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Table of Contents
CASE REPORT
Year : 2020  |  Volume : 8  |  Issue : 2  |  Page : 32-34

Fixed functional space maintainer: Treatment considerations and case report


1 Department of Preventive Dentistry, Alrass Dental College, Qassim University Buraidah, Al Rass, Kingdom of Saudi Arabia
2 Department of Pedodontics and Preventive Dentistry, Yenepoya Dental College, Yenepoya University, Mangalore, Karnataka, India

Date of Submission12-Mar-2020
Date of Acceptance22-Apr-2020
Date of Web Publication21-May-2020

Correspondence Address:
Dr. Mohammed A Habibullah
Department of Preventive Dentistry, Alrass Dental College, Qassim University Buraidah, Al Rass.
Kingdom of Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/INJO.INJO_8_20

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  Abstract 

Despite the advances in caries prevention, early childhood caries (ECC) is a frequently encountered reality in the dental office. The maxillary primary anterior teeth are usually affected in the early stages of ECC, with early pulpal involvement and destruction of the crown structure. The management of grossly decayed maxillary anterior teeth presents a challenge to the clinician. This case report describes the placement of a fixed appliance to replace missing maxillary incisors and discusses the factors to consider before treatment planning.

Keywords: Aesthetic rehabilitation, children, fixed functional space maintainer, primary incisors


How to cite this article:
Habibullah MA, Bhat SS, Hedge SK. Fixed functional space maintainer: Treatment considerations and case report. Int J Oral Care Res 2020;8:32-4

How to cite this URL:
Habibullah MA, Bhat SS, Hedge SK. Fixed functional space maintainer: Treatment considerations and case report. Int J Oral Care Res [serial online] 2020 [cited 2020 Jul 3];8:32-4. Available from: http://www.ijocr.org/text.asp?2020/8/2/32/284680




  Introduction Top


Despite enormous emphasis on oral health promotion, early childhood caries (ECC) is a frequently encountered reality in our clinical practice. The American Academy of Pediatric Dentistry defines ECC as the presence of one or more decayed (non-cavitated or cavitated), missing (due to caries), or filled tooth surfaces in any primary tooth in a child under the age of 6 years.[1]

Maxillary anterior teeth are affected early with pulpal involvement and extensive coronal destruction. Restoration in such cases is complicated, and some cases require extraction.

The successful management of missing anteriors is challenging for dentist. This case report discusses a fixed anterior aesthetic appliance and treatment planning considerations.


  Case Report Top


A 5-year-old female patient reported to our department with the chief complaint of multiple decayed teeth. The parent stressed on the fact that the child was developing self-esteem issues due to her unaesthetic smile. The patient’s medical history was noncontributory.

A detailed intraoral examination revealed no soft tissue abnormalities. Carious root stumps were in relation to maxillary anterior teeth 51, 52, 61, and 62. The mandibular first molars were grossly decayed, necessitating extraction followed by space maintenance. The mandibular anterior teeth showed arrested caries on the labial surface [Figure 1]. All other teeth were in good health. Various treatment options were carefully discussed. A removable functional space maintainer was considered but abandoned as the patient age presented compliance issues, chances for ingestion/aspiration, and breakage or loss of the appliance when it is not worn.[2] To overcome these drawbacks, it was decided to fabricate a fixed type of space maintainer to achieve the twin goals of patient compliance and comfort. The fact that this would also immediately restore the child’s smile was an added advantage.
Figure 1: Preoperative intraoral view

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The primary maxillary second molars were banded with 0.005 × 0.180 steel bands. An alginate impression was made, and the bands were transferred to the impression, stabilized, and the cast was poured.

A stainless steel (SS) wire was adapted along the palatal aspect of the molars from maxillary right second primary molar to the maxillary left second primary molar. This wire was adapted closely to the edentulous area in the anterior region.

The SS wire was soldered onto the palatal aspects of the molar bands. Care was taken to ensure the solder material did not interfere with the occlusion. Acrylic teeth to replace the missing incisors were selected according to shade and size.

These teeth were fixed to the wire using heat cure acrylic with adequate extension of the acrylic plate, ensuring sufficient rigidity and aesthetics. Enhanced retention was facilitated by the labial flange extension and partial hard palate coverage [Figure 2].
Figure 2: Fabrication of the appliance before extraction

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The extraction of the four anterior teeth was undertaken under local anesthesia (2% lignocaine with 1:80,000 adrenaline). Hemostasis was achieved, and the appliance was cemented in place immediately post extraction. Similar to an immediate denture, the instant smile restoration of the child’s smile was apparent [Figure 3]. The acrylic plate acted as a splint covering, protecting the extraction sockets. Post extraction instructions were given, along with analgesics to relieve discomfort. Healing was uneventful.
Figure 3: Postoperative view after appliance insertion

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The patient was recalled for post-insertion checkup after 3 days to assess post-extraction healing, and regular recall visits were scheduled every 2 months. It was decided to trim the acrylic plate at the appropriate area to facilitate the eruption of permanent teeth on subsequent visits.


  Discussion Top


The most compelling reason for the replacement of missing anterior teeth is parental desire.[3] Although children these days are aware and conscious of their anterior teeth,[4] space maintenance, mastication, habit development, speech, and psychological issues also need to be considered before treatment planning.

Space maintenance

Loss of incisors does not generally require space maintenance as the region is stable and with no loss of space from canine to canine.[5] However, if the loss of anterior teeth is associated with the loss of deciduous canine and deciduous first molar before the eruption of second molar, space maintenance becomes mandatory to avoid space loss, which could be significant.[6] In this case, as only incisors were involved, space loss was not a concern.

Speech development

Speech development following the loss of maxillary anteriors is a complex issue, with age determining the need for interventions.

Many sounds require that tongue is in contact with lingual aspect of maxillary incisors. Hence, missing anteriors may predispose to inappropriate speech compensations.[5] This is especially true in the pronunciation of sounds as “Z” or “S”[7] and in children below 3 years of age.[6] However, if these children receive dentures or other prosthetic appliances, they develop good articulation skills[8] with no long-term speech defects.

Mastication

The loss of maxillary anteriors would suggest difficulty in mastication. However most children exhibit an improved ability to eat. The presence of infected anterior teeth inflicts pain on chewing. Hence their removal will improve child’s ability to eat due to relief from this pain.[3] Whenever any parent may express this concern, it would suffice to reassure them.[5]

Aesthetic concerns/psychological development

Young children attach little significance for image alterations.[9] However preschoolers/children attending day care are aware and affected by their appearance.[3] The negative attention from peers may lead to psychological trauma, which may be deep-seated, resulting in imbalanced emotional development.[2] Hence, the restoration of missing anteriors restores the appearance, leading to normal psychological development.

School-going older children, on the contrary, have little problem fitting in as they are with children in the mixed dentition phase and actively exfoliating their primary incisors.[10]

In this case, the carious teeth affected the child and an immediate restoration of her smile was undertaken to prevent lasting psychological trauma.


  Conclusion Top


There is a need for customized treatment planning to manage children with missing primary anterior teeth, and no standardized protocol can be followed. The loss of anterior teeth can be socially and psychologically upsetting for the child. Early and appropriate treatment will ensure that any distress is short-lived.

Child’s behavior and ability to cooperate, clinician’s preferences, economics, professional ability, and aesthetics all need to be considered before deciding on the final treatment plan.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Policy on Early Childhood Caries (ECC). Classifications, consequences, and preventive strategies. Am Acad Pediatr Dent Reference Manual 2018;40:60-2.  Back to cited text no. 1
    
2.
Goenka P, Sarawgi A, Marwah N, Gumber P, Dutta S. Simple fixed functional space maintainer. Int J Clin Pediatr Dent 2014;7:225-8.  Back to cited text no. 2
    
3.
Waggoner WF, Kupietzky A. Anterior esthetic fixed appliances for the preschooler: Considerations and a technique for placement. Pediatr Dent 2001;23:147-50.  Back to cited text no. 3
    
4.
Goel D, Goel GK. Restoring esthetics after anterior tooth loss for a five-year-old child: Natural tooth pontic fiber reinforced prosthesis. Case Rep Dent 2013;2013:215816.  Back to cited text no. 4
    
5.
Christensen JR, Fields HW. Space maintenance in the primary dentition. In: Casamassimo P, Fields H, McTigue D, Nowak A, editors. Pediatric Dentistry–Infancy through Adolescence. 5th ed. St Louis, MO: Elsevier; 2013. p. 379.  Back to cited text no. 5
    
6.
Kupietzky A. The treatment and long-term management of severe multiple avulsions of primary teeth in a 19-month-old child. Pediatr Dent 2001;23:517-21.  Back to cited text no. 6
    
7.
Fymbo LH. The relation of malocclusion of the teeth to defects of speech. Arch Speech 1936;1:204-16.  Back to cited text no. 7
    
8.
Coston GN, Salinas CF. Speech characteristics in patients with hypohidrotic ectodermal dysplasia. Birth Defects Orig Artic Ser 1988;24:229-34.  Back to cited text no. 8
    
9.
Lynch M. Special children, special needs: The ectodermal dysplasias. Pediatr Nurs 1992;18:212-6.  Back to cited text no. 9
    
10.
Koroluk LD, Riekman GA. Parental perceptions of the effects of maxillary incisor extractions in children with nursing caries. ASDC J Dent Child 1991;58:233-6.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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