Treatment Planning and Surgical Considerations in Implant Therapy for Patients With Agenesis, Oligodontia, and Ectodermal Dysplasia: Review and Case Presentation  Anthony G. Sclar, DMD, Janice Kannikal, DMD, Cimara Fortes Ferreira, DDS, MSc, PhD, Steven I. Kaltman, DMD, MD, William B. Parker, DDS  Journal of Oral and Maxillofacial Surgery  Volume 67, Issue 11, Pages 2-12 (November 2009) DOI: 10.1016/j.joms.2009.06.016 Copyright © 2009 American Association of Oral and Maxillofacial Surgeons Terms and Conditions

Figure 1 Pretreatment clinical photographs documenting patient's condition: A, Full face with guarded smile. B, Lips in repose. C, Relaxed smile position. D, Close-up exaggerated smile line. Sclar et al. Implant Therapy and Agenesis, Oligodontia, and Ectodermal Dysplasia. J Oral Maxillofac Surg 2009. Journal of Oral and Maxillofacial Surgery 2009 67, 2-12DOI: (10.1016/j.joms.2009.06.016) Copyright © 2009 American Association of Oral and Maxillofacial Surgeons Terms and Conditions

Figure 2 A, B, Disproportionate mesiodistal spacing for ideal functional and esthetic prosthetic rehabilitation despite prolonged postoperative orthodontic therapy. C, Pretreatment intraoral frontal view showing recapture of lost vertical dimension after maxillary osteotomy with advancement, inferior repositioning, and sinus floor augmentation. Sclar et al. Implant Therapy and Agenesis, Oligodontia, and Ectodermal Dysplasia. J Oral Maxillofac Surg 2009. Journal of Oral and Maxillofacial Surgery 2009 67, 2-12DOI: (10.1016/j.joms.2009.06.016) Copyright © 2009 American Association of Oral and Maxillofacial Surgeons Terms and Conditions

Figure 3 A, Pretreatment radiographs showing severe oligodontia, incomplete orthodontic righting of mandibular canines, disproportionate maxillary lateral incisor, and edentulous gaps. B, Panoramic radiograph showing evidence of healing following maxillary osteotomy with bilateral sinus floor augmentation. Sclar et al. Implant Therapy and Agenesis, Oligodontia, and Ectodermal Dysplasia. J Oral Maxillofac Surg 2009. Journal of Oral and Maxillofacial Surgery 2009 67, 2-12DOI: (10.1016/j.joms.2009.06.016) Copyright © 2009 American Association of Oral and Maxillofacial Surgeons Terms and Conditions

Figure 4 A, B, Pretreatment cone-beam CT scan (Imaging Sciences International, Hatfield, PA). Cross-sections confirmed adequate bone volume at proposed sites for implant rehabilitation as well as horizontal ridge defects and tooth-alveolar housing discrepancies at edentulous maxillary lateral incisor sites. Sclar et al. Implant Therapy and Agenesis, Oligodontia, and Ectodermal Dysplasia. J Oral Maxillofac Surg 2009. Journal of Oral and Maxillofacial Surgery 2009 67, 2-12DOI: (10.1016/j.joms.2009.06.016) Copyright © 2009 American Association of Oral and Maxillofacial Surgeons Terms and Conditions

Figure 5 A-C, Diagnostic wax-up performed on articulated study casts demonstrating feasibility of functional and esthetic implant-assisted dental rehabilitation without additional orthodontic therapy. Sclar et al. Implant Therapy and Agenesis, Oligodontia, and Ectodermal Dysplasia. J Oral Maxillofac Surg 2009. Journal of Oral and Maxillofacial Surgery 2009 67, 2-12DOI: (10.1016/j.joms.2009.06.016) Copyright © 2009 American Association of Oral and Maxillofacial Surgeons Terms and Conditions

Figure 6 Postoperative CT-derived panoramic view showing positions of maxillary and mandibular dental implants. Space limitations and unfavorable axial inclinations of mandibular canine teeth owing to incomplete orthodontic righting guided selection of “tissue level” versus “bone level” implants (Straumann USA, Andover, MA) at specific sites, thereby facilitating restorative treatment phase. Sclar et al. Implant Therapy and Agenesis, Oligodontia, and Ectodermal Dysplasia. J Oral Maxillofac Surg 2009. Journal of Oral and Maxillofacial Surgery 2009 67, 2-12DOI: (10.1016/j.joms.2009.06.016) Copyright © 2009 American Association of Oral and Maxillofacial Surgeons Terms and Conditions

Figure 7 A, B, Postinsertion cone-beam CT scan showing baseline conditions immediately after implant placement. Note, beam hardening effect on sections 85 and 103, where facial cortex is not visualized. Sclar et al. Implant Therapy and Agenesis, Oligodontia, and Ectodermal Dysplasia. J Oral Maxillofac Surg 2009. Journal of Oral and Maxillofacial Surgery 2009 67, 2-12DOI: (10.1016/j.joms.2009.06.016) Copyright © 2009 American Association of Oral and Maxillofacial Surgeons Terms and Conditions

Figure 8 A, Clinical smile at 1 week postoperatively and B, C, intraoral views with provisional restorations in place showing improved lip support and smile esthetics, despite presence of postoperative swelling. Sclar et al. Implant Therapy and Agenesis, Oligodontia, and Ectodermal Dysplasia. J Oral Maxillofac Surg 2009. Journal of Oral and Maxillofacial Surgery 2009 67, 2-12DOI: (10.1016/j.joms.2009.06.016) Copyright © 2009 American Association of Oral and Maxillofacial Surgeons Terms and Conditions

Figure 9 A, B, Intraoral views taken 10 weeks postoperatively after removal of provisional restorations in preparation for routine stability testing before beginning with final restorative phase. Sclar et al. Implant Therapy and Agenesis, Oligodontia, and Ectodermal Dysplasia. J Oral Maxillofac Surg 2009. Journal of Oral and Maxillofacial Surgery 2009 67, 2-12DOI: (10.1016/j.joms.2009.06.016) Copyright © 2009 American Association of Oral and Maxillofacial Surgeons Terms and Conditions

Figure 10 A-D, Post-treatment clinical facial, close-up smile, and intraoral views taken 9 months after final restoration documenting successful implant-assisted esthetic dental reconstruction. Note, improved lip support, natural smile esthetics, and biologic acceptance of restorations as evidenced by healthy periodontal and pre-reimplant soft tissues. Addition of a second maxillary right canine pontic presented an acceptable esthetic solution to the space discrepancy that could not be corrected with orthodontic treatment. Sclar et al. Implant Therapy and Agenesis, Oligodontia, and Ectodermal Dysplasia. J Oral Maxillofac Surg 2009. Journal of Oral and Maxillofacial Surgery 2009 67, 2-12DOI: (10.1016/j.joms.2009.06.016) Copyright © 2009 American Association of Oral and Maxillofacial Surgeons Terms and Conditions

Figure 11 A, Panoramic view and B, cone-beam CT scan (Imaging Sciences International) taken 9 months after delivery of final restoration. Cross-sections taken at maxillary implant sites: C, cone-beam CT cross-sections taken at mandibular implant sites; D, 3-dimensional CT images demonstrating skeletal and dental rehabilitation of patient with ectodermal dysplasia, associated maxillary hypoplasia, and severe oligodontia. E, Intraoral radiographs showing intimate bone-implant contact. Sclar et al. Implant Therapy and Agenesis, Oligodontia, and Ectodermal Dysplasia. J Oral Maxillofac Surg 2009. Journal of Oral and Maxillofacial Surgery 2009 67, 2-12DOI: (10.1016/j.joms.2009.06.016) Copyright © 2009 American Association of Oral and Maxillofacial Surgeons Terms and Conditions