Interdisciplinary Treatment of Non-syndromic 5-Tooth Agenesis Involving Miniscrews

Agenesis of 5 or more permanent teeth is infrequent, and orthodontic treatment for asymmetric or multiple consecutive missing teeth is challenging. Collaboration among dental specialists to develop individualized treatment plans is critical to achieving optimal outcomes and ensuring patient satisfaction. A 15-year-old non-syndromic girl presented with skeletal Class I malocclusion. She had agenesis of 5 asymmetric permanent teeth, comprising 3 consecutive teeth (the maxillary left canine and first and second premolars), the maxillary right second premolar, and the mandibular right first premolar, and 5 persistent deciduous teeth. Miniscrews were placed distal to the mandibular right first deciduous molar and first molar. The mandibular right molars were uprighted and the space left by first premolar agenesis closed by miniscrew-assisted mesial movement of the molars. The bilateral maxillary deciduous second premolars were preserved. After extracting the maxillary left deciduous canine and the first deciduous molar, 2 miniscrew-supported pontics were placed perpendicular to the alveolus to control the adjacent teeth and maintain space. Active treatment lasted 36 months. Prosthetic treatment for the maxillary left canine and first premolar was completed 3 years after dental implant placement. Occlusion remained stable, even after 5 years of retention. This report highlights the finding that excellent occlusion and esthetics can be achieved by collaborative management involving orthodontists, oral surgeons, and prosthodontists in cases of hypodontia.