|Year : 2019 | Volume
| Issue : 3 | Page : 170-172
Esthetic rehabilitation for premature loss of primary anterior teeth
Paridhee Jalan, Aindrila Ghosh, Shabnam Zahir, Gautam Kumar Kundu
Department of Pedodontics and Preventive Dentistry, Guru Nanak Institute of Dental Sciences and Research, Kolkata, West Bengal, India
|Date of Submission||14-Jul-2019|
|Date of Acceptance||03-Sep-2019|
|Date of Web Publication||15-Oct-2019|
Dr. Paridhee Jalan
Department of Pedodontics and Preventive Dentistry, Guru Nanak Institute of Dental Sciences and Research, 157/F, Nilgunj Road, Panihati, Kolkata - 700 114, West Bengal
Over years primary anterior teeth have been prematurely lost due to Early Childhood Caries and trauma. While in the past once lost primary teeth could not be replaced, now due to increased aesthetic demands of the patient and their family, different fixed functional space maintainers have come to the forefront for aesthetically rehabilitating prematurely loss deciduous anterior teeth. This case report discusses how an avulsed deciduous maxillary anterior teeth was replaced in a three and a half year old male patient using a fixed functional space maintainer.
Keywords: Aesthetic rehabilitation, fixed functional space maintainer, primary anterior teeth
|How to cite this article:|
Jalan P, Ghosh A, Zahir S, Kundu GK. Esthetic rehabilitation for premature loss of primary anterior teeth. SRM J Res Dent Sci 2019;10:170-2
|How to cite this URL:|
Jalan P, Ghosh A, Zahir S, Kundu GK. Esthetic rehabilitation for premature loss of primary anterior teeth. SRM J Res Dent Sci [serial online] 2019 [cited 2020 Aug 15];10:170-2. Available from: http://www.srmjrds.in/text.asp?2019/10/3/170/269218
| Introduction|| |
Our smile is a universal welcome to people around, and teeth form an important part of one's smile and facial esthetics.
The premature loss of primary anterior teeth not only affects a child's developing dentition but raises various physiological and psychological concerns as well. Early childhood caries and trauma to dentition are the primary reasons for the premature loss of deciduous maxillary anterior teeth apart from few systemic diseases in infants and toddlers. Deciduous maxillary anterior teeth are important not only for the esthetics but also for tearing of food; for speech in the pronunciations of tongue-tip consonants such as t, d, s, sh, and ch and labial sounds such as f and v; for maintaining integrity of the dental arch as well as for a child's morale. Due to the absence of anterior teeth, there are chances of development of abnormal habits and subsequent malocclusions. Even though the loss of deciduous anterior teeth causes minimal space issues, due to other problems posed by its loss, it is advisable to replace it with a space maintainer. While removable space maintainers are less acceptable in children due to problems with maintenance of oral hygiene and depending on the child's compliance to wear it, fixed space maintainers are preferred. In recent times due to increasing demands of esthetics from the parents, fixed functional space maintainers are the ideal choice to replace a prematurely exfoliated deciduous anterior teeth.
The following case report discusses an approach which can be used for fabrication of anterior fixed functional space maintainer.
| Case Report|| |
A 3½-year-old male patient along with his parents reported to the Outpatient Department of Department of Pedodontics and Preventive Dentistry, GNIDSR, Kolkata, with the chief complaint of missing upper front tooth.
On taking a history, the parents revealed that the kid had suffered trauma from falling of the stairs 4–5 months back. The fall led to complete loss of the upper anterior teeth. The child would abstain from talking to friends and taking part in school activities as he was constantly made fun of by his classmates due to the missing tooth. They thus wanted to get the missing tooth replaced.
On clinical [Figure 1] and radiographical examination [Figure 2], it was observed that there had been an avulsion of 51. A fixed functional space maintainer was planned for the child. The parents were explained about the treatment planned for their child and proper written consent was taken from them. Orthodontic molar bands of appropriate size were selected and placed on 55 and 65. Alginate impression was taken with the bands and the bands were stabilized with bobby pins before pouring dental stone into the impression to obtain a dental cast. Alginate impression of the mandibular arch was also taken and cast was poured to help with the tooth setting.
Twenty gauge stainless wires were then used to form a u-shaped component similar to that of the Nance palatal arch running from 55 to 65. It was then soldered onto the two molar bands. Acrylic tooth of suitable shade was trimmed to appear esthetically pleasing and as close to corresponding deciduous maxillary anterior teeth as possible. Small holes were made on a palatal aspect of the teeth to allow better flow of heat cure acrylic resin and thus improved retention. The teeth were then attached to the modeling wax and wax-up was done [Figure 3]. Care was taken to minimize the wax-up in the palatal and gingival region to make the appliance less bulky and more acceptable to the child.
The appliance was then tried into the patient's mouth, and only after it was acceptable to the patient and his parents comfort wise and esthetically, it was acrylization. The appliance was then flasked and dewaxed followed by heat curing the acrylic. After the required trimming, finishing, and polishing, the appliance was again tried in the child's mouth to confirm the occlusion and esthetics and then was luted onto 55 and 65 with luting glass ionomer cement (Fuji I) [Figure 4]. The child and his parents were highly pleased and satisfied with the new appliance.
The patient was advised on maintaining proper oral hygiene. First recall of the patient was done after 24 h followed by checkup every 3 months. The child and parents were satisfied with the replacement of his lost teeth.
The parents were informed that the appliance would be removed around the age of 6–7 years, to prevent interference of erupting permanent successors. The parents were also advised to return immediately in case there was any problem with the space maintainer, including distortion or breakage.
| Discussion|| |
Northway et al., 1984, stated that the progress of children in school and their psychological wellbeing can be adversely influenced by the condition of their anterior teeth, and thus, premature loss of deciduous anterior teeth should also be considered and given importance.
Space that is created by the early loss of tooth in the dental arch has a tendency to close by the adjacent teeth. After the premature loss of deciduous maxillary anterior teeth, the permanent successors may be proclined, and thus, there may be an increased arch length or perimeter. Northway et al. stated that more space was lost in the 1st year of extraction than in successive years.
Waggoner and Kupietzky, 2001, stated that changes in arch length with tooth migration generally occurred after the eruption of the first permanent molar which coincides with the eruption of the central incisors, at which time the anterior appliance can be removed.
Aswanth et al., 2014, gave an anterior fixed functional space maintainer, similar to the one mentioned in this case report following extraction of severely decayed 51, 52, 61, and 62 to a 4½-year-old boy following complaints of unpleasant look, undernourishment, and alteration in speech. According to them, esthetic space maintainer has been found to have a much wider acceptability and compliance of wearing the appliance by a young child patient. It is a solution to pediatric anterior edentulous arches with compromised speech, esthetic, and behavior of the child including poor social acceptance. Limitations such as long-term follow-up, improper oral hygiene maintenance, and frequent breakage can be decreased by proper education and motivation of the child and the parents. A popular modification for the design of anterior fixed functional space maintainer was given by Jasmin and Groper in 1984 where the acrylic teeth were attached to metal cleats or brackets which were then soldered to the palatal wire instead of attaching it to the acrylic flange as was seen in this case report. Their design has the advantage of minimal palatal coverage with superior oral hygiene maintenance.
One of the major advantages of the appliance used in this case was reduced palatal coverage as well as improved anterior fit due to its modified ridge lap design. This design is simple to construct and can be used for the esthetic rehabilitation of prematurely lost deciduous anterior teeth.
| Conclusion|| |
The premature loss of a primary anterior tooth is an important factor behind the development of speech defects and loss of confidence in children. Early intervention can prevent psychosocial problems from developing in children because of the early loss of primary teeth. Restoration of anterior esthetics and function with these appliances gave a huge psychological boost to both the child and the parents.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
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Khare V, Nayak PA, Khandelwal V, Nayak UA. Fixed functional space maintainer: Novel aesthetic approach for missing maxillary primary anterior teeth. BMJ Case Rep 2013;2013 Pii: bcr2013009585.
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Northway WM, Wainright RL, Demirjian A. Effects of premature loss of deciduous molars. Angle Orthod 1984;54:295-329.
Waggoner WF, Kupietzky A. Anterior esthetic fixed appliances for the preschooler: Considerations and a technique for placement. Pediatr Dent 2001;23:147-50.
Jasmin JR, Groper JN. Fabrication of a more durable fixed anterior esthetic appliance. ASDC J Dent Child 1984;51:124-7.
[Figure 1], [Figure 2], [Figure 3], [Figure 4]