AIM: In the present work we describe a clinical case of multiple tooth agenesis treated and solved with a multidisciplinary approach made of several therapeutic stages and implant-prosthetic rehabilitation.

METHODS: An 18-year-old patient presented with agenesis of 6 teeth (15 – 25 – 34 – 35-44 – 45). The therapeutic approach consisted of two phases: the first was orthodontic and second was implant-prosthetic. The orthodontic treatment involved a ceramic fixed appliance on both arches to provide a fair distribution of the spaces among agenesic teeth, leaving unaltered the unexfoliated deciduous teeth (65-73-75-83-85) which acted as space maintainers, and to avoid the physiological bone resorption that would certainly affect the edentulous area. The above-mentioned deciduous teeth were subsequently extracted during the surgical stage and replaced by post-extraction implants. Therefore, the aim of pre-prosthetic orthodontics was to obtain a correct placement and inclination not only of clinical crowns, but also of tooth roots adjacent to the implant sites.
To compensate the congenital absence of teeth, in the second therapeutic phase we decided to place six implants. It was a more conservative solution than fixed prosthesis, also in the light of the good health of teeth and of the patient?s age, who had almost finished growth. With the technique of immediate loading, under local anesthesia, after flap detachment and preparation of the implant bed by means of osteotomes , implants were placed at the level of tooth 15 (in the space orthodontically created with the use of a spring compressed between teeth 14 and 16). Post-extraction implants were placed at the level of teeth 25, 35 , 33, 45 , 43; after screwing the abutments, resin crowns were cemented on them acting as space maintainers and esthetical provisional implants. After periodic examinations and after osseointegration occurred, implants were prosthetised with fixed metal-ceramic crowns .

RESULTS: thanks to an accurate case analysis and planning, we could achieve both functional and aesthetic objectives, without interfering in any way with the structural integrity of the adjacent teeth.

CONCLUSION: The solution of this clinical case highlights that a multidisciplinary approach is crucial to solve a similar situation in everyday dental practice, since it requires the aid of the orthodontist, surgeon and prosthetist, who work in the patient?s interest and chose the therapy having more advantages for the health of the patient.

Authors:INCHINGOLO Francesco, MARCHIANO’ Simona, SCHINCO Fabio, INCHINGOLO Alessio Danilo,MARRELLI Massimo, INCHINGOLO Angelo Michele, MURA Stefano, PIGNATARO CHIARA, TATULLO Marco, MALCANGI Giuseppina, MARINELLI Grazia,SERAFINI Maurizio, BALICE Pierluigi, PADUANELLI Gregorio, DIPALMA Gianna.