Prosthetic treatment of children and adolescents

Prosthetic treatment of children and adolescents


B. C.

0 - 6 years old
6 - 12 years old 12 - 18 years old

Steal crown

Indications for SSC
• Primary and permament teeth with extesive carious lesions • Hypoplastic of primary or permament teeth • Primary teeth followin pulpotomy or pulpectomy procedures • Teeth with herediatry anomalies • Disabled children in whom oral hygiene is poor • Abutment for space mainainersor prosthetic appliances • Temporary restoration of a fractured tooth

Space maintainers

“ 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.

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, space loss 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.

Primary teeth can be lost prematurely in several ways:

• Traumatic injury • Caries • Some diseases or conditions, including hypophosphatasia, diabetes and aggressive periodontitis, which is unusual in children, can contribute to early tooth loss.

• 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.

• 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.

Benefits of this procedure:
• May reduce or eliminate the need for braces. • Eat comfortably. • Save space for proper eruption of adult teeth.

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

Band and Loop Space Maintainer
Indications: Loss of first primary molar Advantages: Ease of fabrication for the clinician and ease of maintenance for the patient Disadvantages: Opposing tooth may supererupt

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

Distal shoe
Indications: Loss of second primary molar prior to eruption of the first permanent molar

Advantages: Maintains the second primary molar space
Disadvantages: Difficult to fabricate; contraindicated in some medically compromised patients, ie. pathological heart murmur

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

Hawley Appliance / Removable Acrylic
Indications: When multiple teeth are lost and the space maintenance and mastication are of concern Advantages: Can maintain space as well as aid in mastication Disadvantages: Susceptible to fracture or loss

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 and
to evaluate the space maintainer to determine when it needs to be removed.

Prosthetic treatment of children aged 6 - 12

Prosthetic treatment of children aged 12 - 18


• First permanent molars – caries • Incisors – caries, traumatic injury


Dental veneers are wafer-thin, custom-made shells of toothcolored 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.

• discoloration – either 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 (for example, have craters or bulges in them) • teeth with gaps between them (to close the space between these teeth)

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