Pedodontics Premature Loss of Teeth Lecture 15

Pedodontics Premature Loss of Teeth Lecture 15

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Questions and Answers

What is recommended when the first permanent molar is lost after the eruption of the second molar?

Orthodontic evaluation

What is the consequence of not treating the loss of the first permanent molar?

The second molar will move forward within weeks

What is one of the options to consider for replacing the first permanent molar?

Auto transplantation of the third molar

When is it more satisfactory to move the second molar forward into the area formerly occupied by the first molar?

<p>Even though there will be a difference in the number of molars in the opposing arch</p> Signup and view all the answers

What must be done if a child needs corrective treatment other than in the area of the first permanent molar?

<p>Consider maintaining space for a replacement prosthesis</p> Signup and view all the answers

What should be done if the first permanent molar is lost several years before the eruption of the second permanent molar?

<p>Leave the space empty</p> Signup and view all the answers

Which option should be avoided when managing patients with loss of first permanent molars?

<p>Removing all molars</p> Signup and view all the answers

What can compensate for any difference in the number of molars in the opposing arch when moving the second molar forward?

<p>Third molar removal</p> Signup and view all the answers

What is one advantage of auto transplantation of third molars into first molar positions?

<p>Normal occlusion restoration possible</p> Signup and view all the answers

What should be considered if a patient requires prosthetic replacement due to loss of first permanent molars?

<p>Include orthodontic evaluation and decide on maintaining space for replacement prosthesis</p> Signup and view all the answers

What is the most important unit of mastication and essential in the development of desirable occlusion?

<p>First permanent molar</p> Signup and view all the answers

What can rapidly progress from an incipient lesion to pulp exposure in a 6-month period?

<p>First permanent molar</p> Signup and view all the answers

What happens to the second molars after the loss of the first permanent molar in children aged 8-12?

<p>They drift mesially</p> Signup and view all the answers

What happens if the loss of the first permanent molar occurs after the eruption of the second permanent molar in older children?

<p>Exaggerated mesial tipping of second molar</p> Signup and view all the answers

What is one effect if the maxillary first permanent molar loses its opponent?

<p>Maxillary premolars move distally in unison</p> Signup and view all the answers

What changes can occur in dental arches after the loss of the first permanent molar?

<p>Diminished local function</p> Signup and view all the answers

What can be recommended if it is occasionally necessary to extract all primary teeth in a preschool child?

<p>Wear complete denture before eruption of permanent teeth</p> Signup and view all the answers

What starts to rotate as they fall distally after the loss of the first permanent molar?

<p>Maxillary premolar teeth</p> Signup and view all the answers

Which teeth exhibit a tendency to move distally in unison after the loss of the first permanent molar?

<p>Maxillary lateral incisors</p> Signup and view all the answers

What is essential for development and maintenance of desirable occlusion?

<p>First permanent molar</p> Signup and view all the answers

What is the effect of losing the first primary molar as the first permanent molar erupts at age 5-7 years?

<p>Compromised mandibular arch length due to shifting of anterior teeth</p> Signup and view all the answers

What can happen if a second primary molar is lost in a child aged 2-5 years?

<p>No space loss while first permanent molar is in basal bone</p> Signup and view all the answers

What is the recommended management when the first primary molar is lost after the first permanent molar has erupted into occlusion?

<p>Unilateral band or crown and loop appliance</p> Signup and view all the answers

What is indicated for bilateral loss of the primary first molar and retention of the second primary molar in the lower arch?

<p>Distal shoe space maintainer</p> Signup and view all the answers

What happens if a second primary molar is lost after normal cuspal interdigitation has been established?

<p>Minimal space loss regardless of the arch involved</p> Signup and view all the answers

What type of appliance is recommended if a second primary molar is lost just before the eruption of the first permanent molar?

<p>Distal shoe space maintainer</p> Signup and view all the answers

What may lead to mutilation of developing dentition if not addressed properly?

<p>Early loss of primary molars</p> Signup and view all the answers

What is the effect of losing the first primary molar during ages 3-5 years in terms of space loss?

<p>Minimal or no space loss due to mesial movement of second primary molar</p> Signup and view all the answers

What is indicated when managing bilateral mixed dentition space in the mandibular arch?

<p>Bilateral mixed dentition space maintainer with passive lingual arch</p> Signup and view all the answers

Premature loss of first primary molar can lead to _______ force exerted that pushes the second primary molar forward into the first primary molar space

<p>strong</p> Signup and view all the answers

Loss of second primary molar before the eruption of first permanent molar may require a _______ shoe appliance to guide positioning of the first permanent molar

<p>distal</p> Signup and view all the answers

The effect of losing the second primary molar depends on the state of eruption of the first _______ molar

<p>permanent</p> Signup and view all the answers

Loss of multiple primary molars may lead to mutilation of _______ dentition

<p>developing</p> Signup and view all the answers

If the first permanent molars erupt, considerable loss in _______ length can occur if no second primary molar is present as an eruptive guide

<p>arch</p> Signup and view all the answers

For bilateral loss of primary first molar and retention of the second primary molar in the lower arch, two separate unilateral loop appliances are indicated until first permanent molar and _______ eruption is complete

<p>incisor</p> Signup and view all the answers

Loss of multiple primary molars may lead to mutilation of _______ dentition unless an appliance is constructed

<p>developing</p> Signup and view all the answers

Loss of multiple primary molars may lead to _______ of developing dentition unless an appliance is constructed

<p>mutilation</p> Signup and view all the answers

The degree of space loss should be less dramatic if the loss of second primary molar occurs after the first permanent molar has fully erupted and normal _______ interdigitation has been established

<p>cuspal</p> Signup and view all the answers

Premature loss of first primary molar may cause a loss of posterior arch length within the quadrant that can lead to _______ as the canines and premolars erupt in later stages

<p>crowding</p> Signup and view all the answers

The alveolar process is also carried along with ______ and cause problems when prosthetic replacement needed.

<p>molar</p> Signup and view all the answers

1- if first permanent molar removed several years before eruption of second permanent molar, there is excellent chance that second molar erupt in ______ position.

<p>acceptable</p> Signup and view all the answers

When first permanent molar is lost after the eruption of second permanent molar, orthodontic evaluation indicated and the following steps indicated: is a child is need of corrective treatment other than in first permanent molar ______?

<p>area</p> Signup and view all the answers

Another option to consider is auto transplantation of third molar into first molar ______.

<p>position</p> Signup and view all the answers

Without treatment, second molar will tip forward within a matter of ______.

<p>weeks</p> Signup and view all the answers

Should the space be maintained for a replacement ______?

<p>prosthesis</p> Signup and view all the answers

Should the second molar be moved forward into the area formerly occupied by first ______?

<p>molar</p> Signup and view all the answers

The latter choice is more satisfactory, even though there will be difference in number of molars in the opposing arch, a third molar can often be removed to compensate for the ______.

<p>difference</p> Signup and view all the answers

What is recommended when the first permanent molar is lost after the eruption of the second permanent ______?

<p>molar</p> Signup and view all the answers

What is one effect if the maxillary first permanent molar loses its ______?

<p>opponent</p> Signup and view all the answers

A carious lesion may develop rapidly in the first permanent molar and progress from incipient lesion to pulp exposure in a __-month period

<p>6</p> Signup and view all the answers

The loss of the first permanent molar in a child can lead to changes in dental arches that can be traced throughout the child’s life. Unless corrective measures are taken, these changes include diminished local function, drifting of teeth, and continued eruption of opposing teeth. The second molars, even if unerupted, start to drift mesially after the loss of the first permanent molar, causing a greater degree of forward bodily movement especially in 8-12 years old children. Unless corrective measures are taken, in older children, if the loss occurs after the eruption of the second permanent molar, more exaggerated mesial tipping of the second molar can be the expected outcome. Although the premolars undergo the greatest amount of distal drifting, all teeth anterior to the space, including central and lateral on the side where the loss occurred, may show evidence of movement. Contact open and the premolars, in particular, rotate as they fall distally. There is a tendency for maxillary premolars to move distally in unison, whereas those in the lower arch move separately. When the maxillary first permanent molar loses its opponent, it erupts at a faster rate than adjacent teeth.

<p>6</p> Signup and view all the answers

The first permanent molar is the most important unit of mastication and essential in the development of desirable __

<p>occlusion</p> Signup and view all the answers

Loss of the first permanent molar can lead to a change in dental arches that can be traced throughout the child’s life. Unless corrective measures are taken, these changes include diminished local function, drifting of teeth, and continued eruption of opposing teeth. The second molars, even if unerupted, start to drift mesially after the loss of the first permanent molar, causing a greater degree of forward bodily movement especially in 8-12 years old children. Unless corrective measures are taken, in older children, if the loss occurs after the eruption of the second permanent molar, more exaggerated mesial tipping of the second molar can be the expected outcome. Although the premolars undergo the greatest amount of distal drifting, all teeth anterior to the space, including central and lateral on the side where the loss occurred, may show evidence of movement. Contact open and the premolars, in particular, rotate as they fall distally. There is a tendency for maxillary premolars to move distally in unison, whereas those in the lower arch move separately. When the maxillary first permanent molar loses its opponent, it erupts at a faster rate than adjacent __

<p>teeth</p> Signup and view all the answers

When the maxillary first permanent molar loses its opponent, it erupts at a faster rate than adjacent __

<p>teeth</p> Signup and view all the answers

In older children, if the loss of the first permanent molar occurs after the eruption of the second molar, more exaggerated mesial tipping of the second molar can be the expected outcome. Although the premolars undergo the greatest amount of distal drifting, all teeth anterior to the space, including central and lateral on the side where the loss occurred, may show evidence of movement. Contact open and the premolars, in particular, rotate as they fall distally. There is a tendency for maxillary premolars to move distally in unison, whereas those in the lower arch move separately. When the maxillary first permanent molar loses its opponent, it erupts at a faster rate than adjacent __

<p>teeth</p> Signup and view all the answers

The loss of the first permanent molar in a child can lead to changes in dental arches that can be traced throughout the child’s life. Unless corrective measures are taken, these changes include diminished local function, drifting of teeth, and continued eruption of opposing teeth. The second molars, even if unerupted, start to drift mesially after the loss of the first permanent molar, causing a greater degree of forward bodily movement especially in 8-12 years old children. Unless corrective measures are taken, in older children, if the loss occurs after the eruption of the second permanent molar, more exaggerated mesial tipping of the second molar can be the expected outcome. Although the premolars undergo the greatest amount of distal drifting, all teeth anterior to the space, including central and lateral on the side where the loss occurred, may show evidence of movement. Contact open and the premolars, in particular, rotate as they fall distally. There is a tendency for maxillary premolars to move distally in __, whereas those in the lower arch move separately. When the maxillary first permanent molar loses its opponent, it erupts at a faster rate than adjacent teeth.

<p>unison</p> Signup and view all the answers

The loss of the first permanent molar in a child can lead to changes in dental arches that can be traced throughout the child’s life. Unless corrective measures are taken, these changes include diminished local function, drifting of teeth, and continued eruption of opposing teeth. The second molars, even if unerupted, start to drift mesially after the loss of the first permanent molar, causing a greater degree of forward bodily movement especially in 8-12 years old children. Unless corrective measures are taken, in older children, if the loss occurs after the eruption of the second permanent molar, more exaggerated mesial tipping of the second molar can be the expected outcome. Although the premolars undergo the greatest amount of distal drifting, all teeth anterior to the space, including central and lateral on the side where the loss occurred, may show evidence of movement. Contact open and the premolars, in particular, rotate as they fall distally. There is a tendency for maxillary premolars to move __ in unison, whereas those in the lower arch move separately. When the maxillary first permanent molar loses its opponent, it erupts at a faster rate than adjacent teeth.

<p>distally</p> Signup and view all the answers

The loss of the first permanent molar in a child can lead to changes in dental arches that can be traced throughout the child’s life. Unless corrective measures are taken, these changes include diminished local function, drifting of teeth, and continued eruption of opposing teeth. The second molars, even if unerupted, start to drift mesially after the loss of the first permanent molar, causing a greater degree of forward bodily movement especially in 8-12 years old children. Unless corrective measures are taken, in older children, if the loss occurs after the eruption of the second permanent molar, more exaggerated mesial tipping of the second molar can be the expected outcome. Although the premolars undergo the greatest amount of distal drifting, all teeth anterior to the space, including central and lateral on the side where the loss occurred, may show evidence of movement. Contact open and the premolars, in particular, rotate as they fall __. There is a tendency for maxillary premolars to move distally in unison, whereas those in the lower arch move separately. When the maxillary first permanent molar loses its opponent, it erupts at a faster rate than adjacent teeth.

<p>distally</p> Signup and view all the answers

When the maxillary first permanent molar loses its opponent, it erupts at a faster rate than adjacent ______.

<p>teeth</p> Signup and view all the answers

The first permanent molar is the most important unit of mastication and essential in the development of desirable ______. A carious lesion may develop rapidly in the first permanent molar and progress from incipient lesion to pulp exposure in a 6-month period. The loss of the first permanent molar in a child can lead to changes in dental arches that can be traced throughout the child’s life. Unless corrective measures are taken, these changes include diminished local function, drifting of teeth, and continued eruption of opposing teeth. The second molars, even if unerupted, start to drift mesially after the loss of the first permanent molar, causing a greater degree of forward bodily movement especially in 8-12 years old children. Unless corrective measures are taken, in older children, if the loss occurs after the eruption of the second permanent molar, more exaggerated mesial tipping of the second molar can be the expected outcome. Although the premolars undergo the greatest amount of distal drifting, all teeth anterior to the space, including central and lateral on the side where the loss occurred, may show evidence of movement. Contact open and the premolars, in particular, rotate as they fall distally. There is a tendency for maxillary premolars to move distally in unison, whereas those in the lower arch move separately. When the maxillary first permanent molar loses its opponent, it erupts at a faster rate than adjacent teeth.

<p>occlusion</p> Signup and view all the answers

Study Notes

Loss of First Permanent Molar

  • The loss of first permanent molar in a child can lead to changes in dental arches that can be traced throughout the child's life.
  • A carious lesion may develop rapidly in the first permanent molar and progress from an incipient lesion to pulp exposure in a 6-month period.
  • The first permanent molar is the most important unit of mastication and essential in the development of desirable occlusion.

Consequences of Loss of First Permanent Molar

  • Diminished local function
  • Drifting of teeth
  • Continued eruption of opposing teeth
  • The second molars, even if unerupted, start to drift mesially after the loss of the first permanent molar.
  • In older children, if the loss occurs after the eruption of the second permanent molar, more exaggerated mesial tipping of the second molar can be expected.
  • Although the premolars undergo the greatest amount of distal drifting, all teeth anterior to the space, including central and lateral on the side when the loss occurred, may show evidence of movement.
  • Contact opens and the premolars, in particular, rotate as they fall distally.
  • There is a tendency for the maxillary premolar to move distally in unison, whereas those in the lower arch move separately.
  • When the maxillary first permanent molar loses its opponent, it erupts at a faster rate than adjacent teeth.

Management of Loss of First Permanent Molar

  • The treatment of patients with the loss of the first permanent molar must be approached on an individual basis.
  • If the first permanent molar is removed several years before the eruption of the second permanent molar, there is an excellent chance that the second molar will erupt in an acceptable position.
  • When the first permanent molar is lost after the eruption of the second permanent molar, orthodontic evaluation is indicated.
  • The following steps are indicated:
    • Is a child in need of corrective treatment other than in the first permanent molar area?
    • Should the space be maintained for a replacement prosthesis?
    • Should the second molar be moved forward into the area formerly occupied by the first molar?
  • The latter choice is more satisfactory, even though there will be a difference in the number of molars in the opposing arch.
  • A third molar can often be removed to compensate for the difference.

Types of Appliances to be Used

  • Removable acrylic partial denture has been used in the arch after the loss of multiple teeth.
  • Passive lingual arch or Nance appliance
  • Transpalatal-bar appliance
  • It is occasionally necessary to recommend extraction of all primary teeth in a preschool child and wear a complete denture before the eruption of permanent teeth.

Premature Loss of First Primary Molar

  • The effect of premature loss of the first primary molar in both arches is mostly dependent on the state of eruption of the first permanent molar.
  • If the primary first molar is lost during the primary dentition (ages 3-5), there should be little or no space loss associated with the mesial movement of the second primary molar.
  • If the primary first molar is lost as the first permanent molar erupts (ages 5-7), this will cause:
    • A strong force exerted that pushes the second primary molar forward into the first primary molar space.
    • A loss of posterior arch length within the quadrant that can lead to crowding as the canines and premolars erupt in later stages.
    • Mandibular arch length may be further compromised by distal and lingual shifting of anterior teeth toward the side of the first primary tooth loss.

Management of Premature Loss of First Primary Molar

  • The use of a space maintainer is desirable to stabilize the second primary molar and canine positioning.
  • For unilateral loss of primary first molar, a unilateral band or crown and loop is usually the appliance of choice.
  • For bilateral loss of primary first molar and the second primary molar retained in the lower arch, two separate unilateral loop appliances are indicated until the first permanent molar and incisor eruption is complete.

Premature Loss of Second Primary Molar

  • The effect of loss of the second primary molar depends on the state of eruption of the first permanent molar.
  • If a second primary molar is lost in a child (ages 2-5), no space loss should occur while the first permanent molar is in the basal bone.
  • If the first permanent molar erupts, considerable loss in arch length can occur if no second primary molar is present as an eruptive guide.
  • If the loss of the second primary molar occurs after the first permanent molar has fully erupted and normal cuspal interdigitation has been established, the degree of space loss should be less dramatic than earlier during molar transition.

Management of Premature Loss of Second Primary Molar

  • If the loss occurs just before the eruption of the first permanent molar, a space maintainer to guide the positioning of the first permanent molar into normal occlusion is desirable.
  • The appliance of choice is a distal shoe for both maxillary and mandibular arches.
  • If the first permanent molar is erupting, the classic bilateral mixed-dentition space maintainer in the mandibular arch is a passive lingual arch with bands fitted to the first permanent molar.
  • In the maxillary arch, a bilateral mixed-dentition space maintainer to stabilize molar position bilaterally is a Nance appliance.

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