Interdisciplinary Orthodontic Management of Class II Severe Hypodontia Using Improved Super-Elastic Ti-Ni Alloy Wire

This case report presents the orthodontic management of a 23-year-old male with severe hypodontia, specifically the congenital absence of all premolars and bilateral peg laterals. The patient sought treatment due to dissatisfaction with previous orthodontic outcomes, characterized by noticeable spacing in the upper anterior region. Clinical evaluation revealed a skeletal Class II relationship and several dental anomalies, prompting the need for an interdisciplinary approach. The patient was treated using an improved super-elastic Ti-Ni alloy wire (ISW), which provided consistent light continuous forces, high elasticity, and super-elastic properties beneficial for controlling tooth movement in patients with missing teeth and anchorage limitations. The primary objectives were to improve occlusion, overbite, and overjet while preparing for future prosthodontic rehabilitation. The treatment plan included the extraction of non-restorable teeth, application of full-mouth brackets, and strategic orthodontic alignment. Resin restorations enhanced the aesthetics of the peg laterals, and space maintenance was carefully managed throughout the treatment. After 37 months of active treatment, significant improvements were observed, including the closure of anterior spaces and optimal alignment of the teeth. Radiographic assessments confirmed ideal root parallelism. This case highlights the complexities of managing severe hypodontia and underscores the importance of tailored orthodontic strategies and interdisciplinary collaboration in achieving functional and aesthetic outcomes.