Byline: K. Aswanth, Sharath. Asokan, Baby. John
Restoration of primary maxillary incisors severely damaged by caries or trauma is a clinical challenge for pedodontist. In the past, the only treatment option would have been to extract the affected teeth and replace them with prosthetic substitutes. Various therapeutic modalities from removable partial dentures to fixed space maintainer can be used for replacement of such lost teeth. The purpose of this paper was to describe the rehabilitation of primary anterior and posterior teeth in a 5-year-old child using fixed functional space maintainer. It constituted a design, whereby the maxillary primary second molars were used to support the appliance through bands and a wire that contained an acrylic flange bearing trimmed acrylic teeth, both anteriorly and posteriorly. The appliance was both functional and aesthetical.
Early childhood caries (ECC) and dental trauma are the main reasons for premature loss of both anterior and posterior teeth during the infancy and toddler period. Early loss of maxillary incisors due to caries is very common in young children. [sup] Premature tooth loss in anterior incisal segment usually causes minimum space loss and a linguodistal inclination of the teeth, resulting a collapse of the anterior lingually. Apart from this collapse, closure of the space and shift of midline can also occur (Barber). [sup] It can also lead to parafunctional habits as well as altered behavior pattern including depression and increased shyness of a child, which leads to less friendly and non-acceptable daily lifestyle. [sup] These negative effects of anterior tooth loss affects the patient's quality of life and reduces level of confidence. [sup] The lingual sides of anterior teeth, which are required by the tongue for certain phonations, may result in improper speech. The pronunciations of tongue-tip consonants ("t," "d," "s," "sh," and "ch") and labial sounds ("f " and "v") are affected. The development of abnormal tongue habits and hence subsequent malocclusion is also possible. So, the space should be maintained functionally as well as aesthetically by a suitable space maintainer depending on the dental age of the patient. [sup] The space maintainer may be of removable, fixed or semi-fixed, and functional or nonfunctional type. Fixed space maintainers are always acceptable in children as they have less desire to wear removable ones. The removable space maintainers cover large area of oral tissue causing irritation to ulceration.
Reasons for replacement with a prosthetic device are often based on concerns about space maintenance, esthetics, and speech development. Poor dietary habits develop due to child's inability to chew and eat well, following dental extractions. [sup]
In recent times, however, parental pressure for esthetics has become the most common reason for fabrication of partial dentures in children. Parents who...