Customized orthodontic treatment in a complex case of multiple tooth agenesis: importance of biomechanical management and an interdisciplinary approach

Aim: The aim of this study is to demonstrate how a personalized orthodontic strategy, grounded in respecter individual biological response and continuous biomechanical adaptation, can achieve optimal aesthetic and functional outcomes even in complex cases of multiple agenesis. Materials and Methods: A 15-year-oldfemale patient presented to cur attention with multiple agenesis (18, 15, 14, 24, 25, 28, 37,35, 34, 4é), resulting in significant hypodontia with major functional and aesthetic implications, es well as a skeletal and dental deep bite. Following comprehensive clinical and radiographic assessment, a tailored treatment plan was established featuring sequential controlled mechanics and skeletal anchorage with mini screws. The primary objective of orthodontia intervention was the create and preserve premolar spaces in the agenetic areas, restoring a symmetrical upper “social six" and increasing the vertical dimension, in preparation for subsequent upper and lower implant-prosthetic rehabilitation. This goal was achieved by medializing the upper right canine [tooth 13) and avoiding molar distalization through the placement of a mini screw in the region of tooth 16. In the initial phase, the lower arch was banded to correct the deep-bite using posterior occlusal buildups, followed by banding of the upper arch and placement of the palatal and buccal buttons to assist in the derotation and mesialization of tooth 13, after extraction of the deciduous tooth 53, Once the correct position of 13 was achieved, the appliances were removed and retention devices delivered. The case was subsequently integrated into a prosthetic planning process conducted with an interdisciplinary approach. Results and Conclusions: The treatment improved dental symmetry and the vertical dimension. Progressive adjustment of forces in accordance with the individual biological timing facilitated optimal response and balanced facial aesthetics. The personalization of orthodontic mechanics, combined with respect for biological timing and interdisciplinary collaboration, represents the key to success in complex multiple-agenesis cases, enabling predictable, durable and stable outcomes over time in terms of function, aesthetics and oral health.