Aesthetic - functional maintainer for early loss of primary teeth after trauma: case report

relato de caso

Abstract

Introduction

Traumatic dental-alveolar injuries in the primary dentition are acute and multifaceted in nature. These injuries are quite common during childhood due to recurrent activities such as running, playing, and jumping, which can lead to accidental falls and result in these injuries. Trauma-related dental injuries are classified into hard tissue injuries and soft tissue injuries. Each classification has distinct characteristics, prognoses, and treatments, ranging from preservation to loss of the dental element. When premature loss of a primary tooth occurs (before its physiological exfoliation associated with the eruption of the successor permanent tooth), an alternative treatment is the placement of a fixed aesthetic and functional space maintainer. In cases of premature loss of primary teeth, rehabilitation is crucial to restore aesthetics, speech, and swallowing, as well as to prevent the development of the habit of tongue interposition in the edentulous space.

This case report presents a low-cost, easy-to-make, and easy-to-install alternative for the rehabilitation of a patient in early childhood with non-cooperative behavior.

Case Description

Patient L.F., a three-year-old male, presented to the Integrated Pediatric Clinic II during the evening shift of the Dentistry course at Arnaldo College, accompanied by his mother. During the anamnesis, the mother reported the loss of the dental element 51 as the main complaint. According to her, the patient slipped on a wet floor when he was a year and a half old and fractured the tooth in half, which was likely diagnosed as a crown-root fracture, a hard tissue injury characterized by the loss of continuity or rupture of the dental structure involving enamel, dentin, and cementum, with or without pulp exposure. The guardian reported taking him to a dentist in his town in the interior of Minas Gerais shortly after the fall, where the remaining tooth was extracted.

Results

The clinical approach for the patient's rehabilitation involved the placement of a fixed space maintainer with aesthetic and functional purposes, as the loss of a dental element and the resulting space could lead to occlusal disorders, phonetic problems, chewing functional changes, development of a habit of tongue interposition, and self-esteem issues related to social embarrassment for the child and family. During a second consultation, orthodontic bands were fitted on the second primary molars in the upper arch (teeth 55 and 65), choosing the prefabricated bands that best adapted to the teeth. Impressions were taken with alginate (Hydrogum®), with the bands in place, followed by subsequent pouring with type III stone gypsum, so that the model with the orthodontic bands included could be sent to the orthodontic prosthesis laboratory. A palatal bar was fabricated, welded to the bands, and a retentive extension was added for an acrylic tooth in the region of tooth 51. After delivery from the laboratory, the aesthetic-functional space maintainer was cemented to teeth 55 and 65 with glass ionomer cement (Vidrion C®). After cementation, considering the difficulty in maintaining relative isolation from moisture and the non-cooperative behavior of the patient, an incongruence in the color of the “prosthetic” element was observed by students and supervising professors. The problem was presented to the patient's mother, who promptly scheduled a follow-up appointment. A light adjustment was made to the vestibular surface of the prosthetic element 51 with a diamond bur 2200, and a layer of composite resin in shade B1 was applied in light-cured increments to match the color with the neighboring teeth. Conventional composite resin repair steps were followed: two-step adhesive system (37% phosphoric acid and primer + adhesive).

Conclusion

The fixed aesthetic-functional space maintainer is an excellent option for treating patients who have lost a primary anterior tooth prematurely due to trauma, as it aligns well with the primary goals of pediatric dental treatments: restoring function, aesthetics, and quality of life.