Orthodontic and pediatric dental treatment approach in patient with multiple dental anomalies

The purpose of this clinical case report is to discuss the approach to oral rehabilitation of a patient with severe dental alterations such as enamel hypoplasia, change in shape, supernumerary tooth, dental ankylosis, agnesia and crowing in the incisor region. All of these problems compromised not only the esthetical and functional aspects of this patient, but his social relationships as well. Thus integrated planning between Pediatric Dentistry and Orthodontics made it possible to provide the best treatment alternative to recover the patient's stomatognathic system. Esthetic restorations were performed in the anterior tooth region with the use of resin composites, in addition to the use of removable orthodontic appliances, associated with serial extractions and supernumerary tooth removal. There were significant improvements in the esthetic and functional aspects of dentition, in addition to the patient demonstrating good evolution in his psychosocial condition, as he smiled and was more communicative during each follow-up appointment, also according to his mother's reports.

本临床病例报告旨在探讨伴有多种重度牙体异常患者的口腔康复策略。该患者切牙区存在牙釉质发育不全（enamel hypoplasia）、牙体形态改变、多生牙（supernumerary tooth）、牙固连（dental ankylosis）、agnesia及牙列拥挤（crowding，原文crowing为笔误）等问题。上述异常不仅累及患者的咬合功能与面部美观，更对其社交活动造成不良影响。为此，儿童牙科学（Pediatric Dentistry）与正畸学（Orthodontics）联合制定综合诊疗方案，为该患者实现了口颌系统（stomatognathic system）功能恢复的最优治疗选择。治疗过程中，在前牙区采用复合树脂（resin composites）完成美学修复，同时联合使用可摘正畸矫治器（removable orthodontic appliances），并配合序列拔牙（serial extractions）与多生牙拔除术（supernumerary tooth removal）。随访结果显示，患者牙列的美观与功能均得到显著改善；此外，患者的社会心理状态亦呈现良好转归：在每次随访就诊（follow-up appointment）中，其笑容更为自然，沟通意愿显著提升，其母亲亦证实了这一变化。