Management after extraction of a permanent tooth
Introduction :
Premature loss of permanent teeth is unfortunately not uncommon during childhood and adolescence. The maxillary central incisor and the first molar are the teeth most exposed mainly in a growth context, at ages when the maturity of the tooth, the surrounding bone and the periodontal ligament is not reached.
1-Definition:
Avulsion is the total expulsion of the tooth from its socket, with rupture of the vascular-nervous bundle and the integrity of the alveolo-dental ligament . The latter can be either induced or therapeutic (orthodontic, or pathological (situation of a compromised tooth) or spontaneous following dental trauma (generally the case of the upper central incisor).
2-The different clinical situations:
a. Pathological avulsion
The indications for extractions are the consequences of too severe a pathological condition or the failure of conservative and/or endodontic treatment (case of the upper central incisor and the first molar), or of reimplantation (case of the upper central incisor).
Management after extraction of a permanent tooth
- b. Orthodontic avulsion
ICS and PMP extractions are not the extractions of choice in ODF. Indeed, when avulsions are necessary, premolars are the teeth most often extracted. However, there are rare purely orthodontic indications where PMPs are extracted instead of premolars:
-Hyperdivergent patient presenting anterior and posterior dento-maxillary disharmony, in the presence of healthy 3rd molars and without shape abnormality.
-Avulsions of the maxillary PMPs in association with extractions of the 4 premolars during severe class II without growth and without cooperation.
-The indications for molar extractions most often arise from their pathologies. In addition, when they are compromised, their extraction will be preferred to that of healthy premolars in the case of orthodontic treatment by extractions.
Management after extraction of a permanent tooth
c. Traumatic avulsion
This is the situation of traumatic expulsion of the upper central incisor .
3-Treatment plan after loss of a permanent tooth:
a- Case of the first permanent molar:
Therapeutic attitudes towards the loss of a PMP in a child or adolescent
b- Case of the upper central incisor :
- Traumatic emergency situation:
- Situation of pathological avulsion or reimplantation failure:
The therapeutic approach in this case consists of managing the edentulism with temporary removable prosthetic solutions while waiting for a fixed solution at the end of growth and a solution for use in adulthood.
Conclusion :
The loss of a permanent tooth has many consequences for the patient’s teeth, periodontium , occlusion and bone bases. The edentulous space must systematically be maintained, closed or compensated to avoid these consequences.
This requires genuine multidisciplinary clinical reflection in order to establish an individualized treatment plan, thus optimizing the result in adulthood.