Agenesis of multiple primary and permanent teeth unilaterally and its possible management

Oligodontia is the agenesis of numerous teeth (more than six teeth). Agenesis of teeth in primary and permanent dentition is a rare incidence and very few are reported in the dental literature. Although the etiology of congenital agenesis of teeth is unclear, several factors such as a tendency toward genetic predilection, metabolic disorders, trauma, infection, radiation or idiopathic reasons are found to be responsible. Available literature reports agenesis most often of third molars, maxillary lateral incisors, mandibular central and lateral incisors, and mandibular second premolars in decreasing order of frequency of occurrence. Males are more often affected than females. Maxillary primary teeth are more often found affected by agenesis than mandibular primary teeth. Available literature reports missing teeth to be found unilaterally or orbilaterally with a predisposition toward a similar phenomenon occurring in the permanent dentition. In congenital agenesis impaired growth of the alveolar process, reduced lower facial height, speech impairment, deep bite, restriction in the movement of the tongue due to ankyloglossia, asymmetry of the affected side of the face are clinical features evident. There has been no report of complete agenesis of primary and permanent teeth in a whole mandibular quadrant in conjunction with the absence of maxillary second and third molars on the affected side. Here, we report an incidence of a rare occurrence of complete agenesis of more than 10 primary and permanent teeth, unilaterally, in the right mandibular quadrant, in a child of 10 years presenting with a chief complaint of several missing primary teeth and difficulty in speech due to its complete absence. Treatment strategies included various orthodontic and restorative procedures to improve esthetics and function. The orthodontic procedures involved expansion of the narrow maxillary arch to obtain a functionally adapted occlusion and creation of space for future alignment, and uprighting and protecting maxillary right posteriors to accommodate the tongue and rectify speech. Restorative procedures involved fabrication of a removable partial denture as a temporary measure to restore missing teeth, improve esthetics, give lingual support to the lower lip, prevent further downward growth of the right maxillary ridge and to prevent supra eruption of these teeth.