Hypodontia: Ateamapproach to Management: Book Review

Hypodontia: Ateamapproach to Management: Book Review
Fazal Ghani1

How to CITE:

Ghani F.HYPODONTIA:ATeamApproach toManagement:BookReview. JPakDentAssoc. 2012 (01): 53 – 55


This book reflects the collective team skills and experience of what is probably the worlds’ first multi-disciplinary hypodontia clinic which was established by Professor Hobkirk at the Eastman Dental Hospital London in 1977. It provides unique repository of knowledge for clinicians called upon to help individuals and their families affected by the condition. This writing is comprehensive and describes and explains the condition of hypodontia and its clinical management using current information, best practice and a problem based approach.

To me, the need for a book on hypodontia is obvious. Firstly, despite considerable expansion of our knowledge about the etiology and prevention of birth defects affecting the dental and oral development, a rising trend for the condition of hypodontia has been noted in the twentieth century, a pattern expected to continue. Secondly, hypodontia is seen in all ethnic groupswith a greater prevalence in the Chinese and Asian communities. These groups form a major part of the global population. Given that the anticipated global prevalence for hypodontia well over 5% its management in an increasingly dental aware world represents a major challenge. Thirdly, patients with hypodontia not only require lifelong holistic dental care that ismainly of restorative and aesthetic nature, also frequently require a lifetime support from a range of clinicians. This requires the provision of dental care services, to patients with hypodontia, by knowledgeable, well-trained and skilled dental manpower covering a range of primary and secondary specialties. It is particularly important in view of the significant challenges in achieving form, function and desired dento-facial aesthetics, in general and specifically in patients with hypodontia. This book clarifies both the scientific background to the condition as well as the practicalities of dental treatment services to patients with hypodontia. It succeeds in advocating a multidisciplinary and holistic team approach to the treatment of these patients. This book, by implication, also supports the establishment of a new dental specialty dealing with the understanding and management of issues related to congenital and birth defects affecting dento-facial development.

The tone of the book is thoughtful with evidence carefully documented. By intent some material is repeated in different sections to facilitate a continuity of reading without the need for forward and backward switching to text and references. This also ensures the interest of the reader and makes the practitioner cognizant of the importance of the research base for improved patientmanagement. The organization of the reading facilitates the establishment of basic knowledge of the condition, its key issues and features and a phase-wise approach to itsmanagement.Theway inwhich the information has been presented will surely advance the wisdom and skill that is necessary for practice in the field of hypodontia.

All including clinicians undergraduate and graduate students, specialists’ trainees and registrars, general dental practitioners and concerned dental specialists involved in the management of patients with hypodontia will find this book very useful.With its fluent writing style and informative material, the readers will find themselves deeply absorbed. With well-chosen clinical cases of both simple and complex nature and the consideration of relevant analytical, interpretational and management issues, the authors have succeeded in removing speculation from planning the restoration of dental aesthetics and function for these patients. The text and descriptions are very clear and generously supported by key-point boxes, tables, diagrams and figures in addition to well-over 200 very relevant, clear and high quality original-colored clinical pictures together with radiographs depicting conditions and treatment outcomes. The book is also very valuable for researchers and clinicians due to the inclusion of significant references including recent publications, which are referenced in the text and listed at the end of each chapter. The authors of the book are widely regarded as some of the most senior experts and specialists in their respective fields, as is evident from the material included in the text’s three sections and nine chapters. These comprehensively examine hypodontia and its management. The authors first present the relevant background epidemiological and aetiological information of the condition as well as information on its inheritance patterns, syndromic associations and clinical features. They then emphasize the importance of a multidisciplinary approach to the care of patients with the condition. In the next section, detailed consideration is given to key issues influencing themanagement of hypodontia. The text and illustrations given in this section develop the reader’s understanding of the problems related to undesirable spaceswithin and between dental arches, occlusal issues and the complications that can arise in the supporting tissues. The authors have very rightly used the third section to apply the information of the earlier sections and bringing this together in the context of treating patients with hypodontia. This greatly assists the reader to understand the level of contribution of the various dental specialists in the hypodontia team during the various developmental stages of the dentition. Recognizing the fact that treatment effectively remains a lifetime continuum, they have considered three broad groups of patients; the primary / early mixed dentition, the late mixed dentition / early permanent dentition and lastly hypodontia patients with an established dentition. Each chapter, in this section, addresses three main themes: issues specifically related to the age group in question; the multidisciplinary management of patients in the age group with mild, moderate and severe hypodontia; and finally longitudinal examples of the treatment of patients in each of the selected groups.

No doubt managing patients with hypodontia is done mainly with dental restorations or orthodontic and prosthodontic appliances and the criteria to be fulfilled with their provision is that they would have restituted tooth form and function in harmony with the biological environment. To further achieve desired oral environment for the placement of dental restorations and appliances, the authors have very rightly elaborated upon the intraoral pre-prosthetic surgical considerations and options that are required in patients with hypodontia.While for most patients, these could be considered the only required management options, however, in some patientswith hypodontia, reconstructive and plastic surgical interventions may also be required to optimize extraoral hard and soft tissue factors. Such interventions can improve overall facial cosmetics and the achievement of harmony between the form and function of teeth and their biological environment. This is however, not an aspect of care covered in detail in the text, although reference is made to the inclusion of a maxillofacial surgeon in the team. Soft tissue management options and smile correction procedures including surgicalmaxillary impaction or lengthening procedures, lip-switch surgery, nasolabial reconstructive plastic surgery, orthognathic, and alternative periodontal-prosthodontic procedures could perhaps have been considered for inclusion. I suggest that in the next edition consideration should be given to the inclusion of material on the reconstructive and plastic surgical options that may be required in specific situations in patients with hypodontia. This would help to familiarize less experienced practitioners and team members with the concept of including access to a facial plastic surgeonwithin the team’s skillmix.

Despite this personal comment, I strongly recommend this excellent and comprehensive book on hypodontia for acquisition by all medical and dental libraries. Personal copies would be, specially, valuable for specialist trainees in the various disciplines involved in the management of the condition aswell as senior undergraduates and dental practitioners.