Diagnosis: Dental Problems.
Treatment: Dental/Orthodontic Procedure.
The insurer denied braces and monthly visits.
The denial is overturned.

The patient is a male presenting with a skeletal Class I malocclusion and significant spacing. He has a 50% deep bite. He is missing teeth 4, 5, 12, 13, 20, 21, 28, and 29. Primary teeth A, I, J, K, L and T are retained. He is treatment planned for orthodontics to address the spacing and missing teeth. The treatment was denied due to lack of medical necessity.

This treatment is medically necessary.
This patient has oligodontia, which is a more significant form of hypodontia involving agenesis of 6 or more teeth. This patient is missing 8 out of 28 of his permanent teeth (not counting 3rd molars). Several primary teeth are retained but they will not last. Chewing efficiency will be severely compromised if at least some of these teeth aren't planned for replacement - but a multidisciplinary approach involving orthodontics is necessary to ensure proper space creation for the replacement teeth. It is classified as a craniofacial developmental anomaly.
Hypodontia, or tooth agenesis, is the most prevalent craniofacial malformation in humans. Excluding third molars, the reported prevalence of hypodontia ranges from 1.6 to 6.9%, depending on the population studied. Hypodontia individuals often present a significant clinical challenge for orthodontists because, in a number of cases, the treatment time is prolonged, and the treatment outcome may be compromised. Due to the functional problems of the many missing teeth and inevitable loss of the retained primary teeth a combined ortho-prosthetic treatment plan is necessary to restore function. In order for future treatment to be successful this requires orthodontic intervention to create proper space for the replacement teeth.