Loss of primary teeth

Pedodontic

Lec. Dr. Sara Medhat Al-Dabbagh
Fifth stage
Loss of primary incisors
Early loss of lower primary incisors is generally due to ectopic eruption of permanent incisors giving rise to increase intracanine width during permanent incisor eruption, the clinician should monitor development in the lower incisor area and generally not intervene.
Individual circumstances may indicate extraction of the antimere primary incisor to enhance incisor positioning and midline symmetry.
If it lost due to trauma, advanced caries or extraction of neonatal tooth may lead to anterior space loss if it occurs before canine stabilization is realized.
Premature loss of primary maxillary incisors dose not generally result in loss of intracanine dimensions if the primary canine erupted into occlusion at 2 years of age.
The major consequence of early loss of maxillary primary incisors:
Delayed eruption timing of permanent successors
Unattractive appearance
Potential development of deleterious habits (tongue-thrust swallow, forward resting posture of tongue)
improper pronunciation of fricative sounds (s,f)

Anterior appliance may be

acrylic partial dentures
Have been successful in replacement of single and multiple maxillary Primary incisors.
Disadvantages
Need cooperation in wear
Frequent loss or damage


A fixed option
Using primary incisor denture teeth secured from a rigid steel wire (0.036 or 0.040) extended to bands or stainless steel crown on primary molars.an additional stabilization in keeping the wire from flexing can be obtained by placing on occlusal rest on the first primary molar, or by covering the ridge with acrylic resin.

Loss of primary canines

Loss of mandibular primary canine
Most often due to ectopic eruption of permanent lateral incisors, early loss of a mandibular Primary canine is a significant indicator of a tooth size-arch size discrepancy.
Unilateral loss of lower primary canine is frequently followed by:
A shift in the dental midline toward the side of loss
Lingual collapse of incisor segment
Possibly deepening of the bite
The asymmetric disruption in arch integrity complicates normal eruption of the permanent canines and premolars toward the affected side
If ectopic eruption involves bilateral loss of both lower primary canines,
Pronounced lingual inclination and distal drifting of permanent incisors
Deeping of overbite
Increased over jet
Loss of arch perimeter
If one primary canine is lost during incisor eruption, it may be desirable to extract the contralateral primary canine to help maintain arch symmetry.
Although extraction of the contralateral primary canine may improve the appearance of incisor alignment and midline integrity, crowding problems requiring such intervention strongly indicate a significant arch length deficiency that will likely become grossly evident upon permanent canine and premolar eruption.
Maxillary primary canine
The ectopic loss of max. primary canines occurs less frequently than does mandibular loss
When it occurs, ectopic loss of max. primary canine typically reflects a very distal eruptive displacement of the permanent lateral incisor and not necessarily a significant tooth mass problem
A typical upper anterior alignment may occur with resultant crowding and blockage of the permanent canine
Early loss of max. primary canines is an indicator for early orthodontic treatment


Premature loss of first primary molar
The effect of premature loss of first primary molars in both arches is depend on
The state of eruption of the first primary molars;
If it lost during primary dentition from ages 3 to 5 years, there should be little or no space loss associated with mesial movement of second primary molar.
However, as first permanent molars erupt at ages 5 to 7 years, a strong force is exerted that pushes the second primary molar forward into first primary molar space.
This result in loss of posterior arch length within the quadrant that can lead to crowding as the canines and premolars erupt in later stages.
In addition to posterior effects, mandibular arch length may be further compromised by distal and lingual shifting of anterior teeth toward the side of first primary molar tooth loss.
Therefor the loss of a first primary molar in either arch, approximating eruption of first permanent molars, indicates that the use of a space maintainer is generally desirable to stabilize second primary molar and canine positioning.
If the first primary molar is lost after first permanent molars have erupted into occlusion and the second primary molars is still in position, minimal space loss should be evidenced in either arch. This is particularly applicable when first permanent molars are positioned in full class 1 or class 2 cuspal interdigitation.

The band and loop maintainer

Advantages
Easy and economic
Little chair time
Adjusts easily to accommodate the changing dentition
Disadvantages
Dose not restore chewing function
Will not prevent continued eruption of opposing teeth

Technique

A stainless steel band must fitted in tooth
Impression of dentition and band, the band is removed from the tooth and seated in the impression
On the model of impression a piece of 0.036 inch steel wire is used to prepare the loop and soldered to the band
Band and loop appliance cemented intraoral


The stainless steel crown and loop maintainer
If the posterior abutment tooth has extensive caries and require a crown restoration
If the abutment has vital pulp therapy
Technique
The steel crown should be prepared
Before cementation a compound impression is made
The crown removed from the tooth and seated in impression
And the stone working model prepared
A piece of 0.036 inch steel wire is used to prepare the loop