Minimally Invasive Multidisciplinary Management of Tetracycline-stained and Congenitally Missing Teeth.

AIM

This clinical case report describes the multidisciplinary treatment workflow for a complex rehabilitation case to correct skeletal class II malocclusion, bilateral congenitally missing premolars, and improve the esthetic smile in tetracycline-stained teeth.

BACKGROUND

The anterior esthetic zone plays a crucial role in the overall appearance of a patient's smile. Tooth discoloration and congenitally missing premolars are frequently reported in young adults, affecting both esthetics and function. The tetracycline-stained teeth and visible absence of premolars can impact a patient's self-esteem by creating noticeable gaps in the smile. Missing premolars may also cause the remaining teeth to shift, impair the ability to chew effectively, which may lead to uneven wear or malocclusion. Treatment options require a multidisciplinary approach involving an orthodontist, an oral surgeon, and a prosthodontist.

CASE DESCRIPTION

A 34-year-old female presented to a private hospital with complaints of chewing difficulties due to bilateral congenitally missing premolars and was unsatisfied with her smile due to tetracycline-stained teeth. She had a history of taking tetracycline for respiratory infections over the past 30 years. This clinical case report describes the treatment workflow for this complex rehabilitation case, utilizing digital planning to correct skeletal class II malocclusion and create sufficient restorative space for the missing premolars (teeth 12, 13, 20, and 29 according to the universal numbering system) to allow for implant placement with clear aligners. The esthetic smile was enhanced using CAD/CAM technology to fabricate final lithium disilicate restorations. Follow-up over 18 months confirmed the success of the treatment, with the patient expressing satisfaction with both the functional and esthetic outcomes.

CONCLUSION

A multidisciplinary management for the treatment of a complex rehabilitation case involving orthodontic treatment before implant placement and subsequent restorative intervention resulted in predictable outcomes with minimal tooth reduction. This technique provided functional stability, improved esthetics, and increased patient satisfaction.

CLINICAL SIGNIFICANCE

With careful planning and precise execution, the gradual incorporation of digitally guided orthodontic-restorative planning, in conjunction with CAD/CAM technology, can simplify the treatment workflow, leading to accuracy and predictability in complex rehabilitation cases. How to cite this article: Tapananon A, Kamolroongwarakul P, Buranaprasertsuk P. Minimally Invasive Multidisciplinary Management of Tetracycline-stained and Congenitally Missing Teeth. J Contemp Dent Pract 2025;26(5):512-518.