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Complete Overlay Denture as an Alternative Oral Rehabilitation in a 5-Year-Old Child

With Early Childhood Caries

Keshav Kumar Gautam
Keywords: Early Childhood Caries; overlay denture; oral rehabilitation.
Early childhood caries (ECC) with extensively destroyed crowns to which direct restorative procedures are not an option, cons-
truction oI denture might be required to rehabilitate the child both esthetically and Iunctionally. This paper reports a case oI a 5-
year-old patient with ECC and presents an alternative treatment with single maxillary overlay denture. Overlay dentures are
complete or partial removable dentures that are Iabricated over retained teeth or roots that are not specially prepared to accept
coping. Overlay dentures are relatively easy to Iabricate and render satisIactory results Ior the pediatric patient.
Introduction ionomer cement (GC Fuji II, GC Corporation, Tokyo, Jap-
Early childhood caries (ECC) is a speciIic Iorm oI severe an) and coronal portion oI teeth were smoothened Ior any
dental caries that aIIects inIants and young children. It was sharp structure or undercut. Primary impression was made
seen that up to 70 oI disadvantaged preschool children in with alginate (Zelgan 2002, Dentsply, India) because oI its
developing countries are aIIected with ECC. In subpopu- rapid-setting qualities, pleasant smell and taste. The secon-
lations oI poor and minority children, the rate is higher and dary impression was made using custom-made acrylic res-
in impression trays (DPI-RRCold cure acrylic resin, DPI, conditions begin earlier. Although preventive services
Mumbai, India) with rubber base impression material are available Ior early intervention, a deIinitive treatment
(Zeta plus, Zhermack, Badia Polesine Italy). Occlusion Ior children already suIIering Irom severe ECC remains to
rims constructed on the working casts were transIerred to be demonstrated. Overlay denture as earliest possible pros-
the mouth to establish the vertical dimension and centric thetic treatment must be considered, on the one hand to
relation (Figure 4). limit the resorption oI the alveolar ridges, and on the other
The vertical dimension was Iirst determined by swallow- to minimize the emotional and psychological impact creat-
ing, checked by the rest position and associated Iree way ed by the lack oI teeth on the child's relationships. This
space, and Iinally veriIied by means oI phonetics. The cent- article presents a case report oI a 5-year old child patient
ric relation was registered utilizing occlusion rims with a with early childhood caries, to whom complete oral rehabi-
check bite procedure. Plastic teeth with cuspal occlusal Ior- litation was rendered which included single maxillary
ms were used. Their inclines were reduced and central Ios- overlay denture.
sae enlarged both anteriorly and laterally to allowIreedom
in centric position. The teeth were set on the articulator to Case report
achieve balance in protrusive and lateral excursions. Ante- A5-year-old child patient reported with the chieI complain
rior and posterior try-in was done (Figure 5). oI severe decay in upper and lower deciduous dentition
The denture, processed with a conventional type resin (DPI (Figure 1). His mother gave the history oI excessive consu-
Heat cure acrylic resin, DPI, Mumbai, India), were inserted mption oI sweetened Iood with poor oral hygiene mainte-
and the necessary adjustments were carried out. The patie- nance. The gross destruction oI teeth in the anterior region
nt was seen the next day. Retention and stabilization oI the led to the development oI tongue thrusting habit. Oral exa-
dentures were clinically acceptable (Figure 6). DiscomIort mination conIirmed this with a case oI ECC, as maxillary
areas were relieved. There was over display oI denture base dentition showed total coronal destruction; where as lower
because oI cupid shaped upper lip. The patient reported no primary molars were deeply carious. The buccal mucosa,
discomIort and seemed to be adapting well on the Iollow- palate and the Iloor oI the mouth and alveolar ridge were
ing weekly visits. The increased vertical dimension had normal.
established better muscle tonus and lip support. Extraction oI 2 teeth and pulp therapy Ior rest oI maxillary
dentition was planned. Coronal structure in the maxillary
Discussion dentition was insuIIicient Ior the provision oI Iixed prosth-
Tooth integrity is very essential Ior preservation oI occlus- esis (Figure 2). Hence it was decided to Iabricate a maxill-
ion, esthetics, phonetics and psycho-emotional well being ary complete denture overlaying the remaining root stump
oI an individual. When this integrity is compromised due to (overlay denture). Over a period oI time, pulp therapy was
ECCit may lead to many adverse eIIects, especially on the perIormed Ior the entire maxillary dentition and 2 teeth
psychological and physiological conditions oI patients were extracted. Similarly mandibular primary molars were
during childhood. The child may present behavioral and pulpally treated and stainless steel crowns were given
relationship disturbances compromising school perIorma- (Figure 3).
nce. ThereIore, deIinitive treatment in the Iorm oI prosth- The pulpally treated maxillary teeth were sealed with glass
Faculty oI Dental Sciences, IMS, BHU, Varanasi, Uttar Pradesh, India.
Dr. Keshav Kumar Gautam Correspondence: , email:
Indian J Stomatol 2013;4(1):58-60
etic rehabilitation should be taken into consideration Ior and render satisIactory results Ior the pediatric patient.
children suIIering Irom severe ECC (S-ECC). Prosthetic Advantages oI an overlay denture include: improved esth-
rehabilitation in Iorm oI complete dentures has been provi- etics, speech, and mastication; low cost; little chair-side
ded to children with congenital disorders (e.g., cleIt pala- time; reversibility; alterability; maintenance oI alveolar
te), oligodontia, ectodermal dysplasia, and cleidocranial bone and proprioception; and excellent retention and stab-
5-7 11
dysplasia. But, earlier attempts to treat children suIIering ility. Most importantly, there is a great psychological ben-
Irom S-ECC were total extraction oI maxillary teeth Iollo- eIit to the young patient.
wed by construction oI immediate denture. Overlay dent-
Conclusion ure clearly can be prosthesis oI choice in young individuals
The approach to the patients suIIering Irom S- ECCcannot suIIering Irom severe ECC with extensive crown destruct-
be restricted to dental treatment and controlling oI caries ion. An overlay denture is a complete or partial removable
activity, but should also comprehend esthetic and Iuncti- denture Iabricated over retained teeth or roots that are not
onal rehabilitation. Placement oI overlay denture should be prepared with a coping to interIace with the denture. The
considered as treatment oI choice in conditions like this, a Iabrication oI overlay dentures also may be the treatment
Iollow-up oI the child's growth and development should be oI choice Ior other disorders that are associated with malI-
done, in such a way that the treatment perIormed may have ormed or missing teeth, and Ior patients with severely erod-
a positive impact on dentoIacial growth as well as on the
ed or abraded teeth.
psychological well being.
Complete overlay dentures are relatively easy to Iabricate
Indian J Stomatol 2013;4(1):58-60
Figure 6: Post-operative Irontal view
Figure 5: Try in
Figure 4: Jaw relation Figure 3: Radiograph showing completed pulp
therapy and stainless steel crown placement
Figure 2: Occlusion oI patient beIore denture Iabrication Figure 1: Pre-operative Irontal view
Indian J Stomatol 2013;4(1):58-60
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