846 Bone Grafting as an Alternative Approach to Treating Severe Hypodontia in a Child

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Abstract Background Severe hypodontia (developmental absence of teeth) can have significant functional and cosmetic impact, causing dietary restrictions, speech delay and bullying. Management in childhood is usually with removable dental prostheses, but retention and stability are often compromised by hypoplastic dento-alveolar bone ridges in the edentulous areas. Presenting problems A 3-year-old child was referred to Paediatric Dentistry with no erupted primary teeth. Radiographs revealed developmental absence of the entire primary dentition. Genetic investigation was negative for changes in genes known to be associated with hypodontia. In the permanent dentition only first molars were radiographically present. The child was struggling with bullying and self-confidence related to his dental appearance and speech. Investigations Plain films and cone beam computed tomography (CBCT) revealed agenesis of all canines and incisors in both jaws, an atrophic edentulous anterior maxilla, and soft tissue communication with the nasal fossa floor. Clinical management Despite provision of a retentive upper removable prosthesis was made impossible by a fleshy anterior maxillary ridge with severe atrophy of the dento-alveolar bone and inadequate sulcus depth. Multiple removable prostheses were fabricated, but retention and stability were poor. He was referred to maxillofacial surgery for excision of redundant fleshy tissue in the anterior maxilla and placement of corticocancellous block graft from the hip with Sonic Weld (KLS Martin) to augment and consolidate the ridge. A successfully retentive prosthesis was subsequently fabricated. Discussion This case presents an unusually invasive, but effective alternative approach to treating severe hypodontia in childhood, where hypoplastic dental ridge and sulcus depth can restrict treatment options.