DESCRIPTION Up to 250 words summarising the importance of the image(s)
Deciduous maxillary incisor’s early loss leads to linguo distal inclination, space loss, collapse of anterior incisor segment and midline shift.[1] Missing upper front teeth causes para functional habits, depression leading to psychological problems, difficulty in pronunciation leading to reduced level of confidence.[2] A 6 year old boy reported to dental clinic with the chief complaint of missing teeth in upper front region (Figure 1, 2 and 3). Parents revealed that the child had trauma and avulsion of upper anterior teeth while child was running 6 months back. Medical and family history was not significant. On intraoral examination 51, 52, 53, 54, 61, 62, 63, 64, 72, 73, 74 teeth were missing. Root stumps in relation to 82, 83, 84 and dental caries with respect to 75 and 85 were found. Build of the child was normal for his age. Orthopantogram confirmed completely avulsed upper incisors (Figure 4).

Pulpectomy followed by stainless steel crown was performed on 75 and 85. 82, 83 and 84 were extracted. Fixed anterior aesthetic space maintainer was given in relation to 51, 52, 53, 54, 61, 62, 63 and 64. Design consisted of two parts: a U shaped wire adapted to bands and other part to engage artificial teeth (Figure 5 and 6). After soldering casts were mounted on hinge articulator and B1 shade was selected followed by teeth setting (Figure 7). Appliance was cemented with luting glass ionomer cement. For 72, 73, and 74 no treatment was performed since the succedaneous teeth was already in the process of eruption. The occlusion was evaluated for any premature contact (Figure 8 and 9). Patient was recalled after 6 months for follow up (Figure 10). Rehabilitation of primary anterior teeth aesthetically has psychological effect on the child`s self-esteem.[3]

LEARNING POINTS/TAKE HOME MESSAGE 2 to 3 bullet points – this is a required field
  • Loss of tooth in child leads to inability to eat and chew which may cause poor dietary habits resulting to weight loss therefore rehabilitation treatment options should be considered.
  • Under five years of age children with anterior tooth loss are affected socially and children who attend day care or preschool programs may become aware of their appearance.
  • Absence of maxillary anterior teeth, the lingual sides of which are needed by the tongue for certain phonation, may result in improper speech they have difficulty in pronunciation of letters like S, Z and Th.
REFERENCES Vancouver style (max 3)
  1. Adewumi AO, Horton C, Guelmann M, Dixon-Wood V, McGorray SP. Parental perception vs professional assessment of speech changes following premature loss of maxillary primary incisors. Pediatr Dent. 2012; 34:295-9.
  2. Koroluk LD, Riekman GA. Parental perceptions of the effects of maxillary incisors extractions in children with nursing caries. J Dent Child. 1991; 58:233-36.
  3. Slack GL, Jones JM. Psychological effect of fractured incisors. Br Dent J 1955; 99:386-8.
FIGURE/VIDEO CAPTIONS figures should NOT be embedded in this document

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