Prosthetic treatment in children 6 DM

Prosthodontics in childhood Dental prosthetic treatment of children is planned with respect to the special conditions accompayning the absence of teeth Dental prosthetic appliances has temporary function Prostethetics: principal functions: Rehabilitation of masticatory efficiency Protection of dental pulp Esthetic function

Prosthodontics in childhood 4 Prevention and correction of speech abnormalities 5. Support optimal development of teeth and their eruption 6. Support growth of dental arches 7. Support growth of facial bones 8. Prevention of harmful habits

Prosthodontics in childhood 9. Provision of space maintainance 10. Obturation of congenital defects of orofacial structures 11. To create conditions for prosthodontics in adult age Other functions: Stop bleeding (cover plate) To keep developmental oppening following the surgery intervention (ocludor) To fix the loosed teeth after trauma or osteomyelitis (splint)

Basic principles of prosthodontic treatment in children non toxic materials to dental pulp appliances must not irritate soft tissues appliances must not irritate marginal gingiva appliances must not extend to gingival sulcus appliances must not inhibit development and growth of dental arches appliances do not include active clasps (unless a combination with orthodontic appliance)

Prosthodontics dentures in children with deciduous dentition Fixed dentures Removable dentures Fixed dentures: protective temporary crown (protect vital pulp after dental trauma in vital teeth) fixed space maintainers fixed splint

Reconstruction of deciduos crowns: Types of temporary crowns: Protective celuloid crown Metallic crown Stainless steel crown for distal teeth prefabricated Resin crowns for frontal teeth Indications: after trauma of frontal teeth carious destruction of frontal teeth carious destruction of lateral teeth developmental anomalies

Indications for stainless steel crowns:

Stainless steel crown are manufactured by 3M ESPE, they come several sizes numbered from 2 to 7. Step by step technique for fiting stainless steel crown: Local analgesia Reduction of occlusal height Reduction of distal and mesial surfaces Select a crown for trial fit Crimp the crown margins (scissors, pliers) Cement the crown on the tooth Final check Follow up

Prosthodontics dentures in children with deciduous dentition B) fixed space mainterners band with wire loop keep the space for permanent tooth after premature extraction of deciduos tooth

Prosthodontics dentures in children with deciduous dentition fixed splint immobilize teeth after trauma immobilize teeth in case of osteomyelitis (wire and composite, fibre splint)

Removable dentures in deciduous dentition Removable partial dentures (space maintainers) Vestibular screen Lingual bar Removable partial dentures are designed to allow modifications when growth occurs and when teeth erupt and migrate. Partial dentures are also indicated for long or widely distributed edentulous spans or when bone resorption and remodeling is anticipated immediately following extraction or traumatic tooth loss.

Removable dentures design For patient with growing arches, maxillary dentures usually are designed with acrylic base. Acrylic base is extended, covers the whole palate. Clasps are not used, but some orthodontic springs may be incorporated in the design to achieve simple tooth movement if necessary.

it shoud be construced with minimal damage to the tissues it should allow hygienic and cosmetic demants Retention is provided by: extended body 90% inclination of deciduous teeth RECALL SHORTER LIFETIME

Prosthodontics treatment for children with permanent dentition Indications: dental caries dental trauma congenitaly missing teeth malformed teeth erosion by dietary habits Goals of prosthodontics treatment psychological rehabilitation esthetic rehabilitation to achieve complet root formation

Prosthodontics treatment of the adolescents Fixed Removable Fixed crowns and bridges 1. All ceramic crowns 2. Metal- ceramic crowns 3. Resin crowns Indications: dental caries, tooth trauma, malformed tooth, discolored tooth, developmental anomalies, premature loss of teeth

Prosthodontics treatment of the adolescents Preparation of all ceramic crown: required normal tooth preparation smooth finish line is 0.8 mm in depth around the entire tooth lingual reduction 1 mm axial surfaces are reduce to a depth of 0,8 mm an incisal edge reduction 1.5 – 2 mm

whenever possible, cervical margin shoud not be extended into gingival sulcus of an adolescent patient (subgingival margin can produce in case of inadequate hygiene accelerated gingival recession)

Prosthodontics treatment of the adolescents Preparation of metal- ceramic crown: smooth finish line is 1.0 mm in depth around the entire tooth lingual reduction 1 mm axial surfaces are reduce to a depth of 0,8 mm an incisal edge reduction 2 mm whenever possible, cervical margin shoud not be extended into gingival sulcus of an adolescent patient (subgingival margin can produce in case of inadequate hygiene accelerated gingival recession)

Fixed partial dentures Indications: tooth lost after trauma congenital lack of tooth formation extensive caries Resin bonded retainers (dens pendens, Maryland bridge, Rochet bridge) should be provided immediately after tooth lost to prevent tipping or rotation of the abutment teeth retention and resistance form is achieved through tooth preparation

Fixed partial dentures 2. Complete crown retainers (dental bridge) - when a resin bonded retainers cannot be used because of the tooth condition, crown form, crown lenght, axial alignment, occlusal forces or conditions requiring maximal retention and resistance form, use of complete – coverage retainer is indicated

Removable partial dentures Indications: excessive span lenght the inability to achieve adequate retention for a fixed prosthesis congenital malformation injuries of multiple teeth

Removable partial dentures Major objectives in construction of removable partial dentures: The restoration of the functions of mastication and speech The restoration of dental and facial esthetics The preservation of the ramaining teeth and their supportive tissues