The premature loss of primary teeth can lead to drifting of permanent or primary teeth and result in potential alignment problems.
The possible sequelae following an early loss of primary teeth are:
Primary Incisor
- Generally, there is no loss in arch circumference, even if the teeth drift and redistribute.
- Primary anterior teeth are not required for nutrition or speech development. Replacement is done solely to improve aesthetics (for social advantage).
Primary Canine
- Permanent incisors may tilt lingually or ditch distally. This can lead to delayed eruption, impaction or malpositioning of permanent canine.
Primary First Molar
- During active eruption of permanent first molar: Primary second molar may move or tilt mesially, resulting in decreased space for the eruption of first premolar.
- During active eruption of permanent lateral incisor: Distal ditching of primary canine, which may lead to a shift in midline towards the affected side and an eventual overbite. This may also result in block out of permanent canine.
Primary Second Molar
- Before eruption of permanent first molar: May lead to mesial tilting or migration of permanent first molar, closing on the space for second premolar.
- After eruption of permanent first molar: Mesial tipping of permanent first molars (maxillary first molars would also rotate mesially along the palatal root).
Selection of Space Maintainer
Space maintenance is appropriate only when adequate space is available for the eruption of succedaneous teeth and when all unerupted teeth are present and at the normal age of development.
A space maintainer is unnecessary if the permanent successor will erupt within 6 months i.e., if more than half or two-third of its root has formed. Also, they are inadequate/inappropriate if permanent tooth is missing, or enough space is not available for the permanent tooth.
Primary Anterior Teeth
- Loss of Incisors: Acrylic prosthesis soldered with bands or SS crown on molars.
- Unilateral Loss of Canine: Band and loop with primary first molar as abutment.
- Bilateral Loss of Canines: Nance palatal holding arch (maxilla), Lingual arch (mandible).
Primary First Molar
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Unilateral Loss: Band and loop appliance, where the primary second molar is the abutment.
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Bilateral Loss:
- Upper arch: Nance palatal holding arch, Trans palatal arch, Bilateral band and loop space maintainer.
- Lower arch: Lingual arch, Bilateral band and loop space maintainer.
- Abutment: Permanent first molars (first choice), or primary second molars.
Primary Second Molar
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Unilateral Loss: Band and loop space maintainer.
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Bilateral Loss:
- Upper arch: Nance palatal holding arch (appliance of choice), Bilateral band and loop space maintainer.
- Lower arch: Lingual arch (appliance of choice).
- Abutment: Permanent first molars.
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Prior to eruption of permanent first molars: Distal shoe space maintainer.
Management
The management of early loss of posterior teeth is depicted as under:
References
- Textbook of Orthodontics (2nd Edition), Gurkeerat Singh, Jaypee Brothers Medical Publishers (P) Ltd.
- William R. Proffit- Contemporary Orthodontics (6th edition), Elsevier Mosby.
*This article is an excerpt from the above mentioned books and Medical Sutras does not make any ownership or affiliation claims.