Pedodontics PDF - Premature Loss of Teeth

Pedodontics PREMATURE LOSS OF TEETH Lec 15 Dr. Rawaa B. fadhil B.D.S M.Sc. Premature loss of first primary molar  The effect of premature loss of first primary molar in both arches is mostly dependent on the state of eruption of the first permanent molar 1- if the primary first molar is lost during...

Pedodontics PREMATURE LOSS OF TEETH Lec 15 Dr. Rawaa B. fadhil B.D.S M.Sc. Premature loss of first primary molar  The effect of premature loss of first primary molar in both arches is mostly dependent on the state of eruption of the first permanent molar 1- if the primary first molar is lost during the primary dentition from ages (3-5) years, there should be little or no space loss associated with mesial movement of second primary molar 2- if the primary first molar is lost as the first permanent molar erupt at age (5-7) years, this will cause: A- strong force exerted that pushes the second primary molar forward into the first primary molar space B- a loss of posterior arch length within the quadrant that can lead to crowding as the canines and premolars erupt in later stages C- mandibular arch length may be further compromised by distal and lingual shifting of anterior teeth toward the side of first primary tooth loss  Therefore the loss of first primary molar in either arch, approximating eruption of first permanent molars, indicating that the use of space maintainer desirable to stabilize second primary molar and canine positioning  3- if first primary molar lost after first permanent molar have erupted into occlusion and second primary molar still in position, minimal space loss should be evidence in either arch Management A- for unilateral loss of primary first molar- unilateral band or crown and loop is usually the appliance of choice B- bilateral loss of primary first molar loss and the second primary molar retained in lower arch- two separate unilateral loop appliance are indicated until first permanent molar and incisor eruption is complete Premature loss of second primary molar  The effect of loss of second primary molar depend on the state of eruption of first permanent molar 1- if a second primary molar is lost in a child (2-5) years of age, no space loss should occur while the first permanent molar is in the basal bone, the option for managing such early loss are very limited due to lack of retention elements for fixed appliance and difficulties with patient cooperation in the use of appliance in this age 2- if the first permanent molars erupt, considerable loss in arch length can occur if no second primary molar is present as an eruptive guide  3- if the loss of second primary molar occur after the first permanent molar have fully erupted and normal cuspal interdigitation has been established, the degree of space loss should be less dramatic than earlier during molar transition, regardless of the arch involved Management  A- if the loss occur just before eruption of first permanent molar, when first molar covered with oral mucosa and thin partial covering of bone, a space maintainer to guide positioning of first permanent molar into normal occlusion is desirable, the appliance of choice is distal shoe for both maxillary and mandibular arches  B- if the first permanent molar are erupting- the classic bilateral mixed-dentition space maintainer in mandibular arch is passive lingual arch with bands fitted to first permanent molar Management  C- while in maxillary arch, bilateral mixed dentition space maintainer to stabilize molar position bilaterally is Nance appliance Areas of multiple primary molar loss  Loss of multiple primary molars may lead to mutilation of developing dentition unless an appliance is constructed to maintain relationships of the remaining teeth and to guide eruption of developing teeth. The types to be used are: 1- removable acrylic partial denture have been used in arch after the loss of multiple teeth 2- passive lingual arch or Nance appliance 3- transpalatal-bar appliance 4- it is occasionally necessary to recommend extraction of all primary teeth in preschool child and wear complete denture before the eruption of permanent teeth Loss of first permanent molar  The first permanent molar is the most important unit of mastication and essential in development of desirable occlusion  A carious lesion may develop rapidly in first permanent molar and progress from incipient lesion to pulp exposure in a 6-month period  The loss of first permanent molar in child can lead to change in dental arches that can traced throughout the child’s life Unless a corrective measures are instituted, these changes include: 1- diminished local function 2- drifting of teeth 3- Continued eruption of opposing teeth 4- The second molars, even if unerupted, start to drift mesially after the loss of first permanent molar, a greater degree of forward bodily movement will occur with loss of first permanent molar in 8-12 years old children Unless a corrective measures are instituted, these changes include: 5- in older children, if the loss occurs after the eruption of second permanent molar , more exaggerated mesial tipping of second molar can be the expected outcome 6- although the premolars undergo the greatest amount of distal drifting, all teeth anterior to space , including central and lateral on the side when loss occurred, may show evidence of movement 7- contact open and the premolars, in particular, rotate as they fall distally, there is tendency for maxillary premolar to move distally in unison, whereas those in lower arch move separately 8- when the maxillary first permanent molar loses its opponent, it erupt at faster rate than adjacent teeth. The alveolar process is also carried along with molar and cause problems when prosthetic replacement needed Management  The treatment of patients with loss of first permanent molar must be approached on an individual basis: 1- if first permanent molar removed several years before eruption of second permanent molar , there is excellent chance that second molar erupt in acceptable position, 2- 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 area?  should the space be maintained for a replacement prosthesis?  should the second molar be moved forward into the area formerly occupied by first molar?  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 difference, without treatment, second molar will tip forward within a matter of weeks 3- another option to consider is auto transplantation of third molar into first molar position