CASE REPORT |
https://doi.org/10.5005/jp-journals-10077-3280 |
Management of Missing Premolar in Growing Child: A Case Report
1–4Department of Paediatric Dentistry, Malla Reddy Institute of Dental Sciences (MRIDS), Hyderabad, Telangana, India
Corresponding Author: Rajesh Ragulakollu, Department of Paediatric Dentistry, Malla Reddy Institute of Dental Sciences (MRIDS), Hyderabad, Telangana, India, Phone: +91 9014485370, e-mail: ragrajeshr@gmail.com
Received: 28 August 2023; Accepted: 21 September 2023; Published on: 30 December 2023
ABSTRACT
Aim and objective: To evaluate a new technique of prosthetic rehabilitation of missing premolars in growing children using mini-implant.
Background: Treatment modalities for restoring missing teeth include removable partial dentures and tooth-bonded prostheses. They have the disadvantage of loss of alveolar bony architecture, discomfort, and frequent replacement or modification. The mini-implant mimics the implant in many aspects, and hence, can overcome the above drawbacks.
Case description: A 12-year-old male patient had undergone enucleation of a dentigerous cyst involving the mandibular second premolar. A few months after surgery, the patient reported to the department of paediatric and preventive dentistry for the replacement of missing teeth. To prevent loss of alveolar width and length, a mini-implant was inserted and the composite build was done with an incremental technique.
Conclusion: Mini-implant could be a better alternative to removable partial dentures and tooth-bonded prostheses.
Clinical significance: Considering the various advantages of a mini-implant, it could act as a predecessor for an implant.
How to cite this article: Ragulakollu R, Supraja AN, Achanta A, et al. Management of Missing Premolar in Growing Child: A Case Report. J South Asian Assoc Pediatr Dent 2023;6(3):143–146.
Source of support: Nil
Conflict of interest: None
Keywords: Case report, Dentigerous cyst, Enucleation, Growing children, Mini-implant
INTRODUCTION
Early loss of permanent teeth can result in loss of alveolar structure, development of deleterious habits, difficulty in mastication, and other functional defects.1 Emulate for the space of the implant and space closure are the most common treatment modalities practiced.2 Restoration of esthetics, masticatory function, and good prognosis favors the selection of the later.
Teeth-retained banded, bonded prosthesis and removable partial dentures are advocated in a growing child to maintain the space until growth is ceased and followed by a dental implant.3 Loss of alveolar width and compromised esthetics are the main drawbacks of the above.
Dental implants, which are widely used in adults, are contraindicated in children and growing adolescents as there is a chance of the implant submerged compared to permanent teeth.4 The above disadvantages can be overcome by mini-implant-supported tooth replacement.5 It preserves the architecture of alveolar bone thereby avoiding surgical procedures like bone grafting at a later stage for implant placement. Since it doesn’t osseointegrate, it also provides space for the implant after its removal.
Clinicians reported the use of a mini-implant for the replacement of anterior teeth, in this case report, we have successfully used a mini-implant for replacing premolar teeth.
CASE DESCRIPTION
A 13-year-old male patient reported to the department of paediatric and preventive dentistry with a chief complaint of missing teeth in the right lower back region and its replacement. The patient presented a history of enucleation of the right mandibular second premolar associated with a dentigerous cyst a few months back leading to partial edentulism (Fig. 1). The treatment plan for space regaining and prosthetic rehabilitation was explained. Parents preferred mini-screw implant supported prosthesis only and a written informed consent of parent was obtained. One infrazygomatic titanium stainless steel implant (SK Surgicals IZC D 2.0 mm, L 10–14 mm) with a diameter of 2.0 mm and a length of 14 mm was selected. A dental implant kit with a manual driver was also provided.
Fig. 1A to F: (A to C) Preoperative clinical photographs; (D) Preoperative radiograph before enucleation; (E) Postoperative radiograph after enucleation; (F) Postoperative radiograph showing evidence of bone healing
Local anesthetic was administered by infiltration technique in the buccal and lingual sulcus followed by a mid-crestal incision. A full-thickness flap was raised to expose the crystal bone. Mini-implant was inserted with the help of a 2 mm implant driver manually until the threading was completely into the bone (Fig. 2). No drill was required as the mini-implant moved into the alveolus without much resistance. The presence of a mental foramen determines the direction of placement. In this patient, the apex of the implant was directed buccolingually to avoid compression of it. The composite buildup was done with an incremental technique (Fig. 3). The orifice on the coronal aspect of the mini-implant serves to increase retention. A review of the case was done after 1 year. Except for chipping off restoration on the buccal side, the stability of the mini-implant was good (Fig. 4A). Radiographic examination presented no signs of resorption (Figs 4B and C). The buccal surface was finished with the finishing burs for a smooth surface (Figs 4C and D).
Figs 2A to C: (A and B) Clinical images after insertion of mini-implant; (C) Radiograph image after placement of mini-implant
Figs 3A to C: (A) Postoperative clinical photograph after insertion of mini-implant and crown buildup; (B) Postoperative radiograph after insertion and crown buildup
Figs 4A to C: (A) Clinical photograph after 12 months; (B) Radiographic image after 12 months; (C) Postoperative cone-beam computed tomography systems cross-sectional image; (D) Clinical image after finishing
DISCUSSION
Loss of permanent teeth at an early age may lead to functional, esthetic, and psychological issues.6 Various treatment modalities like removable partial dentures, tooth bonded prostheses are advised.
Tooth-supported dentures consist of dental clasps and occlusal rests which not only minimize the contact with the mucosa but also add retention to the denture. Drawbacks like frequent episodes of refabrication to overcome growth, gingival inflammation, and bone resorption restrict the use of these.7 Bonded bridges face frequent debonding. This mandates to search for better methods of prosthetic rehabilitation of missing teeth.
A dental implant is a good alternative in adults but is contraindicated in children. Dental implants act as an ankylosed tooth leading to infraocclusion of teeth when inserted before termination of craniofacial growth.8 Mini-implants could be promising in these circumstances to provide anchorage for crowns. Mini-implants are easy to insert, present minimum osseointegration, and hence, can be removed without much damage after growth termination. It minimizes the loss of alveolar bone thickness, thereby facilitating implant placement in the future.9 The success rate depends on the morphology and anatomy of the bone, the selection of appropriate length, and the width of the mini-implant.10
A multicenter study conducted to evaluate the behavior of mini-implants concluded vital findings. It could be an alternative to implants in constricted alveolar ridges and where the interdental space is lost.11 Due to the small diameter of the mini-implant, it may facilitate the movement of bony structures. In a follow-up study of 4 years, the survival rate of mini-implants for a complete denture was 95% and the average bone loss was insignificant.12,13 Hence, it was recommended for replacing mandibular canines in growing patients.14,15 With the support literature we have successfully inserted a mini-implant in a growing child for replacing the second premolars.
Sfeir et al.15 reported a case series of three children with ectodermal dysplasia (ED), in whom mini-implants with diameters ranging from 1.8 to 2.4 mm and lengths of 13 mm were inserted in the mandibular/maxillary anterior region followed by prosthetic rehabilitation over the implants and stated that after the follow-up, all the mini-implants were well integrated without any abnormality in the growth and development of the jaws.
For the placement of mini-implants in the premolar, various factors like the location of the mental foramen and growth patterns should be considered. The location of the mental foramen varies with age. It is observed that its location is greater in the inferior third of the mandible in the age-group of 10 and 11-years-old.16 Hence, based on its location, one can approximately select the length of the mini-implant for insertion within the safe zone. A panoramic radiograph can present vital information about its location.
Mini-implants may impede the vertical development of the alveolar ridge; hence, it is preferable to insert them perpendicular to the alveolar crest.17 This may not be true in all cases. Pertaining to the small size of the mini-implant, the inhibition of alveolar growth is insignificant compared to the implant.18
CONCLUSION
Mini-implants could be a promising option for prosthetic rehabilitation. It mimics implants in many aspects and provides a framework for their placement after the growth is terminated. Along with the psychological benefits of preservation of crystal as well as buccolingual bone, thereby eliminating surgical procedures for bone augmentation in the future.
The previous case reports presented proved the success of mini-implants in the anterior region; the present case reports success suggests it could also be indicated in the premolar region. Further studies may be needed to evaluate its success at various other sites.
ORCID
Rajesh Ragulakollu https://orcid.org/0000-0003-4620-233X
Atluri N Supraja https://orcid.org/0000-0002-2298-0965
Alekhya Achanta https://orcid.org/0009-0004-3663-8409
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