- Email: [email protected]
Immediate dentures for children
Completedentures
W. R. E. Laird,
B.D.S.*
University of Glasgow, Glasgow Dental Hospital and School, Glasgow, Scotland
A
n increasing number of children require prosthetic treatment after extraction of all their deciduous teeth as a result of severe caries. This increase in demand for care may result from an increased incidence in caries or from an increased awareness of the public of the prosthetic facilities available for children. Edentulous children require dentures to restore appearance and muscle function and to minimize possible psychologic disturbances which may arise from a prolonged edentulous condition. Treatment procedures have been described by many authors.‘-* The concept of immediate restorations is widely accepted by the dental profession. Advantages, disadvantages, and the various techniques have been documented.“^” Child patients also benefit from immediate restorations. Some of the more important advantages are the maintenance of appearance, the avoidance of undesirable habits in muscle function, the protection of the extraction wounds from trauma, and the splint-like action of the denture to control postextraction hemorrhage. From the viewpoint of the dentist, problems are minimized when records of the natural occlusion are available. Herein is a report of a child treated for immediate dentures. The four-year-old girl had a full complement of deciduous teeth with severe caries (Fig, 1). She was unable to eat normally and was restricted to soft foods because of decreased masticator-y ability. However, she did not complain of dental pain. Her parents were distressed by the appearance of her teeth and had no objection to their removal or to the provision of dentures. PLAN OF TREATMENT All of the maxillary teeth and the mandibular molars were indicated for rernoval with provision of dentures until eruption of the permanent teeth. The child was well-behaved and cooperative, and the parents were intelligent and appreciative of the problems which might be encountered, so it was decided to construct an immediate upper denture. *Lecturer
358
in Dental
Prosthetics.
Immediate
Volume 24 Number 4
Fig. 1. The extreme carious state of the upper immediate denture the treatment of choice.
Fig. 2. The upper
denture
was placed
dentures
teeth made extraction
immediately
following
for children
and construction
the removal
of the upper
359
of an
teeth.
TECHNIQUE OF DENTURE CONSTRUCTION Upper and lower impressions were made in alginate (irreversible hydrocolloid) impression material, and a wax interocclusal record was made in centric occlusion. Casts were poured in artificial stone and were mounted on an articulator. The teeth on the upper cast were removed, and the denture was finished with labial and buccal flanges. The maxillary teeth were extracted under general anesthesia at an outpatient session, and the immediate denture was placed (Fig. 2). Instructions were given to the mother that the denture should not be removed under any circumstances and that the patient should return in three days, or earlier if necessary. At the next visit, the mother reported that the child had experienced only slight discomfort with the exception of the immediate postoperative period. The
360
Laird
Fig. 3. The immediate
denture
in place
17 days after
surgery.
child was able to eat her soft diet comfortably, The denture was removed, and the mouth was rinsed. All sockets showed that a healthy blood clot had formed. Instructions were given regarding care of the denture. At the next appointment, 14 days later, the child had resumed a normal diet, and both child and parents were pleased with the improvement in appearance (Fig. 3). Two months later, a new denture was constructed to replace the immediate denture. DISCUSSION The methods which have been described are quite simple. Initially, allowance must be made for the general health of the patient, but the most important consideration is that children selected for this treatment should be well disciplined and cooperative. The parents must appreciate the difficulties which may sometime arise. Some aspects of the treatment merit further consideration. With patience, impressions may be made easily, especially if there is no history of previous dental trauma. A wax or alginate interocclusal record is adequate when a sufEcient number of natural teeth remain to ensure correct occlusion and to prevent overclosure of the vertical dimension of occlusion. Where a full complement of teeth is present, the casts can be occluded by fitting the opposing teeth together in centric occlusion. In the construction of immediate dentures, the Iabial and buccal flanges must be included. Often all of the deciduous teeth in one jaw can be extracted and the denture can be inserted at one appointment. The presence of a flange ensures ade-
Volume 24 Number 4
Immediate
dentures
for children
361
quate retention and stability by providing a good border seal. If both upper and lower immediate dentures are to be made, the upper denture is made first. This sequence allows the child to become accustomed to one denture at a time, and as the upper denture has superior retention and stability, it should be provided first. When success is established with the upper denture, the lower denture is accepted with confidence. If the health of the patient permits, the teeth are removed under general anesthesia. This procedure avoids the unfavorable complication created by using a local anesthetic which lasts for some time and does not assist in the wearing of dentures. Normally, an immediate denture should be removed, cleaned, and adjusted the when treating children, a period of at least first day postoperatively. However, three days should lapse before the dentures are removed. By this time, some reduction in postoperative edema will have taken place, and there will be less pain associated with the removal and reinsertion of the denture. However, should unexpected complications arise, the parents are advised to return with the child immediately. The parents must understand that the primary purpose of the treatment is the extraction of the carious teeth. An immediate denture is merely an additional, although desirable, refinement. If the child rejects the denture, it should, in no way, reflect on the ability of the dentist. The only loss is time, and a conventional denture may be constructed at a later date. SUMMARY Indications have been given for the treatment of preschool children for immediate dentures. A method of treatment has been described. Not every child is suitable for treatment with immediate dentures. An attempt must be made to gain the confidence and cooperation of both the patient and the parents. I am deeply indebted to my colleague, Mr. J. C. Thomson, for his constructive criticism and advice in the preparation of this article. Thanks is also due to Mr. J. B. Davies who kindly prepared the illustrations.
References 1. James, P. M. C.: Restoration of Function by Dentures in Small Children, D. Practitioner & D. Record 4: 116117, 1953. 2. Slack, G. L., and Davey, J. R.: Full Dentures for a Three Year Old Boy, Brit. D. J. 95: 125-127, 1953. 3. Cockburn, A., and MacGregor, A. R.: Treatment of the Edentulous Child, D. Practitioner & D. Record 11: 309-313, 1961. 4. Laird, W. R. E.: Dentures for Children, Brit. D. J. 121: 385-386, 1966. 5. Allen, A. G.: Immediate Dentures, Brit. D. J. 92: 212-215, 1952. 6. Fenn, H. R. B., Liddelow, K. P., and Gimson, A. P.: Clinical Dental Prosthetics, London, 1961, Staples Press. UNIVERSITY OF GLASGOW GLASGOW DENTAL HOSPITAL AND SCHOOL 211 RENFREW ST. GLASGOW, C.3, SCOTLAND
W. R. E. Laird,
B.D.S.*
University of Glasgow, Glasgow Dental Hospital and School, Glasgow, Scotland
A
n increasing number of children require prosthetic treatment after extraction of all their deciduous teeth as a result of severe caries. This increase in demand for care may result from an increased incidence in caries or from an increased awareness of the public of the prosthetic facilities available for children. Edentulous children require dentures to restore appearance and muscle function and to minimize possible psychologic disturbances which may arise from a prolonged edentulous condition. Treatment procedures have been described by many authors.‘-* The concept of immediate restorations is widely accepted by the dental profession. Advantages, disadvantages, and the various techniques have been documented.“^” Child patients also benefit from immediate restorations. Some of the more important advantages are the maintenance of appearance, the avoidance of undesirable habits in muscle function, the protection of the extraction wounds from trauma, and the splint-like action of the denture to control postextraction hemorrhage. From the viewpoint of the dentist, problems are minimized when records of the natural occlusion are available. Herein is a report of a child treated for immediate dentures. The four-year-old girl had a full complement of deciduous teeth with severe caries (Fig, 1). She was unable to eat normally and was restricted to soft foods because of decreased masticator-y ability. However, she did not complain of dental pain. Her parents were distressed by the appearance of her teeth and had no objection to their removal or to the provision of dentures. PLAN OF TREATMENT All of the maxillary teeth and the mandibular molars were indicated for rernoval with provision of dentures until eruption of the permanent teeth. The child was well-behaved and cooperative, and the parents were intelligent and appreciative of the problems which might be encountered, so it was decided to construct an immediate upper denture. *Lecturer
358
in Dental
Prosthetics.
Immediate
Volume 24 Number 4
Fig. 1. The extreme carious state of the upper immediate denture the treatment of choice.
Fig. 2. The upper
denture
was placed
dentures
teeth made extraction
immediately
following
for children
and construction
the removal
of the upper
359
of an
teeth.
TECHNIQUE OF DENTURE CONSTRUCTION Upper and lower impressions were made in alginate (irreversible hydrocolloid) impression material, and a wax interocclusal record was made in centric occlusion. Casts were poured in artificial stone and were mounted on an articulator. The teeth on the upper cast were removed, and the denture was finished with labial and buccal flanges. The maxillary teeth were extracted under general anesthesia at an outpatient session, and the immediate denture was placed (Fig. 2). Instructions were given to the mother that the denture should not be removed under any circumstances and that the patient should return in three days, or earlier if necessary. At the next visit, the mother reported that the child had experienced only slight discomfort with the exception of the immediate postoperative period. The
360
Laird
Fig. 3. The immediate
denture
in place
17 days after
surgery.
child was able to eat her soft diet comfortably, The denture was removed, and the mouth was rinsed. All sockets showed that a healthy blood clot had formed. Instructions were given regarding care of the denture. At the next appointment, 14 days later, the child had resumed a normal diet, and both child and parents were pleased with the improvement in appearance (Fig. 3). Two months later, a new denture was constructed to replace the immediate denture. DISCUSSION The methods which have been described are quite simple. Initially, allowance must be made for the general health of the patient, but the most important consideration is that children selected for this treatment should be well disciplined and cooperative. The parents must appreciate the difficulties which may sometime arise. Some aspects of the treatment merit further consideration. With patience, impressions may be made easily, especially if there is no history of previous dental trauma. A wax or alginate interocclusal record is adequate when a sufEcient number of natural teeth remain to ensure correct occlusion and to prevent overclosure of the vertical dimension of occlusion. Where a full complement of teeth is present, the casts can be occluded by fitting the opposing teeth together in centric occlusion. In the construction of immediate dentures, the Iabial and buccal flanges must be included. Often all of the deciduous teeth in one jaw can be extracted and the denture can be inserted at one appointment. The presence of a flange ensures ade-
Volume 24 Number 4
Immediate
dentures
for children
361
quate retention and stability by providing a good border seal. If both upper and lower immediate dentures are to be made, the upper denture is made first. This sequence allows the child to become accustomed to one denture at a time, and as the upper denture has superior retention and stability, it should be provided first. When success is established with the upper denture, the lower denture is accepted with confidence. If the health of the patient permits, the teeth are removed under general anesthesia. This procedure avoids the unfavorable complication created by using a local anesthetic which lasts for some time and does not assist in the wearing of dentures. Normally, an immediate denture should be removed, cleaned, and adjusted the when treating children, a period of at least first day postoperatively. However, three days should lapse before the dentures are removed. By this time, some reduction in postoperative edema will have taken place, and there will be less pain associated with the removal and reinsertion of the denture. However, should unexpected complications arise, the parents are advised to return with the child immediately. The parents must understand that the primary purpose of the treatment is the extraction of the carious teeth. An immediate denture is merely an additional, although desirable, refinement. If the child rejects the denture, it should, in no way, reflect on the ability of the dentist. The only loss is time, and a conventional denture may be constructed at a later date. SUMMARY Indications have been given for the treatment of preschool children for immediate dentures. A method of treatment has been described. Not every child is suitable for treatment with immediate dentures. An attempt must be made to gain the confidence and cooperation of both the patient and the parents. I am deeply indebted to my colleague, Mr. J. C. Thomson, for his constructive criticism and advice in the preparation of this article. Thanks is also due to Mr. J. B. Davies who kindly prepared the illustrations.
References 1. James, P. M. C.: Restoration of Function by Dentures in Small Children, D. Practitioner & D. Record 4: 116117, 1953. 2. Slack, G. L., and Davey, J. R.: Full Dentures for a Three Year Old Boy, Brit. D. J. 95: 125-127, 1953. 3. Cockburn, A., and MacGregor, A. R.: Treatment of the Edentulous Child, D. Practitioner & D. Record 11: 309-313, 1961. 4. Laird, W. R. E.: Dentures for Children, Brit. D. J. 121: 385-386, 1966. 5. Allen, A. G.: Immediate Dentures, Brit. D. J. 92: 212-215, 1952. 6. Fenn, H. R. B., Liddelow, K. P., and Gimson, A. P.: Clinical Dental Prosthetics, London, 1961, Staples Press. UNIVERSITY OF GLASGOW GLASGOW DENTAL HOSPITAL AND SCHOOL 211 RENFREW ST. GLASGOW, C.3, SCOTLAND