early loss of deciduous dentition by almuzian

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Early loss of deciduous dentitionAetiology1. Local factors Trauma Periapical pathology Periodontal problem Caries2. General factors Congenital disease, fibrous dysplasia Nutritional, vit D defficiency Endocrine, diabetes Genetic disease, hypophosphatesia or Elhar Danlos sundrome Tumour Iatrogenic

Amount and rate of space closure is dependent on many variables1. Stage of eruption of successors 2. Which tooth: space loss greater for E`s than D`s by mesial drift of 2o teeth3. Which arch: rate of space closure is greater in maxilla4. Amount of crowding: greater space loss in crowded dentitions5. Occlusal interlocks Balancing & Compensating Extractions Balancing extractions: Removal of a second tooth in the same arch, but on the opposite side, to preserve midline and molar symmetry Compensating extractions: Removal of a second tooth on the same side of the mouth, but in the opposite arch, to preserve the molar relationship RCSEng guidelines Recommendations 1. Radiographic screening is highly desirable before extracting primary molars to check for the presence, position and correct formation of the crowns and roots of successional teeth. Potential problems indicate the need to seek an orthodontic opinion before teeth are removed. 2. Loss of primary incisors Early loss of primary incisors has little effect upon the permanent dentition although it does detract from appearance. It is not necessary to balance or compensate the loss of a primary incisor.3. Loss of primary canines Early loss of a primary canine in all but spaced dentitions is likely to have most effect on centre lines. The more crowded the dentition, the more the need for balance. 4. Loss of primary first molars With regard to a primary first molar, a balancing extraction may be needed in a crowded arch but compensation is not needed. 5. Loss of primary second molars There is no need to balance the loss of a primary second molar because this will have no appreciable effect on centreline coincidence. However when a primary second molar has to be extracted consideration should be given to fitting a space maintainerSpace maintenance Advantages 1. Aesthetic purposes 2. Preserve Lee way space3. Prevent potential mesial drift of permanent molars4. Prevent distal drift of incisors5. Prevent mid-line deviations6. Prevent overeruption Disadvantages 1. Need to insert immediately2. Long treatment 3. No guarantee it will prevent later treatment 4. Compliance, oral hygiene, regular inspection5. Proclination of labial segements

Indications 1. Good OH and low caries rate is essential2. Loss of central incisor for aesthetic purposes3. Difficult to assess clinically the occlusion at the current stage.4. In an occlusion with only mild crowding where any further space loss would result in the need for more complex orthodontic treatment 5. In an occlusion with severe crowding where any further space loss would result in more than a single tooth unit of space being required.6. If a permanent successor will erupt within 6 months (i.e., if more than one-half to two-thirds of its root has formed), a space maintainer is unnecessary. 7. If there is not enough space for the permanent tooth or if it is missing, space maintenance alone is inadequate or inappropriate

Techniques include1. Band and loop 2. Bonded rigid wire 3. URA and partial denture; used if more than one tooth is lost and to replace anterior tooth4. Lingual arch 5. Transpalatal arches6. Nance appliance7. Distal Shoe Space Maintainers: The distal shoe has a unique application and is the appliance of choice when a primary second molar is lost before eruption of the permanent first molar. It consists of a metal or plastic guide plane along which the permanent molar erupts. The guide plane is attached to a fixed or removable retaining device To be effective, the guide plane must extend into the alveolar process so that it is located approximately 1 mm below the mesial marginal ridge of the permanent first molar, at or before its emergence from the bone. When fixed, the distal shoe is usually retained with a band instead of a stainless steel crown so that it can be replaced by another type of space maintainer after the permanent first molar erupts. If primary first and second molars are missing, the appliance must be removable and the guide plane is incorporated into a partial denture because of the length of the edentulous span. It is contraindicated in patients who are at risk for sub-acute bacterial endocarditis or are

Space regaining Procedures can be employed if space has been lost due to drifting regained space is limited to 3mm or lessTechnique Sectional fixed appliance URA Lip bumper HG Molar distalization technique can be used to regain space

Management of Lee way spaceBrennan, 2000, Gianelly 20001. If a lingual arch is placed during the mixed dentition only an arch length decrease of 0.44 mm has been reported, and gaining 4.44 mm leeway space. 2. Also the stability were good after lingual arch treatment3. However it was shown that intercanine is increased after using lingual arch and this bec the 3s migrate distally.An early mesial shift and late mesial shift 1. If there is spacing in the primary dentition as the permanent maxillary and mandibular first molars erupt, the space mesial to lower deciduous molars lets these teeth move forward, allowing the permanent molars to erupt into a Class I relationship. This is called an early mesial shift. So, most of the Leeway space will be used to relief incisors crowding2. if there is no spacing between the deciduous teeth (i.e. a closed primary dentition), there is no mesial movement of the mandibular deciduous molars as the permanent molars erupt, and they erupt into a cusp-to-cusp relationship. The mandibular Leeway space therefore allows for mesial migration of the lower first molars into a Class I relationship as the deciduous molars are shed. This is called a late mesial shift 3. Therefore, if lower arch length is preserved to use the leeway space to relieve crowding, correction of the molar relationship will require distalization of the maxillary first molars, often using headgear. Mohammed Almuzian, University of Glasgow, 2014Page 5


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