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 Table of Contents  
CASE REPORT
Year : 2021  |  Volume : 13  |  Issue : 3  |  Page : 205-208

An esthetic approach for premature missing maxillary primary anterior teeth: A series of two case reports


Department of Pedodontics and Preventive Dentistry, Buddha Institute of Dental Sciences and Hospital, Patna, Bihar, India

Date of Submission14-Oct-2020
Date of Acceptance08-Jan-2021
Date of Web Publication12-Jul-2021

Correspondence Address:
Siddharth Anand
Department of Pedodontics and Preventive Dentistry, Buddha Institute of Dental Sciences and Hospital, Patna, Bihar
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IJDS.IJDS_184_20

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  Abstract 


The aesthetic rehabilitation of a young toddler who are suffering from multiple tooth loss due to early childhood caries or extensive dental trauma is one of the challenging tasks for the Paediatric dentist in his/her day to day practise. Due to the loss of primary anterior teeth at an early age, loss of esthetic, masticatory efficiency, and mispronunciation of labiodentals sounds and development of abnormal oral habits are developed. Parent's desire plays one of the most major roles for an anterior esthetic appliance for their wards. This case report discusses and elaborates in detail one of the type of fixed anterior esthetic appliance and the considerations to be made while making treatment plan for when and why to place them.

Keywords: Dental trauma, esthetic, Groper appliance, primary teeth, rehabilitation


How to cite this article:
Anand S, Singh A, Jyoti D, Sulekha, Seal B. An esthetic approach for premature missing maxillary primary anterior teeth: A series of two case reports. Indian J Dent Sci 2021;13:205-8

How to cite this URL:
Anand S, Singh A, Jyoti D, Sulekha, Seal B. An esthetic approach for premature missing maxillary primary anterior teeth: A series of two case reports. Indian J Dent Sci [serial online] 2021 [cited 2021 Sep 20];13:205-8. Available from: http://www.ijds.in/text.asp?2021/13/3/205/321177




  Introduction Top


Primary teeth are improperly referred to as “temporary teeth” whereas in reality, they are very much responsible for general health, mastication, esthetics, phonetics and self-esteem, psychological comfort, etc of a child. Primary teeth play an integral role on the quality of life. The premature loss of primary anterior teeth not only affects a child's developing dentition but also raises various physiological and psychological concerns as well. Early childhood caries and trauma to dentition are the primary reasons for the premature loss of deciduous maxillary anterior teeth.[1]

When deciduous teeth are lost at an earlier age, replacement and prosthetic management is very important to restore all functions including esthetics and psychological development of the child. The replacement should be such that it should not interfere with the eruption process of the underlying successor. Various esthetic options are available which include removable or fixed partial dentures. Removable space maintainers are least acceptable in young children due to difficulties with maintenance of oral hygiene and depending on the child's compliance and cooperation to wear it, hence fixed space maintainers are preferred.[2] In recent times due to increasing demands of esthetics from the parents, fixed functional space maintainers are the ideal choice to replace a prematurely exfoliated deciduous anterior teeth.

The main objective for this appliance was to help in space maintenance, masticatory function, speech, and esthetic appearance.


  Case Report Top


Case 1

A 4 year old male child patient with his parents reported to the Department of Pedodontics and Preventive Dentistry, having chief complaint of missing upper front tooth. On taking a detailed history, the parents revealed that the kid had suffered trauma from falling of the stairs 1 year back. The fall led to complete loss of the maxillary anterior teeth. The parents were concerned regarding the anterior esthetics and wanted to restore it.

On clinical and radiographical examination, it was observed that there had been an avulsion of #51, #52, and #61 [Figure 1]. A fixed functional space maintainer was planned for the child. The parents were explained about the treatment planned for their child, and proper written consent was taken from them. Orthodontic molar bands of appropriate size were selected and placed on #55 and #65. Alginate impression was taken with the bands, and the bands were stabilized Alginate impression of the mandibular arch was also taken, and cast was poured to help with the tooth setting. A framework of round stainless steel wire of 1.00 mm diameter was made, extending from the end of one band to the end of other band. Then the ends of the wire were soldered to the subsequent molar bands of the maxillary teeth. Acrylic resin teeth were fabricated and trimmed according to the primary incisors and compared with the adjacent teeth. Modelling wax-up trial was performed and occlusion was adjusted with lower teeth. Later separating media was applied in the cast and using cold cure acrylic, denture base was fabricated [Figure 2]. Then the fabricated appliance was removed from the cast and intra-oral trial was done. Later, trimming and polishing of the appliance was done according to its requirement and was cemented with glass ionomer luting cement (GC Gold Label Type 1, U.S.A.) on the molar bands of #55 and #65 [Figure 3].
Figure 1: Case 1 – Preoperative front view

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Figure 2: Case 1 – Fabrication of Gropers appliance

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Figure 3: Case 1 – Postoperative front view

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Case 2

A 5 year old boy with his father reported to the Department of Pedodontics and Preventive dentistry with complain of pain in the right upper and lower back tooth region for past 1 week. The father was more anxious about the esthetics of his child, and he desired for an aesthetic substitute of the anterior teeth. The past dental history revealed that the patient underwent extraction of maxillary central (#51, #61) due to caries [Figure 4]. A fixed functional space maintainer was planned for the child. Then in the following appointment #55 and #65 were banded with band size: 0.005 x 0.180 and alginate impressions were made for the upper and lower arches. The positive replica of alginate impressions were made with dental stone. On the upper cast, a 0.9 mm round stainless steel wire framework was made, spanning from the end of one band to the other, while making a zig-zag pattern in the anterior region. The zig-zag wire pattern was made to incorporate acrylic segment for better retention. The ends of the wire were soldered to the subsequent molar bands. Acrylic resin teeth were fabricated and trimmed according to the primary incisors and compared with the adjacent teeth [Figure 5]. Modelling wax-up trial was performed and occlusion was corrected with the opposite lower teeth. Necessary trimming and polishing of the appliance was done followed by cementing it with glass ionomer luting cement (GC Gold Label Type 1, U.S.A.) [Figure 6].
Figure 4: Case 2 – Preoperative front view

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Figure 5: Case 2 – Fabrication of Gropers appliance

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Figure 6: Case 2 – Postoperative front view

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  Discussion Top


Before the age of 3 years, the early loss of deciduous anterior teeth may result in speech problems.[3] One of the most considerable and logical reasons for substituting missing primary anterior teeth is to rehabilitate an esthetic appearance and thus promotes a normal psychological development in the child. It is one of the best substitutes for deciduous anterior edentulous arches with compromised speech, esthetic, and behavior of the child including poor social acceptance. Limitations such as improper oral hygiene maintenance, long-term follow-up and recurrent breakage can be minimized by thorough education and motivation of the child as well as the parents.[1] The parental desire is the main reason for the placement of an anterior esthetic appliance. There is lack of studies in the literature which suggests that the early loss of the primary maxillary incisors will lead to an undesirable effects on the growth and development of the child.[4] However, we have to consider regarding the masticatory inefficiency, speech problems, an unesthetic appearance, abnormal oral habits, that may result from the loss of primary anterior teeth at an early age.

After the eruption of primary canines, loss of deciduous incisors are insignificant contemplation for space loss, though rarely in a crowded dentition there may be a rearrangement of some anterior teeth.[5] Another contemplation is the child's speech development after the extraction of primary incisors such as error in the labio-lingual sounds. The reasons for such contemplation are because many sounds are made when the tongue touches the palatal side of the maxillary incisors, and improper speech compensations might develop if the primary anterior teeth are missing.[6]

To the best of our knowledge, only prefabricated acrylic moulds are available (3M ESPE Polycarbonate Crowns) for primary teeth, so, customized acrylic resin tooth in accordance with the facial morphology of the child was prepared. The main advantage of customized acrylic teeth is that it provides a natural aesthetic appearance as it is individualized to shape and size of each child. The gum fit design makes the acrylic teeth to lie on the alveolar ridge without any acrylic flange amplifying over the vestibule. This helps to prevent the gingival inflammation and irritation. The acrylic component on the palatal side serves as a major connector stabilizing the wire component to the customized teeth. The thickness of the acrylic plate ranges from 1 mm to 2 mm making it more desirable for the child while mastication and speech.

Aswanth et al. gave an anterior fixed functional space maintainer, as mentioned in this case report following extraction of severely decayed #51, #52, #61, and #62 to a 4½-year-old boy following complaints of unpleasant look, undernourishment, and alteration in speech. According to them, esthetic space maintainer has been found to have an immense seemless and conformity of wearing the appliance by a young child patient.[7]

Riekman and Badrawy reported that the lingual sides of maxillary anterior teeth which is required by the tongue for certain phonations and non-appearance of these teeth may result in inappropriate speech.[3] It frequently affects sounds such as “s,” “z,” and “th.” Gable et al concluded that early loss of incisors had no prolonged effects on speech.[8]

This space maintainer offers benefits in respect of esthetics, restoration of masticatory and speech efficiency and prevention of abnormal oral habit development. The main disadvantage is the accumulation of food debris and plaque.[9] Hence, parents have to be instructed to supervise the maintenance of proper oral hygiene in their child.


  Conclusion Top


One of the best substitute of the missing primary incisors with Groper appliance come up with a reasonable treatment alternative for preschool children with severe early childhood caries or early dental trauma. The simple and easy technique or procedures in fabrication of the appliance facilitates it to be used in regular clinical practice with favourable results both to the child in establishing a positive perspective and the pediatric dentist in aesthetic replacement of the primary anterior missing teeth.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Jalan P, Ghosh A, Zahir S, Kundu GK. Esthetic rehabilitation for premature loss of primary anterior teeth. SRM J Res Dent Sci 2019;10:170-2.  Back to cited text no. 1
  [Full text]  
2.
Aniyo R, Kaur G, Neha. Groper's appliance: Fixed appliance for an anterior teeth. Int Res J Med Sci 2019;1:52 54.  Back to cited text no. 2
    
3.
Riekman GA, Badrawy HE. Effect of premature loss of primary maxillary incisors on speech. Pediatr Dent 1985;7:119 22.  Back to cited text no. 3
    
4.
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. 4
    
5.
Christensen JR, Fields HW. Space maintenance in the primary dentition. In: Pinkham JR, editor. Pediatric Dentistry: Infancy through Adolescence. 2nd ed. Philadelphia: WB Saunders Company; 1994. p. 358-63.  Back to cited text no. 5
    
6.
Dyson JE. Prosthodontics for children. In: Wei SH, editor. Pediatric Dentistry: Total Patient Care. Philadelphia: Lea and Febiger; 1988. p. 259-74.  Back to cited text no. 6
    
7.
Aswanth KP, Asokan S, Baby John J. Fixed functional space maintainer: A weight gainer: A case report. J Indian Acad Dent Spec 2014;1:25-7.  Back to cited text no. 7
    
8.
Gable TO, Kummer AW, Lee L, Creaghead NA, Moore LJ. Premature loss of the maxillary primary incisors: Effect on speech production. ASDC J Dent Child 1995;62:173-9.  Back to cited text no. 8
    
9.
Joybell CC, Ramesh K, Simon P, Mohan J, Ramesh M. Dental rehabilitation of a child with early childhood caries using Groper's appliance. J Pharm Bioallied Sci 2015;7:S704-7.  Back to cited text no. 9
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]



 

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