Prosthetic Treatment

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  • 8/13/2019 Prosthetic Treatment


    Prosthetic treatment of

    children and adolescents

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    Prosthetic treatment of children and adolescents


    A. 0 - 6 years old

    B. 6 - 12 years old

    C. 12 - 18 years old

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    Steal crown

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    Indications for SSC

    Primary and permament teeth with extesive carious lesions

    Hypoplastic of primary or permament teeth

    Primary teeth followin pulpotomy or pulpectomyprocedures

    Teeth with herediatry anomalies

    Disabled children in whom oral hygiene is poor

    Abutment for space mainainersor prosthetic appliances Temporary restoration of a fractured tooth

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    Space maintainers

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    A space maintainer is an intra-oral appliance used to preserve

    arch length following the premature loss of primary teeth/tooth.

    This allows the permanent teeth to erupt unhindered into proper

    alignment and occlusion.

    A space maintainer is recommended after the untimely loss of a

    primary tooth.

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    1. Space closure occurs during the first 6 months after extraction.

    It is best to insert the appliance as soon as possible following

    the extraction.

    2. Loss of space occurs primarily due to a tipping movement of

    teeth (mesially or distally). In the maxillary molar region, spaceloss occurs due to rotation (mesial-in) in conjunction with

    mesial tipping.

    3. Erupting premolars usually require 4-5 months to move through

    1mm of bone.

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    Primary teeth can be lost

    prematurely in several ways:

    Traumatic injury


    Some diseases or conditions, including hypophosphatasia,

    diabetes and aggressive periodontitis, which is unusual in

    children, can contribute to early tooth loss.

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    The premature loss of primary molars may require the placement of

    a space maintainer to prevent the migration of the adjacent teeth,

    depending upon the teeth present and the arch length.

    When loss of a primary canine occurs, the dental arch midline may

    be compromised and the arch length also may be reduced. The

    premature loss of primary canines may therefore require the

    placement of a space maintaining appliance to prevent midline

    deviation and/or loss of arch length, perimeter and/or circumference. The premature loss of primary incisors does not usually require the

    placement of a dental appliance for the maintenance of space because

    mesial movement of the adjacent teeth is not generally expected.

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    A space maintainer is usually not necessary if there is a

    sufficient amount of space present to allow for eruption of

    permanent tooth/teeth.

    A space maintainer may not be recommended if severe crowding

    exists, such that space maintenance is of minimal effect and

    subsequent orthodontic intervention is indicated.

    A space maintainer may not be necessary if the succedaneous

    tooth will be erupting soon.

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    Benefits of this procedure:

    May reduce or eliminate the need for braces.

    Eat comfortably.

    Save space for proper eruption of adult teeth.

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    Types of space maintainers

    Fixed appliances:

    Band and loop / Crown and loop

    Distal shoe

    Lower lingual arch / transpalataarch

    Nance appliance

    Removable appliances:

    Hawley appliance / Removable dentures

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    Band and Loop Space Maintainer

    Indications: Loss of first primary molar

    Advantages: Ease of fabrication for the clinicianand ease of maintenance for the patient

    Disadvantages: Opposing tooth may supererupt

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    Crown and Loop Space Maintainer

    Indications: Loss of first primary molar with significant loss

    of tooth substance of the abutment tooth

    Advantages: Same as above

    Disadvantages: More difficult to fabricate than band and loop

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    Distal shoe

    Indications: Loss of second primary molar prior to

    eruption of the first permanent molar

    Advantages: Maintains the second primary molar


    Disadvantages: Difficult to fabricate;

    contraindicated in some medically compromised

    patients, ie. pathological heart murmur

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    Indications: Loss of second primary molar in the

    maxilla-counterpart to LLHA

    Advantages: Maintains the tooth space and the

    leeway space

    Disadvantages: Meticulous hygiene of the acrylic

    button is required

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    Hawley Appliance / Removable


    Indications: When multiple teeth are lost and the

    space maintenance and mastication are of concern

    Advantages: Can maintain space as well as aid in


    Disadvantages: Susceptible to fracture or loss

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    Care of space maintainers

    Avoid sticky sweets, popcorn, ice and or chewing gum.

    Don't tug or push on the space maintainer with your fingers or tongue.

    Keep it clean with brushing and flossing.

    At night carefully clean around all wires, bands and other areas of the

    appliance, as it tends to trap food.

    After cleaning, please inspect the appliance carefully for damage.

    Keep your 6 month check up appointments to monitor oral health andto evaluate the space maintainer to determine when it needs to be


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    Prosthetic treatment of children aged 6 - 12

    Prosthetic treatment of children aged 12 - 18

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    First permanent molarscaries

    Incisorscaries, traumatic injury

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    Dental veneers are wafer-thin, custom-made shells of tooth-

    colored materials designed to cover the front surface of teeth to

    improve your appearance. These shells are bonded to the front of the

    teeth changing their color, shape, size or length.

    Dental veneers can be made from porcelain or from resin

    composite materials.

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    discolorationeither because of root canal treatment; stains from

    tetracycline or other drugs, excessive fluoride or

    other causes; or the presence of large resin fillings that have

    discolored the tooth

    after traumatic injury

    teeth that are misaligned, uneven, or irregularly shaped (forexample, have craters or bulges in them)

    teeth with gaps between them (to close the space between these