Innovative Temps Improve the Confidence of a Teen with Anodontia.
When patients undergo cosmetic dentistry, it’s often an emotional transformation. Even after just the temporaries are seated, patients usually see a dramatic change. The old dentistry is gone and is replaced with a stunning approximation of the final results. Many patients break down and tear up when they see their new smiles. Fifteen-year-old Taya Deitlaf’s case was no exception. After Taya’s temps were seated, there wasn’t a dry eye in the operatory.
Taya’s case, however, was anything but typical. When Taya was about three years old, her mom, Holly, took her to a dentist for her first exam. The results from the X-rays surprised everyone—even the dentist. Holly remembered, “The dentist was so shocked and he told me that this was one for the record books. He said that the X-rays only showed two permanent teeth—her two front teeth. The rest of the X-ray [where the permanent teeth would normally appear] was dark. There was nothing there.”
A Rare Disorder
Taya was born with anodontia, which is a rare condition. Taya has only two permanent teeth (tooth numbers 8 and 9) that came in when she was in kindergarten. After learning about her daughter’s condition, Holly remarked, “He [the dentist] was just so shocked and didn’t have a solution. He told me, ‘We’re not quite sure what to do from here.’”
After a few years, Taya’s family moved and she visited a different pediatric dentist. But that dentist hadn’t encountered Taya’s condition either, and he was also unsure how to help her. That dentist worked hard to protect Taya’s primary teeth and told her to wait until she was older before doing anything in terms of a permanent solution.
Holly learned that once Taya was 18 or 19 years old and had stopped growing, she could get full mouth implants (also known as All-On-Four® implants). In the future, the implants would function as a permanent replacement for her missing teeth. In the meantime, 15-year-old Taya was suffering with primary teeth that were too small for her mouth.
Being self-conscious about her small primary teeth, Taya refused to smile with her teeth showing in photographs. She explained, “It was kind of embarrassing to smile. I didn’t like the way my teeth looked. I probably would have smiled with my teeth if someone really pushed it, but given the choice, I wouldn’t ever show my teeth.”
Holly said, “To us, it wasn’t that big of a deal. Of course, Taya is beautiful no matter what. But for Taya, it affected her confidence, and that was really concerning.” To make matters worse, Taya would grind her teeth at night. Holly remembered, “She had to wear a bite guard [orthotic] at night because she was cracking her teeth from grinding so hard.” Holly worried that Taya could lose some teeth despite the orthotic.
Searching for Answers
Both Holly and Taya hoped something could be done to help Taya’s dental health concerns before she reached adulthood. Holly said, “Her situation is so extreme, no one had actually seen it. They may have read about it in school, but none of the dentists we visited with had actually seen a case like Taya’s. We were frustrated that there wasn’t a clear solution for Taya until she was much older.”
A Maverick Solution
Holly and Taya were in a state of limbo until Taya’s aunt approached Peggy Nelson, the Director of Business Development at Arrowhead Dental Laboratory in Salt Lake City, UT, about the case. When Peggy learned about the situation, she immediately contacted Dr. Britton from Arlington, TX.
Dr. Britton is the instructor for the Removables Course and the Sleep Course for the Dr. Dick Barnes Group seminars. After hearing about Taya, Dr. Britton flew from Texas to Utah to meet her. During their first visit, Dr. Britton thought about his own daughter and he empathized with the young patient. Taya explained that she was nervous at the prospect of entering high school with just her “baby” teeth. Dr. Britton said, “I’m not sure exactly what we’re going to do, but we’re going to come up with a solution so you don’t have to go into high school with the same smile.”
Dr. Britton reached out to Arrowhead’s Technical Consultant LaMont Carpenter and Cosmetic Reconstruction Specialist Erik McKinnie—both of whom he had worked with for several years. He also contacted an oral surgeon for his suggestions and input, and took a cone beam X-ray. Dr. Britton was confident that with the help of these expert minds, they could come up with a viable option for Taya while she was still growing.
As they brainstormed about potential treatments, the team had to contend with Taya’s sleep issues and bruxism. In addition, they needed to make something that would last until she was old enough to receive permanent implants. They needed to open her bite and move the mandible forward. They also planned for minor tissue contouring to get more tooth structure for retention, and to make her smile more even throughout the buccal corridor.
Contouring the tissue was somewhat problematic because of the crown-to-root ratio with the primary teeth. Dr. Britton would have to laser back the tissue as much as possible without compromising the root. Ultimately, he wasn’t able to do much crown lengthening on most of Taya’s posterior teeth. The team decided to try a set of acrylic removable temporaries on Taya to make sure that she could tolerate the new vertical and mandible position, and to confirm that the temps were aesthetically pleasing. Taya wore the acrylic temps for approximately two weeks.
While wearing them, Taya had a bit of a lisp when speaking, so she practiced reading out loud and wore them as much as possible to familiarize herself with the function and feel of her new smile. The patient reported that the quality of her sleep improved. She said, “I immediately noticed that I didn’t wake up as much in the middle of the night when I was wearing them.”
After a series of additional appointments, Dr. Britton decided they would put Snowcaps™ (long-term provisional temporaries made from Radica®) on Taya’s primary teeth. The restorations would completely cover the primary teeth and would be bonded on so they wouldn’t come off. Taya could wear the Snowcaps™ for two to three years, at which time she would be old enough for full mouth implants.
Erik built Taya’s restorations in segments—three for the upper arch and three for the lower arch. The segmented Snowcaps™ could be removed and replaced if Taya’s dentition shifted or moved while she was still growing, or if there were any other issues (such as cracking or pain) with the temporary restorations.
Seating the actual Snowcaps™ was a relatively quick procedure—it only took about two hours. Taya said, “I really didn’t feel much of anything. My gums were a little sore the next day, but that was it!” For the big reveal, Dr. Britton asked Taya to close her eyes. He then helped Taya walk towards the mirror in the operatory. Taya’s mom and dad, Dr. Britton’s team members, Peggy Nelson, and a few other Arrowhead employees were watching closely. Taya said, “When I opened my eyes, it was crazy! I was super happy. It looked amazing. And everyone in the room was crying.” A day later, Dr. Britton checked on Taya’s smile and made only minor adjustments. She was still beaming from the day before.
Worth the Wait
Today, Taya says that she couldn’t be happier that Dr. Britton and Arrowhead found a temporary solution for her while she is still young. She said, “The best thing is having teeth that look like they fit in my mouth. More than a few people have said, ‘You got your braces off!’ I have to laugh because it was much more than braces, but I just love my new smile!” In addition to improving her aesthetics, Holly reports that with the Snowcaps™, Taya doesn’t grind her teeth like before, and now wakes up refreshed.
To maintain her restorations, Taya uses a Waterpik® every day because she can’t floss the Snowcaps™ like regular teeth, but she doesn’t mind. She brushes them every day like regular teeth, and she can eat things that she previously avoided when she just had her primary teeth. Her overall confidence is soaring, and she is willing to smile with her teeth showing in photos now.
Going forward, Dr. Britton plans to check up on Taya every few months to make sure that everything is functioning properly. If any adjustments are needed, he can address them immediately. The Snowcaps™ will help Taya look and feel her best during her teenage years.
Holly said that she is grateful they found a doctor who has a good relationship with expert professionals, because their combined expertise solved a unique dilemma—one that had stymied other doctors. She said, “It is such a relief to have a solution after years of wondering if anything could be done. Having Taya feel healthy, happy, and confident made it all worth it. We’re so grateful to Dr. Britton and his team members, and to Arrowhead Dental Lab for the hours of problem-solving they put into her case.”