Personalised orthodontic treatment of a case of multiple tooth agenesis with aligners: case report

Aim: This case report describes the orthodontic management of a patient with multiple agenesis. The aim of this study is to illustrate an adaptive and customised therapeutic approach, planned in relation to the clinical evolution and individual needs of the patient. Materials and Methods: A 16-year-old patient came in for his first visit due to a family history of tooth agenesis. Based on the orthodontic case study {radiographic examinations, intraoral scans, and intraoral and extraoral photographs], multiple agenesis of elements 1.2 and 3,5, the presence of 2,3 retained, and reported previous avulsion of 2.2 with conoid morphology were highlighted. CBCT allowed for accurate planning of a multidisciplinary treatment pian including the insertion of an 8 mm mini-screw in position 3.5 to preserve bone volume and a subsequent treatment with clear aligners. During the planning phase, the application of two additional mini-screws was planned to promote the distalization of the canines, but the excellent clinical response, correct orthodontic planning and total cooperation of the patient allowed for appropriate bodily distalization of the canines, making the procedure unnecessary. The agenesis of the upper lateral incisors was temporarily compensated for by filling the pontics with A2 composite resin to maintain aesthetic and functional continuity while awaiting the final prosthetic solution. In the final phase, a sectional arch was inserted to finish the 4.5 derotation and optimise the alignment in the fourth quadrant. Results and Conclusions: The treatment achieved a significant improvement in dental alignment and preservation of bone volume in the edentulous site at level 3.5, The case is still ongoing and the next steps will include finishing the treatment, consolidating occlusal and aesthetic stability, and planning the final prosthetic management of the upper laterals.