Esthetic anterior space maintenance.

This paper describes an appliance to replace prematurely lost maxillary anterior teeth. A review of the literature is given. The prosthesis is different from previous appliances in its use of intraorally placed composite-filled celluloid crown forms. This allows for superior control of both esthetics and functional occlusal relationships. A case presentation is given describing laboratory and office procedures. JL remature loss of primary anterior teeth is an event that may present significant problems for the growing child. These concerns are not only limited to the developing dentition, but also may affect physiological as well as psychosocial growth patterns. This paper describes an appliance designed to eliminate the damaging effects of premature anterior tooth loss. Children with nursing bottle caries or traumatic injuries of the anterior teeth often require extraction of the affected teeth. Early loss can be quite disturbing to the young child especially when he views himself as being different from his peers. Parents often blame themselves for tooth loss and relate feelings of guilt regarding their child's appearance (Figure 1). In addition, parents have reported personality changes that include children who will not smile and appear withdrawn. Tooth loss can have subtle effects on the child's speech. In order to hide missing teeth the embarrassed child may restrict lip and jaw movements while speaking. Anterior dental dysharmonies can interfere with normal tongue placement which then can lead to the development of maladaptive articulatory habits. In addition, the absence of maxillary anterior teeth may initiate a tongue thrust pattern. Most authors contend that once the primary cuspids erupt, space loss in the anterior region is negligible. However, collapse of anterior arch integrity is evident in cases where the incisor teeth are in close approximation prior to extraction. In determining the nasolabial angle, the position of the maxillary incisors plays an important role in the anteroposterior position of the lips. Figure 1. Typical appearance of a three-year-old patient following extractions of the primary maxillary anterior incisors. Restorative options available to the practitioner for treatment of anterior tooth loss include both removable and fixed appliances. There is essentially one design with various modifications for removable appliances. In situations where a fixed appliance is desired, there are several options to be considered: (1) a Nance-type appliance with acrylic pontics processed to the lingual arch, (2) porcelain fused to metal bridge utilizing full coverage of abutment teeth, and (3) acid-etch retention of crowns and pontics. This paper describes one design of a fixed appliance.