Pediatric prosthesis

Pediatric prosthesis

Introduction :

The early years of life are critical to children’s overall development, including their oral health. Protecting their smiles from an early age is crucial because preventive dental care lays the foundation for long-term dental health. Even baby teeth are important for growth and development. Our focus is on pediatric prosthetics, emphasizing the importance of this early care to ensure a healthy and confident future for our young patients.

Etiology of toothlessness:

1-Caries disease: Dental caries is more common in children than in adults, being the main cause of tooth loss. In very young children (between two and six years old), early childhood caries (ECC) is a major problem. It manifests itself by multiple caries, mainly in the upper anterior teeth, evolving rapidly and often associated with baby bottle syndrome.

2- Genetic Factors: Some tooth absences are due to genetic factors, where anomalies influence the development of teeth, causing dental agenesis.

3- Delayed Tooth Eruption : Some children may experience a delay in tooth eruption, which may make it appear as though teeth are temporarily missing.

4. Syndromes: Some genetic syndromes may be associated with dental agenesis. For example, hypodontia may be an aspect of syndromes such as Ectodermal syndrome .

5. Trauma: Dental trauma is common, accounting for 85% of oral injuries. Preschool children are particularly vulnerable. Between birth and 6 years of age, children with open bites and protruding teeth are more likely to be injured, especially to the maxillary incisors.

6. Infections: Serious infections or illnesses that occur during early childhood can sometimes disrupt the normal development of permanent teeth.

7. Heredity: Some children may inherit the genetic disposition for missing certain teeth, which can be seen in families.

8. Environmental Factors: Environmental factors such as exposure to toxic substances during pregnancy can influence dental development.

9. Metabolic Diseases: Metabolic diseases such as hypophosphatasia can cause tooth loss in children, with varying effects depending on the type and severity of the disease.

consequence of toothlessness:

Premature loss of dental organs leads to growth disturbances at several levels.

1. Disruptions to the bony bases: Early dental extractions can disrupt local growth, creating spaces between the teeth and disrupting the balance of the jaws and even the face.

2. Disturbances in the growth of the mandibular condyles: Unilateral chewing, due to tooth loss on one side of the jaw, can cause muscular imbalance, which affects abnormal condylar morphology and jaw movement .

3. Disturbances in the growth of alveolar processes: Alveolar growth is guided by the eruption of temporary then permanent teeth and by the functioning of the teeth.

4. Disturbances in the relationship of the arches: Significant edentulation can cause the establishment of a class II or III relationship.

Pediatric prosthesis

5. Disruptions in functions:

• Impact on Chewing : Tooth loss in children can compromise their ability to chew effectively, leading to nutritional problems.
• Impact on breathing : In cases of edentulism, a reduction in the height of the lower third of the face accompanied by a low position of the tongue can lead to a preference for mouth breathing rather than nose breathing.
• Impact on phonation: The absence of a tooth can lead to speech delays or pronunciation alterations, such as hissing or slurring .
• Impact on swallowing: Early loss of temporary teeth, especially molars and incisors, disrupts this function and prolongs infant swallowing.

6. Intra-arch dental consequences: Tooth loss causes migration of neighboring teeth, altering the stability of the arch.

7. Self-Esteem ( Psychosocial Consequences) : Edentulism can have a significant impact on a child’s self-esteem, especially as they grow and interact socially. Children may feel embarrassed or have low self-esteem due to the absence of visible teeth. 

1. Interest of the pediatric prosthesis:

Pediatric dentures are dental devices that are specifically designed to meet the unique needs of children who have lost teeth prematurely or have dental abnormalities. The primary goals of a pediatric denture are to:

1. Aesthetic
2. Restoration of oral functions
3. Growth Stimulation
4. Prevention of Complications and Malocclusions
5. Oral Care Education and Adherence
6. Optimizing future therapeutic potential
7. Restoring Trust
8. Space Hold and Eruption Guide
9. Indication and contraindication

Indication

Contraindication

Pediatric prosthesis is indicated in cases of early tooth loss and significant decay.In the case of children with poly caries, it is very often characterized by rapid progression, and results in significant loss of substance; (baby bottle syndrome)In the case of avulsions in case of infectious complicationsIn case of trauma In the case of default number anomalies (agenesis)In the case of shape anomalies (dysplasia)In the case of structural anomalies ( amelogenesis imperfecta, dentinogenesis imperfecta, dyschromia, etc.)To prevent certain anomalies, such as swallowing anomalies (this involves replacing the incisors which is very important to prevent this anomaly).

Child under 2 years oldPoor oral hygieneThe child’s lack of cooperationLack of motivation of parents and childIf restoration of temporary teeth is indicated

Practitioner-patient relationship:

Building a trusting relationship early in treatment is crucial. A warm and positive team can help facilitate interactions with children. Assessing the child’s and parents’ motivation and preparing them psychologically is also essential. It is important to:

• Explain, give compliments.
• Be courteous and attentive.
• Do not assert what will not be verified.
• Communication in its various forms is essential.
• Clinical examination in children:

Pediatric prosthesis

The clinical examination of a child requiring a pediatric prosthesis remains unremarkable and is based on the patient-practitioner relationship, allowing treatment to be planned and adequate follow-up to be ensured.

Therapeutic Option:

Ideally, treatment should begin in the second and third year of life. Often, there is pressure from parents to establish a “normal” appearance as soon as possible. Due to the rapid growth of the jaws, dentures require frequent adjustments to accommodate the child’s development.

Prosthesis  Removable in children:

A-Indications: The indications for these devices correspond to tooth loss in the same arch.

B- Principle: They are most frequently made of resin according to the same principles as partial or total removable prosthesis devices in adults.

C- Therapy: relies on the cooperation of the child, parents and dentist, with periodic check-ups recommended every two months.

D- Control : During the controls, it is necessary to check:

• Oral hygiene
• Stability and retention of the prosthesis
• Signs of prosthesis wear
• Growth and development of the jaws
• The appearance of permanent teeth.

Prosthesis fixed in child:

The fixed prosthesis can be designed to be compatible with the natural evolution of the child’s teeth, thus helping to maintain harmony in their smile during their development.

Pediatric prosthesis

Indication and contraindication

Indication	contraindication​
Extensive caries ; creeping; recurrent cariesAfter endodontic treatmentHereditary or acquired enamel defects : hypoplasia , amelogenesis imperfectaFractures of permanent and temporary incisorsSevere bruxismAbutment teeth for prosthesesAs part of maintaining space	Primary molars close to exfoliation.Primary molars with more than half of the roots resorbed.Teeth showing mobility.Teeth that are not restorable.Patients suffering from allergies.

B-1 Posterior Crowns in Pediatric Dentistry

Stainless steel crowns (SSC) can be defined as prefabricated crown forms that are tailored to individual teeth and cemented with a biocompatible luting agent.

The technique:

Seven steps of crown placement are:

1. Size
2. Crown selection
3. Adaptation
4. Fitting
5. Finishing
6. Sealing
7. Cleaning

B-2 Anterior Crowns in Pediatric Dentistry
Oral health is crucial for esthetics, but is threatened by dental caries, especially in the upper incisors of children, which can lead to complete loss of the dental crown. To address this, fixed prosthetics, including resin or clear polycarbonate crowns, are essential to meet esthetic and functional needs. The prosthesis can be fixed in two ways: directly in the mouth after selection of the appropriate crown, or indirectly through laboratory treatment.

Prosthesis Implant in child:

Implant treatments during growth were the subject of a favorable opinion from the HAS in 2006 entitled “Treatments of multiple agenesis linked to ectodermal dysplasia or other rare diseases, in children with oligodontia, with placement of 2 implants (or 4 maximum) only in the anterior mandibular region beyond 6 years and until the end of growth, after failure or intolerance of the functional prosthesis”

Conclusion

In conclusion, pediatric prosthetics represent much more than just a medical solution for children who need them. They embody hope, resilience, and the possibility of living a fulfilling life despite challenges. A proverb that is well suited to this perspective is: “Every child is a unique star in the sky of humanity, and a pediatric prosthesis is the means to make that star shine even brighter.”

Pediatric prosthesis