|Year : 2021 | Volume
| Issue : 1 | Page : 44-48
Dental management and restoration of confidence in children with hollywood appliance: A case series
Amit Kumar Pathak, Sanketa Bharat Patil
Department of Pediatric and Preventive Dentistry, Clove Dental (Star Dental Pvt Ltd.), New Delhi, India
|Date of Submission||07-Apr-2020|
|Date of Acceptance||06-Jan-2021|
|Date of Web Publication||22-Apr-2021|
Dr. Amit Kumar Pathak
House No. 3598, Street No. 96, B-Block, Near Apex Public School, Sant Nagar, Burari, New Delhi - 110 084
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Loss of anterior teeth can have a detrimental effect on children's quality of life, and the therapeutic approaches are always challenging. Missing teeth can have a marked psychosocial effect and functional implications for a growing child. This report describes the replacement of missing teeth in 5-and 9-year-old male patients by Hollywood appliance. These cases illustrate the essential role of the pediatric dentist in the management of missing teeth in the mixed dentition stage. The treatment outcomes had a positive impact on the confidence of children as well.
Keywords: Anterior tooth rehabilitation in children, esthetic space maintainer, Hollywood appliance, restoration of confidence
|How to cite this article:|
Pathak AK, Patil SB. Dental management and restoration of confidence in children with hollywood appliance: A case series. J Interdiscip Dentistry 2021;11:44-8
|How to cite this URL:|
Pathak AK, Patil SB. Dental management and restoration of confidence in children with hollywood appliance: A case series. J Interdiscip Dentistry [serial online] 2021 [cited 2021 Jun 18];11:44-8. Available from: https://www.jidonline.com/text.asp?2021/11/1/44/314176
| Clinical Relevance to Interdisciplinary Dentistry|| |
The application and fabrication of Hollywood Appliance involves Department of Pediatric and Preventive Dentistry, Aesthetic Dentistry and Prosthodontic. Also, the appliance acts as a functional space maintainer thus helps in preventing any malocclusion and therefore involves Orthodontics as well.
| Introduction|| |
Caries and trauma can be the major cause for the early loss of teeth in a pediatric patient. The greatest challenge faced by a pediatric dentist is the esthetic as well as functional rehabilitation of the missing teeth.
Premature loss of teeth causes minimal space loss, lingual collapsing of anterior teeth, and minimal shift along with parafunctional habits as well as psychological problems and diminishes confidence.,
The literature reports of restoration of decayed anterior teeth using strip crowns, but there are very less literature supporting fixed rehabilitation of premature loss of anterior teeth in children. For premature loss of posterior teeth, there are many different types of appliances that can be used as fixed space maintainers including band and loop appliance, crown and loop appliance, distal shoe appliance, transpalatal arch, Nance palatal arch appliance, lingual arch, and fixed wire composite space maintainers.,
In this article, we are going to discuss two cases, first of early childhood caries and second of trauma, causing early loss of anterior teeth. Rehabilitation was done using a modification of Nance palatal arch appliance so that it can be used as a replacement of premature loss of teeth in the anterior and can be esthetically as well as functionally be good.
| Case Reports|| |
Case report 1
A 5-year-old boy reported to the clinic with a chief complaint of decayed upper front teeth. On clinical and radiographical examination, it was found that 51 was grossly decayed, while in relation to 61, pulpectomy was done with Metapex obturation. 52 and 62 had dentinal caries [Figure 1], [Figure 2], [Figure 3].
As 61 was asymptomatic, and in relation to 51, the roots were completely resorbed, so a clinical decision was made to go for extraction in relation to 51, sealing the orifice of 61 using glass-ionomer cement, and strip crowns in relation to 52 and 62. To maintain the esthetic as well as the function of the anterior, it was decided to fabricate a fixed dentulous appliance for replacing the 51 and 61. 55 and 65 were banded (band size: 0.005” × 0.180”), and rubber-based impressions were made for the upper and lower arches.
Casts were poured with Type IV gypsum product. On the maxillary cast, a stainless steel wire (0.9 mm) framework was made, expanding the Nance palatal arch in the anterior region to reinforce the acrylic segment. The ends of the wire were then soldered to the corresponding molar bands [Figure 4] and [Figure 5].
In the anterior region of the upper cast, a wax up was done with trimmed acrylic teeth. After all necessary adjustments, dewaxing was carried out and the appliance was heat cured. After necessary trimming and polishing, the appliance was cemented with Fuji Type I glass-ionomer luting cement (GC Corporation, Tokyo, Japan). Postoperative occlusion was checked. Hence, as to guide for the eruption of permanent teeth, the patient is on regular follow-ups every 6 months [Figure 6], [Figure 7], [Figure 8]. On each follow-up, X-ray is taken to check for the eruption status of the permanent tooth [Figure 9]. The patient as per so far is doing good with the appliance and no complication noted. Once the permanent tooth is ready to erupt, the appliance can be removed.
Case report 2
A 9-year-old boy reported to the clinic with a chief complaint of missing upper front teeth following a trauma which occurred 6 months ago. On asking history, parents reported that the patient was into a road traffic accident following which the patient was taken to a nearby hospital. There was no loss of consciousness or vomiting following the trauma. Once discharged from the hospital the same day, parents visited a general dentist after a week for the loss of anterior teeth. Replantation was not tried for the patient because of loss of teeth following trauma. Parents were suggested to go for implant placement and crown but looking into the growing age of the child; parents did not opt for the same and asked for the alternative. As an alternative, Maryland bridge was tried by the dentist, but it was not successful. Not satisfied by the other dentist, the patient visited our clinic.
On examination, it was found that 11 and 21 were missing with erupting 12 and 22 [Figure 10].
On evaluation of the bone and the space, it was suggested to the parents that implant and crown can only be placed once the maturity is reached but, in the mean, while to maintain the space, esthetics as well as the function of the anterior segment, it was decided to fabricate a fixed dentulous appliance for replacing the 11 and 21. 16 and 26 were banded (band size: 0.006” × 0.180”), and rubber-based impressions were made for the upper and lower arches.
Casts were poured with Type IV gypsum product. On the maxillary cast, using stainless steel wire (0.9 mm) framework was made and fabrication of the appliance was carried out. After necessary trimming and polishing, the appliance was cemented with Fuji Type I glass-ionomer luting cement (GC Corporation, Tokyo, Japan). Postoperative occlusion was checked. The patient is on regular follow-ups [Figure 11] and [Figure 12]. The patient is on regular follow-up every 6 months to check for any change. The patient is amazingly comfortable with the appliance and is doing good with his social life as well. The moment patient will attain his maturity; the treatment can be modified to give him a permanent prosthesis in the form of implant and crown or bridge.
| Discussion|| |
Replacement of anterior teeth in a growing child is an elective procedure and totally depends on the parental desire as well as the socioeconomic status.
Major problems noted with loss of anterior teeth include esthetic problem, tipping of adjacent teeth, overeruption of antagonist teeth, midline deviation, masticatory impairment, speech problems, lingual dysfunction. Also premature loss of anterior teeth affects the patient socially and psychologically and causes problem with phonation of “s”, “z,” and “th.”,,,,
A good space maintainer should maintain space; restore physiological mastication; prevent overeruption of opposing teeth; allow physiological growth; and should be hygienic, durable, and of low cost. When comes to premature loss of posterior primary tooth, we have space maintainers such as band and loop, Nance palatal arch appliance, transpalatal appliance, or lingual appliances which provide us with enough space for the eruption of permanent tooth but no as such any fixed appliance has been maintained in literature for missing anterior tooth. The advantage with this appliance is that, along with the all abovesaid advantages, it helps in restoring the esthetics and phonation of the patient, thus boosting the confidence.
Advantages of fixed prosthesis over removable prosthesis include better maintenance of oral hygiene. Fixed appliance is more stable and comfortable to the patient as it covers lesser tissue surface; provide more stable occlusion; better esthetic; insert little or no pressure on ridge and has splinting action therefore does not cause any mobility to the adjacent teeth. Most importantly, fixed appliance is more suitable for a physically or mentally handicapped patients, psychological impaired patients and pediatric patients.
With all these advantages, there come limitations as well. This appliance cannot be given in case of patients with deep bite, reduced overjet, or crossbite. Furthermore, this appliance is not suitable for the patients with seizure disorder, mentally retarded child, immune-compromised child, and child with poor oral hygiene or for patients for whom there is poor ability to be followed up. Along with this, a regular follow-up with the patient will help in attaining the best with the appliance.
| Conclusion|| |
Restoring the loss of anterior teeth not only boosts up the patient psychologically but also enhances the facial esthetics. The appliance acts as functional space maintainer, assists in development of proper speech, and prevents development of any untoward oral habits.
On comparing the advantages and the limitations as well as the need of the patient, this appliance can prove to be a better replacement by not only providing the function but also the esthetic, thus boosting up the morals of the child.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Marwaha M, Bhat M, Singh Nanda KD. Building-up a smile in a 5-year-old child: A case report. Int J Clin Pediatr Dent 2012;5:151-4.
Waggoner WF, Kupietzky A. Anterior esthetic fixed appliances for the preschooler: Considerations and a technique for placement. Pediatr Dent 2001;23:147-50.
Tandon S. Textbook of Pedodontics. Hyderabad, New Delhi: Paras Medical Publisher; 2008. p. 446-65.
Khare V, Nayak PA, Khandelwal V, Nayak UA. Fixed functional space maintainer: Novel aesthetic approach for missing maxillary primary anterior teeth. BMJ Case Rep 2013;2013:bcr2013009585.
Kirzioğlu Z, Ertürk MS. Success of reinforced fiber material space maintainers. J Dent Child (Chic) 2004;71:158-62.
Laing E, Ashley P, Naini FB, Gill DS. Space maintenance. Int J Paediatr Dent 2009;19:155-62.
Liegeois F, Limme M. Modified bonded bridge space maintainer. J Clin Pediatr Dent 1999;23:281-4.
Koroluk LD, Riekman GA. Parental perceptions of the effects of maxillary incisor extractions in children with nursing caries. ASDC J Dent Child 1991;58:233-6.
Riekman GA, El Badrawy HE. Effect of premature loss of primary maxillary incisors on speech. Pediatr Dent 1985;7:119-22.
Christensen JR, Fields HW. Space maintenance in the primary dentition. In: Pinkham JR, editor. Pediatric Dentistry: Infancy through Adolescence. 2nd
ed. Philadelphia: W.B. Saunders Company; 1994. p. 358-63.
Das PK, Datta P, Bora A, Zahir S, Kundu GK. A simple modification of aesthetic fixed appliance for replacement of avulsed maxillary primary incisors. Int J Applied Dent Sci 2015;1:23-5.
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10], [Figure 11], [Figure 12]