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Journal of Indian Society of Pedodontics and Preventive Dentistry Official publication of Indian Society of Pedodontics and Preventive Dentistry
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CASE REPORT
Year : 2012  |  Volume : 30  |  Issue : 4  |  Page : 349-351
 

Management of early loss of first permanent molar: A new technique


Department of Pedodontics and Preventive Dentistry, College of Dental Sciences, Davangere (KA), India

Date of Web Publication19-Mar-2013

Correspondence Address:
B S Rajashekhara
Department of Pedodontics and Preventive Dentistry, College of Dental Sciences, Davangere (KA)
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-4388.108942

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   Abstract 

The loss of a permanent first molar in adolescent patient creates a need for early space maintenance and restoration of function. To ascertain function and esthetics, immediate treatments include interim restorative approaches. This paper describes a conservative, functional and cost-effective bridge as an interim restoration after the loss of permanent first molar in an early adolescent dentition.


Keywords: Conservative, first molar, functional, interim restoration, permanent, space maintenance


How to cite this article:
Rajashekhara B S, Keyur J M, Bhavna D, Poonacha K S. Management of early loss of first permanent molar: A new technique. J Indian Soc Pedod Prev Dent 2012;30:349-51

How to cite this URL:
Rajashekhara B S, Keyur J M, Bhavna D, Poonacha K S. Management of early loss of first permanent molar: A new technique. J Indian Soc Pedod Prev Dent [serial online] 2012 [cited 2019 Dec 15];30:349-51. Available from: http://www.jisppd.com/text.asp?2012/30/4/349/108942



   Introduction Top


The first permanent molar is undeniably the most important unit of mastication and is essential in the development of functionally desirable occlusion. The loss of a first permanent molar in a child can lead to changes in the dental arches that can be traced throughout the life of that person. Unless appropriate corrective measures are instituted, these changes include diminished local function, drifting of teeth, and continued eruption of opposing teeth. [1] The different procedures or techniques have one or the other limitations. So this paper describes a new technique of management of early loss of a permanent mandibular first molar in an adolescent patient.


   Case Report Top


A 13-year-old male with no relevant systemic history reported with carious lower permanent first molars to the Department of Pedodontics, KM Shah Dental College and Hospital, Vadodara.

On examination 36 and 46 were deeply carious, 36 was planned for root canal treatment followed by stainless steel crown where as 46 fractured due to caries and had a large periapical pathology, which was a poor candidate for endodontic treatment and restoration[Figure 1], [Figure 2] and [Figure 3], hence it was extracted. The permanent second molar had not erupted completely thus the crown height available was short, since the patient was not willing to wear a removable appliance, a fixed appliance was fabricated as an affordable interim alternative. The follow-up for 12 months revealed satisfactorily results. This bridge was intended to remain in place until the patient's occlusion is enough to receive a permanent prosthetic replacement or an implant.
Figure 1: Intraoral view

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Figure 2: IOPAs of 36 showing root canal treatment

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Figure 3: IOPA of 46

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Technique

Band adaptation was done for the mesial and distal abutment teeth i.e., second premolar and permanent second molar [Figure 4]a. Alginate impressions of both the arches were made, the mandibular alginate impression was poured in stone with the bands in place thus providing a working model.
Figures 4: (a-c) Band adoptation and appliancefabrication on 45, 46 and 47

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A wire mesh was constructed by bending 26-G stainless steel orthodontic wires. The width of mesh was 4-mm less than the bucco-lingual width of the crowns. The length and contour of mesh corresponded to the edentulous space. The mesh was soldered to the bands contoured for the abutment teeth [Figure 4]b. The mesh served to hold the three units of bridge together, the gingival extension of the wire mesh was placed 1 mm above the ridge to allow adequate cleansing while not allowing food entrapment or gingival irritation, the occlusal rest is prepared on second molars to hold the appliance in place and the solder joints were finished and polished. A mandibular first molar resin tooth was selected as pontic. The pontic was attached to the finished wire framework using auto polymer rising acrylic resin, matching the shade of the pontic. The acrylic attachment was finished and polished [Figure 4]c.

The bridge was ready for a try in, in the patient's mouth for final adjustments. The bridge was assessed for the gingival extension and soft tissue blanching. The occlusal and eccentric movements were adjusted. The bridge was cemented with Fuji I Glassionomer luting cement [Figure 5]. In a follow-up of 12 months, the bridge exhibited excellent soft tissue acceptance and has restored the masticatory function as well.
Figure 5: Postoperative intraoral view

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   Discussion Top


Ideally, as the occlusion develops from the primary dentition through the transitional (or mixed) dentition to the permanent dentition, a sequence of events occurs in an orderly and timely fashion. These events result in a functional, esthetic, and stable occlusion. When this sequence is disrupted, however, problems arise that may affect the ultimate occlusal status of the permanent dentition. When such disruptions do occur, appropriate corrective measures are needed to restore the normal process of occlusal development. Such corrective procedures may involve some type of passive space maintenance, active tooth guidance, or a combination of both.

The space can be maintained, this may be accomplished in one of the several ways. [1]

  • Cast overlay band and loop.
  • Band and loop maintainer with occlusal bar and rest.
  • Conventional fixed bridge work.
  • Etched casting, resin-bonded posterior bridge.
  • Single-unit implant prosthesis.
  • Auto-transplantation of third molars into the first molar position.
  • Stainless steel crown bridge. [2]
The bridge provides us with an additional treatment modality in case of an early loss of a permanent tooth in young adolescent patients. It has soft tissue sparing as compared to a treatment partial denture.

Success of bonded prosthesis is variable, design-dependent and requires the abutment teeth to have adequate structure and sound enamel for etching and bonding. [3]

The bridge is functional, readily acceptable, maintains the mesiodistal dimensions of the lost tooth, prevents supra eruption of opposing teeth and does not restrict normal growth and development, as is required of an ideal space maintainer. [4]

It is easy to construct, needs a short fabrication time and the materials are easily available in a pediatric dental clinic. Since the laboratory technique is simple, fabrication and delivery of the prosthesis can be accomplished in a single appointment. The appliance has been shown to have an excellent patient compliance and is easy to clean and maintain. It has decreased likelihood of breaking or getting lost. Hygiene is easily maintained with no food entrapment. The bridge can be easily removed and recemented for fluoride application at recall appointments, if the need arises.


   Conclusions Top


Managing space and arch integrity in early loss of first permanent molar is a challenging task for the Pedodontist. Implication of this new technique makes the complicated task uncomplicated.

 
   References Top

1.McDonald RE, Avery DR. Dentistry for the child and adolescent. Missouri Elsevier 2004. p. 644-6.  Back to cited text no. 1
    
2.Dimri M, Jain A. Stainlees Steel Crown Bridge Replacing Permanent Molar In The Adolescent Patient: A Case Report. J Indian Soc Pedo Prev Dent 2001;2:74-6.  Back to cited text no. 2
    
3.Berckally T, Smales R. A Retrospective clinical evaluation of resin bonded bridges inserted at Adelaide Dental Hospital. Aust Dent J 1993;38:85-96.  Back to cited text no. 3
    
4.Graber TM. Orthodontics: Principles and Practice. Philadephia W.B.: Saunders and Co; 1992. p. 640-1.  Back to cited text no. 4
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]



 

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    Abstract
   Introduction
   Case Report
   Discussion
   Conclusions
    References
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