim of this article is to review the role of orthodontics in endosseous implant rehabilitation of patients with hypodontia. The MEDLINE, Web of Science, Scopus, Cochrane databases, and necessary scientific textbooks were searched for relevant studies and reviews, and as far as possible, they were only included if they had been cited at least once in the literature. Dental implants are susceptible to overloading as the periodontal ligament is absent and the proprioceptive nerve endings are either lacking or very limited. Patients with hypodontia may present with skeletal features such as short and retrognathic maxilla, prognathic mandible, and shorter lower anterior facial height, and they sometimes need orthognathic correction as part of their overall treatment. Dental problems vary and include bimaxillary retroclination of incisors, spacing, centerline discrepancies, microdontia, hypoplastic enamels, ankylosis of the retained primary teeth, overeruptions, and volume deficiencies of alveolar ridges. The challenges mentioned, as well as bone volume deficiencies, compromise the successful placement of implants. Orthodontic strategies and techniques, such as uprighting mechanics, extrusion/intrusion, delayed space opening, and orthodontic implant site-switching, can be used to create, preserve, or augment the implant site. After orthodontic site development, the final planned position of the teeth should be maintained with a rigid bonded retainer; overlooking this stage may compromise the implant site and require orthodontic retreatment.