What is Adentia?
Adentia (synonym: hypodentia, oligodentia, from a – negative prefix and lat. Dens – genus. Dentis tooth) – absence of several or all teeth. The etiology is unknown. The complete absence of teeth is very rare. For a dentist, these disorders are only relevant in terms of diagnosis.
Causes of Adentia
The cause of edentulous is not precisely established, presumably it occurs due to resorption of the follicle under the influence of general, toxic diseases or inflammatory processes as a result of complications of the disease of milk teeth. Some see the cause of edentulous anomalies in the formation of tooth primordia due to endocrinopathy or hereditary predisposition.
Symptoms of Adentia
There are congenital primary and acquired secondary. By the number of missing teeth can be partial and complete.
Adentia secondary (adentia secundaria).
It is formed after removal (loss) of teeth in the bite of milk or permanent teeth due to caries, odontogenic inflammatory process, surgery for tumors and other causes.
Adentia secondary complete occlusion of permanent teeth (adentia secundaria totalis).
Complete absence of teeth. Etiology and pathogenesis: the lower jaw has the ability to significantly approach the nose. Soft tissues of the prioral area sink down, forming many wrinkles (early aging of the skin). The muscles of the near-salt area are sluggish, atrophic. Reduction of the jaws due to loss of teeth is significant. The alveolar processes first atrophy, and then the jaw body. On the edentulous jaws there may be bony non-painful, blunt protrusions — exostoses or sharp painful bony protrusions — the edges of the holes of the teeth or parts of the jaw. There are different degrees of jaw atrophy, on the basis of which they are classified. With secondary full edentulous, the angle of the jaw becomes blunt. Signs: in the absence of teeth, the possibility of biting and chewing food is excluded, speech clarity is impaired. Treatment: prosthetics with removable dentures. Complications – pressure sores, insufficient fixation of the prosthesis on the jaws due to significant atrophy of the jaw body. The phenomenon of intolerance to the polymer or dye of plastic, traumatic palatinitis.
Adentia secondary partial (adentia secundaria partialis).
Violation of the integrity of the dentition, due to the death of cut and formed milk and permanent teeth.
Adentia is a secondary partial, complicated by the wear of hard dental tissue and hyperesthesia.
Etiology: functional insufficiency of enamel. Symptoms: in the early stages of the development of the disease, the edge of the knife from chemical irritants, in the later stages – severe pain sensitivity of the hard tissues of the teeth when touched with instruments, closing of the dentition, exposure to thermal and chemical irritants. The patient eliminates all the stimuli during the meal: cold, hot, sour, sweet, hard. Treatment: depulpation of teeth with pronounced hyperesthesia. Dissection of non-pulped teeth is contraindicated even with anesthesia.
Adentia is a secondary partial, complicated by a direct traumatic node.
Etiology: overloading of hard dental or periodontal tissues. Symptoms: overloading of hard tooth tissues, worn out, the appearance of a pathological gingival and bone pockets with inflammatory phenomena, the appearance of an abscess is possible. The relative functional center on the teeth with a well-preserved periodontal disease is expressed. Treatment: prosthetics that can relieve a weakened periodontal with periodontal syndrome. Covering erased crowns of artificial teeth. Erased crowns of the teeth with a decrease in the height of the lower part of the face restored orthopedic or orthodontic.
Adentia secondary partial occlusion of permanent teeth.
Etiology: congenital (no germ) or acquired (tooth extraction due to caries complication, trauma, odontogenic inflammatory process, surgery for a tumor). Clinic: violation of the integrity of the dentition. The dentomaxillary system disintegrates into various functioning units. Formed power dissociation of the dentition. Secondary partial adentia is observed in different stages – compensated, subcompensated and decompensated. A conditioned reflex of processing food is developed on the intact part of the dentition. In the compensated stage, the patient is subject to a dispensary observation of the reaction of the tissues surrounding the defect. In the stage of sub-and decompensation of the dentition, it is advisable prosthetics to normalize its work.
Adentia primary full (adentia prima totalis).
Observed in the bite of milk and permanent teeth. The main symptom is the complete absence of tooth rudiments (radiography).
Adentia primary full bite milk teeth.
The etiology is unknown. Baby teeth are completely absent, which is determined by inspection and palpation of the jaw from the side of the oral cavity. Radiographically not determined the rudiments of milk teeth. The lower part of the face is sharply reduced. The jaws are underdeveloped, the alveolar process appears in the form of a thin unsharply protruding lace. The hillocks of the upper jaw are weakly expressed, the palate is flat. Signs: nibble and chewing of food is excluded, therefore the patient uses only soft and liquid food. The diction is violated, the lingo-dental sounds are not clearly pronounced: D, 3, L, N, T, H. When the nasal passages are underdeveloped, nasal-oral breathing. Usually, with full bite of milk teeth, the scalp is underdeveloped, no eyebrows, eyelashes, nails are rudimentary or absent. Springflows often do not grow, there is no fusion of the maxillofacial bones, and the seams of the skull bones. Due to weak hair growth, the forehead is large and bulging. Treatment: prosthetics with laminar prostheses. Prostheses can be applied after 3-4 years of age. Complications: jaw growth is delayed due to the pressure of the prostheses.
Adentia primary replaceable bite milk and permanent teeth.
Observed during the change of teeth. The bite is missing part of the milk and permanent teeth. Clinic: there are trem between the teeth. The jaws are underdeveloped in the horizontal and vertical planes. The lower part of the face is low. When the dentition is closed, the face assumes a senile appearance, since the lower jaw pulls too much towards the upper jaw. Violated the act of processing food in the mouth. With a significant number of missing teeth, the pronunciation of various sounds is difficult. Treatment: prosthetics with removable prostheses in order to stimulate the growth of the jaws. Complications: loosening of the abutment teeth and klammer violation of the integrity of the enamel. Prostheses should be adjusted throughout the entire period of growth and development of the jaws.
Adentia Primary Partial (adentia prima partialis).
Observed in the bite of milk and permanent teeth. The main feature: reduction (nedokomplekt) teeth, teeth beginnings are missing (radiography).
Adentia primary partial occlusion of milk teeth.
The etiology is unknown. Signs: reduced the number of milk teeth in the dentition, tooth rudiments are absent (X-ray). Between the erupting teeth are formed tremes. In the absence of a significant number of teeth, there is underdevelopment of the jaws. When edentulous on one jaw in the dentition, the antagonizing teeth are crowded together or piled on top of each other. Separate teeth are located outside the dentition or retenirovanny. Treatment: children must be supervised. If there is a tendency to delay the growth of the jaw, a removable denture without clasps should be applied. The prosthesis is replaced or corrected after 5-6 months.
Adentia primary partial occlusion of permanent teeth.
Etiology: inflammation associated with milk teeth. In the bite of replaceable and permanent teeth on one or both jaws, a number of teeth are missing and their rudiments are absent. There are significant gaps between the teeth that have cut through. Usually the jaw with a reduced number of teeth is underdeveloped. When adentia is partial on one jaw, the dentition of antagonists may form incorrectly, the teeth are piled on top of each other, placed outside the dentition, or remain retained. As a result of three and wrong dental position, chronic localized gingivitis is possible. Signs: expressed functional impairment is not observed. With significant gaps between the teeth, a violation of speech clarity, the appearance of whistling sounds is possible. Treatment: prosthetics are indicated if there are sufficient gaps between the teeth to establish artificial teeth. In the bite of the period of change of teeth, a removable denture is imposed to normalize the processes of jaw growth. After the end of jaw growth, significant defects can be eliminated by bridges.
Diagnosis of Adentia
Diagnosis of the complete absence of teeth (complete secondary edentulous) is made by clinical examination and history taking. Diagnosis is aimed at eliminating factors that prevent the immediate start of prosthetics. Such factors may be the presence of: – not removed roots under the mucous membrane; – exostoses; – tumor-like diseases; – inflammatory processes; – Diseases and lesions of the oral mucosa.
In connection with the different approaches of specialists to the orthopedic treatment of complete adentia, depending on the degree of atrophy of the prosthetic bed tissues and for the objectification of the state of the beds, as well as to draw up a rational treatment plan, a large number of classifications have been proposed. The most used of them are listed below. Schröder (H.Schreder, 1927) identified three types of upper edentulous jaws: Type 1 – characterized by minor atrophy of the alveolar processes and mounds, high arch of the sky. The sites of attachment of the bridles of the lips, tongue, cord and transitional fold are located at a sufficient distance from the tops of the alveolar processes. Type 2 – characterized by an average degree of atrophy of the alveolar processes and bumps, the arch of the sky is preserved. Bridles of the lips, tongue, cords and transitional fold are located closer to the tops of the alveolar process. Type 3 – characterized by significant atrophy of the alveolar process. Hillocks atrophied completely. The sky is flat. The bridles of the lips, tongue, cords and transitional fold are flush with the tops of the alveolar processes. Keller (Kehller, 1929) identified four types of lower edentulous jaws: Type 1 – characterized by slight atrophy of the alveolar process. The sites of attachment of muscles and folds are located at a sufficient distance from the apex of the alveolar process. Type 2 – characterized by significant, almost complete, uniform atrophy of the alveolar process. The sites of attachment of muscles and folds are located almost at the level of the apex of the alveolar process. The crest of the alveolar process barely rises above the bottom of the oral cavity, presenting a narrow, knife-like formation in the anterior region. Type 3 – characterized by significant atrophy of the alveolar process in the lateral areas, while relatively preserved in the anterior. 4th type – characterized by significant atrophy of the alveolar process in the anterior segment, while preserved in the lateral. The mucous membrane of the prosthetic lodges is classified by Supple into 4 classes, depending on the process of atrophy of the alveolar process, mucous membrane, or a combination of processes. Grade 1 (“perfect mouth”) – alveolar processes and palate are covered with a uniform layer of moderately supple mucous membrane, the compliance of which increases to the back third of the sky. The sites of attachment of bridles and natural folds are located at a sufficient distance from the apex of the alveolar process. Grade 2 (hard mouth) – atrophic mucous membrane covers the alveolar processes and the sky with a thin, as if stretched layer. Places of attachment of bridles and natural folds are located closer to the tops of the alveolar processes. Grade 3 (soft mouth) – alveolar processes and the sky are covered with loosened mucous membrane. Grade 4 (dangling comb) – excess mucous membrane is a comb, due to atrophy of the bone of the alveolar process.
Methods of treatment of primary edentulous:
– Pre-orthodontic trainer, according to age.
– Dispensary registration.
Partial primary edentia in the period of permanent bite.
Treatment in childhood is aimed at stimulating proper teething and preventing deformities – all as in the case of adentia during the milk bite. After the eruption of permanent 7 teeth, we can talk about the replacement of missing teeth. As a rule, such treatment is preceded by a full orthodontic preparation, and then the restoration of the missing tooth.
– Implantation of a missing tooth.
– Adhesive bridge.
– Prosthetics with the use of metal-ceramic crowns, inlays, crowns on zirconium oxide. This treatment model is applied, as a rule, when the dentition defect is one-sided (one tooth is missing).
Methods of treatment of secondary complete adentia
The principles of treatment of patients with complete secondary edentulous mean the simultaneous solution of several tasks: – restoration of sufficient functional ability of the dental system; – prevention of the development of pathological processes and complications; – improving the quality of life of patients; – elimination of negative psycho-emotional consequences associated with the complete absence of teeth. The manufacture of prostheses is not shown if the existing prosthesis is still functional or if its function can be restored (for example, repair, relocation). Prosthesis manufacture includes: examination, planning, preparation for prosthetics and all measures for the manufacture and fixation of a prosthesis, including the elimination of deficiencies and control. This also includes instructing and teaching the patient to care for the prosthesis and oral cavity. The dentist orthopedist should determine the features of the prosthesis, depending on the anatomical, physiological, pathological and hygienic state of the dental system. When choosing between equally effective types of prostheses, it should be guided by cost-effectiveness indicators. In cases where it is impossible to complete the treatment immediately, the use of immediate dentures is indicated, especially to prevent the development of the temporomandibular joint pathology. You can use only those materials and alloys that are approved for use, clinically tested, the safety of which is proven and confirmed by clinical experience. The basis of a complete denture should be made, as a rule, from plastic. Reinforcement of the prosthesis base with special metal mesh can be used. For the manufacture of metal base must be a thorough justification. When a confirmed allergic reaction of the tissues of the oral cavity to the material of the prosthesis should be carried out tests and choose the material that proved to be portable. When the edentulous jaw shows the removal of a functional impression (impression), the functional formation of the edge of the prosthesis is necessary, i.e. To remove the impression (impression) it is necessary to manufacture an individual rigid impression (impression) spoon. Making a removable denture on the edentulous jaw using a plastic or metal base includes the following: anatomical, functional impressions (impressions) of both jaws, determining the central ratio of jaws, checking the structure of the prosthesis, overlaying, fitting, fitting, installing, remote control and proofing. If necessary, use soft pads under the prosthesis.