Dr. Rob Veis

Problem: Early loss of the primary anteriors due to severe caries or trauma.

Solution: Replace the damaged teeth with a beautiful fixed interim primary bridge.

Pediatric space management is often the key to preventing a serious malocclusion in the permanent dentition. The early loss of primary anteriors can result in the development of speech problems, tongue thrusting, abnormal chewing and swallowing problems; abnormal growth of the maxilla and the mandible; and even the development of a permanent of a permanent Class II dentofacial abnormality. If the permanent teeth are not going to erupt in six months, appliance therapy to maintain the space indicated. If space loss has already occurred, a space-regaining device should be used prior to placing this appliance.

Our clinical case exemplifies the premature loss of anterior teeth due to Baby Bottle Syndrome. On the day of the extraction, the doctor delivered a Groper Fixed Anterior Bridge. Esthetics and strength are the key advantages to this popular design. The anterior bridge is made extra strong by attaching each tooth separately to a specially designed, stainless steel pad (a Space Maintainers exclusive). Each unit is then welded and soldered to the arch wire. As you can see, within a week, the tissue is healed and the patient is able to maintain normal speech, function and esthetics.

Bonded four-unit Groper fixed anterior bridge.		Severe caries due to Baby Bottle Syndrome.
Special stainless steel pads hold each tooth in place.		Groper appliance one week after delivery.

Treatment Procedures:

1. Start by taking an accurate alginate impression of both the upper and the lower arch and pour them up in yellow stone. Taking these impressions prior to extracting the teeth that you intend to replace is optional. Some clinicians like to deliver the appliance immediately and others prefer to let the ridge heal first.
   
2. Take a centric occlusion bite relationship. This must be done to assure that there is an appropriate amount of occlusal clearance to construct the appliance. It is also essential to properly set the teeth in the best position.
   
3. This is a fixed appliance. Both bands and stainless steel crowns are acceptable. When using your own bands, take your impression and pour it up without the bands in place. Let the lab fit your bands on the stone cast. To guarantee the fit, the teeth to be banded must be fully erupted. When using crowns, take the impressions and pour it up with the crowns in place.
   
4. Select a shade. Because children's teeth are very white, your standard Bioform and Vita shade guides will generally not work. Space Maintainers has a special Pedo-Shade Guide that will allow you to select an appropriate shade.
   
5. Fill out your lab slip completely. Mark your bands left and right. Wrap your models and bite relationship separately to protect against breakage.
   
6. Cement the materials with glass ionomer cement. An appliance should be used to maintain the space until the beginning of the eruption of the adult anteriors. It may be necessary to replace this appliance during the course of treatment, if it is going to be years before the adult teeth are going to erupt.