Pediatric

Prosthodontics
Guided by:
Dr T.H. KOTAIAH,MDS,PROFESSOR & HOD

Dr SUNEETHA,MDS,ASSISTANT PROFESSOR
Presented by:
Dr SWETHA,BDS,TUTOR NIHARIKA MALLA,INTERN
Contents:

1.Definition 5 prosthodontic
treatment options
2.Introduction
6.Anatomical and
3.Reasons for tooth loss
psychological
4.Need for pediatric considerations in a child
prosthodontics.
7.Complete dentures 12.use of implants in

8.Removable partial Children

dentures 13.Maxillofacial
prosthesis
9.Fixed partial dentures
10.overdentures
11. Obturators
Definition:

● Prosthodontics for children is the division

of art and science of dentistry,which is
concerned with the replacement of missing
primary and permanent teeth by fixed or
removable substitutes.
Introduction:
● Prosthodontics in children is more challenging
because of the anatomy,erupting teeth,growth
patterns,patient cooperation and understanding.
● Pediatric patients may be required to follow -up
more often than adult patients needing
procedures like relines or refits of removable
prosthesis because of growth patterns.
Vah ● Because children are often
affected psychologically by
the unaccepted appearance of
diseased,damaged,or missing
teeth,one should not allow
chronological age to preclude
performing whatever
treatment is necessary to
provide proper function and
esthetics.
How does tooth loss occur in
children?
Teeth can be lost or require replacement as a result of
number of factors:

● Caries
● Trauma
● Infection
● Congenital anomalies,e.g.,cleft lip and palate
deformities
● Systemic
disorders,e.g.,osteopetrosis,óculo
mandibulo dyscephaly
● Premature tooth loss
● Radiation damage
● Intrinsic stains
● Neoplasia
Why do we need pediatric
prosthodontics?
Replacement of teeth is required to establish:
● Esthetics
● Speech
● Mastication
● Integrity of dental arches
● Health of supporting tissues
● Prevention of undesirable habits
● Psychological and mental health of
patients
Prosthodontic treatment options:

A.Fixed prosthesis
1.Single crowns
a)anterior crowns
b)posterior crowns
2.Fixed partial dentures:
a)full veneer retainers
b)partial veneer retainers
c)resin bonded retainers
3.Radicular retained prosthesis(post and
core),implant prosthesis
2.Removable prosthesis:
a)overdentures
b)removable partial dentures
c)implant retained prosthesis

3.Maxillofacial prosthesis:
a)obturators
b)rehabilitation prosthesis
4.Prosthesis in special case
considerations.
Anatomical and psychological
considerations in a child patient:
Oral mucosa and skin:
● Unlike adults the denture bearing mucosa in children
is thicker and well circulated
● They are therefore less prone to trauma
● Skin changes,e.g.,giving proper dentures can
compensate skin folds around the mouth in child
patient.
Residual bony changes:
● Maxillary and mandibular bones are more porous
in children and have abundant blood supply.
● This results in faster healing of the extraction
sockets following which the prosthesis is
constructed.
● Growth of the dental arches requires a frequent
change of denture.
Tongue and taste changes:
● Loss of teeth results in placement of tongue
between the edentulous ridges.
● Unlike adults inflammation of tongue or taste
buds or taste alteration is uncommon in
children.
Salivary flow changes:
● Children have a good salivary flow and thus
have fewer problems during denture wear.
● Xerostomia might be seen in certain
syndromes.
Psychology of patients:
● Child may develop inferiority complex if
teased by friends and ridiculed by parents
during this period.
PRE-PROSTHETIC PREPARATION:
It comprises of the following procedures:
● Removal of grossly decayed deciduous or
permanent teeth.
● If the decayed teeth are in restorable condition
then they should be utilized for overdenture
construction.
● Removal of exostosis or tori
● Treatment of bony or soft tissue lesions like
cysts,tumors,frenal attachments.
● Vestibuloplasty or ridge augmentation for small
flat ridges.e.g.,ectodermal dysplasia.
● Surgical correction of cleft lip and cleft palate.
● Alveolectomy for removal of sharp bony spicules
is carried out while taking care of the permanent
tooth bud.
Complete
dentures
Definition:

Complete denture has been designed as a

dental prosthesis that replaces all of
natural dentition and associated
structures of the maxilla and
mandible.(boucher,1982)
Technique of denture construction:
1.Tray selection.
2.Primary impression making.
3.pouring of primary cast.
4.Secondary impression making.
5.occlusal rim fabrication.
6.Recording the jaw relations.
7.Teeth selection.
8.Teeth setting.
9.Try in.
10.Denture delivery.
Modifications in steps of complete
denture construction in children:
● Operant conditioning is utilized if necessary for
impression making.
● Silicon based impression materials can be used
for primary impression because of its pleasant
taste and smell.
● Distraction tactics used while making impression
can prevent gagging.
● Special care should be taken while recording
jaw relations in patients under 7 years of age
due to underdeveloped neuromuscular
activity.
● Semi Adjustable articulator such as
“dentatus ARL” can be used in teenagers
and simple hinge articulators can be used in
younger children.
● Zero degree denture teeth are selected and
arranged in a flat plane.
● While teeth setting in 2-5 years patients ,all
deciduous and primate spaces should be
considered.
● In 6-7 years old patients the permanent
first molars are present,primate spaces still
exist and deep bite is present.
● Between 9-10 years is the “ugly duckling
stage”
● By 12-13 years all permanent teeth are
present except premolars.
● After denture delivery appointment is
arranged at intervals of 6 months for
children of 2-3 years of age and 3 months
for older children of about 5 years of age.
● Dentures should be periodically relined
following adjustments made for erupting
teeth.
● *Fig:complete dentures in
child. Child suffering from
● Ectodermal dysplasia.
*Fig:A 5 year old child hazel suffering from ectodermal
dysplasia getting complete denture fabrication done.
Fig:6 year old ryan of brazil who lost his teeth when
he was 3 years old due to caries got his teeth replaced
by complete dentures.
Removable
partial
dentures
classification:
A) According to brauer(1964):

Class 1:unilateral maxillary posteriors.

Class 2:unilateral mandibular posteriors.

Class 3:bilateral maxillary posteriors.

Class 4:bilateral mandibular posteriors.

Class 5:bilateral maxillary anterior posterior.

Class 6:bilateral mandibular anterior posterior.

Class 7:one or more primary or permanent teeth.

Class 8:complete primary.

B)According to type of material by finn(1997):

● Maxillary dentures
1. Acrylic
2. Acrylic with wrought wire clasps
3. Acrylic with cast metal framework
● Mandibular dentures
1. Acrylic
2. Acrylic with wrought wire clasps
3. Acrylic with lingual bar and wrought wire clasp
4. Acrylic with cast metal clasps containing occlusal rests
5. Wrought wire clasps soldered to a lingual bar with acrylic saddles.
In pediatric dentistry,removable dentures play a major role in
restoring the function,esthetics,phonetics as well as space
maintainers.

INDICATIONS :

● Restoration of appearance.(aesthetics)
● Weak abutment tooth which cannot support a fixed appliance.
● Closure of cleft palate and congenitally missing teeth.
● Edentulous area where more than 1 mm bone over the
erupting permanent tooth is present.
● Correction of speech abnormalities.
● Prevention of harmful oral habits.
● Restoration of masticatory efficiency.
● Primary or young permanent tooth lost as a result of trauma.
● The dentures are indicated only after the child is of 8 years of
age.

ADVANTAGES:
● They are easier to fabricate.
● Can be used as space maintainers.
● Not very expensive
● Easy to remodel or reline as the jaw grows.
DISADVANTAGES:
● May result in caries in the adjacent teeth.
● The teeth may sccumb to periodontal diseases.
● Untoward affect on growth and development.
● Loss of alveolar bone.
● Oral mucosal disorders.
 COMPONENTS OF REMOVABLE PARTIAL
DENTURES:
1. Denture base
2. Clasp
● Maxillary denture : cast clasps.

Wrought clasps.

● Mandibular dentures: one piece casting including lingual bar .

Cast clasps and lingual bars soldered together.

Wrought clasps and wrought bar soldered together.

3. Occlusal rests
● The denture base provides stability and retention to the
denture.
● The main function of clasp is retention.
● Occlusal rests are required for first permanent molars to
prevent its mesial tipping as the denture settles in the
second deciduous molar area.

INSTRUCTIONS:

● The patient is given instructions similar to complete

denture and shown the technique for insertion and
removal of denture.
FIG : 1. opg of child suffering from papillon lefevre syndrome shows early tooth loss and alveolar bone
resorption 2.child is given removable partial dentures in maintenance phase and recalled every 3 month
for monitoring growth and oral hygiene.
FIG:Removable partial denture given in a
child with nursing bottle caries
FIG :Removable partial dentures given as functional space maintainers
Fixed
partial
dentures
DEFINITION:

Fixed partial denture is a tooth borne partial

denture that is intended to be permanently
attached to the teeth or roots that furnish
support to the restoration.(boucher,1982)
INDICATIONS:

● Endodontically treated teeth.

● Congenitally malformed teeth.
● Hypoplastic teeth.
● Fractured teeth.
● Congenitally missing teeth.
● Discolored teeth.
CONTRAINDICATIONS:
● In younger patients greater care must be taken during
preparation of teeth.
● Deciduous and young permanent teeth having a large pulp
chamber.
● Teeth under partial eruption stage.
● Mobile or periodontally involved teeth.
● Grossly carious teeth with a minimum tooth structure.

If unfavorable response is expected due to periodontal

considerations then adequate periodontal management
should be carried out.
RESTORATION OF A SINGLE
MALFORMED,DISCOLORED OR
FRACTURED TEETH

This could be carried out by various restorative procedures

like:

● Resin jackets all ceramic and metal ceramic crowns on

vital teeth.
● All ceramic and metal ceramic crowns supported by
post and cores on non vital teeth.
RESTORATION OF A SINGLE OR MULTIPLE
MISSING TEETH:
This is accomplished by:

● Resin bonded retainers as an alternative to

conventional fixed partial dentures.
● Pin ledge and partial veneer crown retainers.
● Inlay retainers.
● Full veneer crown retainers.
● Fixed partial denture pontics
● Cantilivered prosthetics.
FIG:Glass fibre reinforced composite FPD in
a pre adolscent child.
 overdentures

FIG:Mandibular overdenture in a child suffering from

hypohydrotic ectodermal dysplasis
 DEFINITION:
Overdentures is a complete or partial removable dentures supported
by retained roots to provide support,stability,tactile and
proprioceptive sensation to reduce ridge resorption.(boucher,1982 )

● Primary overdentures can be constructed at 3 years of age since

the growth in the maxillary arch anterior to intercanine line is
reduced by then.
● As the jaw grows the patient ‘grows out’ of the dentures distally.
● Growth of the palatal vault from these 5th to 11th years should
also be kept in mind while constructing the dentures.
TYPES OF OVERDENTURES:

Based on stage of patient’s dentition and time of treatment:

1. Immediate overdentures
2. Transitional overdentures
3. Remote overdentures
INDICATIONS:

1. Patient with very few teeth.

2. Teeth with a small clinical crown or short roots.
3. Small dental arches with a little lip support.
4. Large spaces between teeth which cannot be corrected
orthodontically.
5. Congenital malformation.
CONTRAINDICATIONS:
1. When other type of prosthesis can achieve superior results.
2. Patient with poor oral hygiene.
3. Psychological factors.

ADVANTAGES:
1. Broader distribution of functional and parafunctional
forces.
2. Conservation of alveolar ridges and remaining abutment
teeth.
3. Prosthesis stability and retention are improved.
● Minimal palatal coverage is required since the
prosthesis is retained by the teeth.
● Better proprioceptive response.
● Fewer denture adjustments are required.
● Can easily converted in to complete denture.

DISADVANTAGES:
● Bulkier than complete dentures.
● Increased risk of caries if oral hygiene is not properly
maintained.
obturators
DEFINITION:

An obturator is defined as ‘prosthesis used to

close a congenital or acquired tissue opening
primarily of the hard palate and/or contiguous
alveolar structures.
 Types of obturators:

SURGICAL PHASE HEALING PHASE HEALED PHASE

SURGICAL OBTURATOR INTERIM OBTURATOR DEFINITIVE OBTURATOR

IMMEDIATE DELAYED IMMEDIATE DELAYED

 OBTURATORS

Surgical obturators Transitional Definitive

Acrylic Silicone

Solid acrylic Buccal flange obturator Hollow acrylic

Closed type
Open type

Process with acrylic 2 - piece(shape on) Hollow silicone

Based on function:

1. Feeding obturators - used

for feeding newborn or
infant with congenital
maxillary defects.

FIG:feeding obturator is
given in infant with cleft lip
and palate.A floss is attached
to the obturator to prevent
aspiration.
2.SURGICAL
OBTURATOR:

Used immediately
following surgery to
facilitate healing and
wound healing.
3 . HOLLOW
OBTURATOR:

Is hollow to reduce bulk

and increase retention
and stability.
4 . INTERIM
OBTURATOR:

Maintains esthetics and

physiology during
healing following
surgery and trauma.
5 . METAL BASE
OBTURATOR:

Is permanent and is
placed after complete
healing of the wound
and growth completion.
6 . PALATAL
OBTURATOR:
A)DENTAL
OBTURATOR:

Used for hard palate.

b)SPEECH BULB
OBTURATOR:
Used for soft palate
defects and
velopharyngeal closure.
INDICATIONS:
● Congenital defects .e.g, cleft lip and cleft palate.
● Acquired oral defects of maxillary carcinomas.

ADVANTAGES:

● Restoration of functions like

mastication,deglutition,aesthetics and speech.
● Improvement of psychological trauma.
● Preservation and normal development of remaining oral
structures.
Obturators for cleft lip and palate defects:

Management of these patients is required from the very

beginning to meet the needs of the newborn.

● Stage i (0-18 months)

● Stage ii (18 months - 5 years)
● Stage iii (6 -10 or 11 years of age)
Use of implants in children
INTRODUCTION:

Implant placement in children and adolescents are circumvented

due to several unfavorable potential effects including trauma to
tooth germs,tooth eruption disorders and multidimensional
restrictions of skeletal craniofacial growth.However in children
who suffer from extended hypodontia,anodontia,oligodontia or
congenital syndromes like ectodermal dysplasia the use of
implants is becoming popular.
 COMPLICATIONS:
● Implants inserted into pediatric patients do not follow the
regular growth process of the craniofacial skeleton and are
known to behave similar to ankylosed teeth, resulting in both
functional and esthetical disadvantages.
● They can interfere with the position and eruption of adjacent
tooth germs,thus resulting in potential severe trauma of the
patient.
● They does not participate in growth process.
● Adjacent tooth germs exhibit morphological changes and
disorders of eruption.
 IMPLANT TIMING:
The finding of the best ideal time of implant treatment in
children seems quite difficult because many different aspects
have to be considered while finding best individual treatment
strategy.

● The placement of implants in children with ED must be a

team effort consisting of a surgeon,pediatric
dentist,prosthodontist,orthodontist and periodontist.
● Safest time to place implant seems to be during the decline of
adolescent growth curve or near adulthood
● Factors like existing dentition,status of mastication,phonetics
● The patient and child should be compliant to implant
placement and implant hygiene.
● In children suitable site for implant placement is
anterior mandible.
● Mini and micro implants are being introduced in
pediatric patients.
● Implants are also being used in maxillofacial prosthesis.
FIG:Mini-implants placed on a child suffering from ED who
complained of anodontia and lack of stability and retention
of previous dentures.
FIG:Early placement of implants in a child
adjacent to permanent molars resulting in
anterior open bite in aftermath.
Maxillofacial prosthesis in children

● Prosthetic rehabilitation of maxillofacial defects is very

challenging.
● The advent of material science has paved way for
improved quality of prosthetic service.
● Till date none of the materials satisfy all the
requirements of ideal material.each material has its
own advantages and disadvantages.
TYPES OF MAXILLOFACIAL
PROSTHESIS:
1. NASAL PROSTHESIS:A removable prosthesis which
artificially restores a missing nose.
2. ORBITAL PROSTHESIS:A removable replacements of
the contents and surrounding structures of the eye socket.
3. OCULAR PROSTHESIS:An artificial replacement for a
missing or damaged eyeball.
4. AURICULAR PROSTHESIS:A removable prosthesis
which artificially restores a missing ear.
5 . MIDFACIAL PROSTHESIS:A large removable prosthesis
which restores a defect in the middle third of the face.

6 . SOMATO PROSTHESIS:A prosthesis that replaces external

parts of the body such as fingers and soft tissue defects.

7. IMPLANT CRANIOFACIAL PROSTHESIS:Permanent

replacement for a portion of the skull.

8 . MANDIBULAR RESECTION PROSTHESIS:That replaces

the missing portion of jaw and teeth.
9 . PALATAL AUGMENTATION PROSTHESIS:For
patients with a partially removed tongue or lower jaw.

10 .SPEECH AID PROSTHESIS:A prosthesis used to

improve speech in neurological impairment.

11 . TRISMUS APPLIANCE:Prosthesis that assist in

increasing the mouth opening.
ADVANTAGES:
1. Requires little surgery or no surgery.
2. Patient spends less time away from home and job.
3. More often natural looking.

DISADVANTAGES :
1. The necessity of fastening the appliance to the skin and
removing it everyday.
2. The occasional need of constructing a new prosthesis.
FIG:Artificial eye given to a child with
anophthalmic socket.
REFERENCES:
● Textbook of pedodontics - shobha tandon
● Principles and practice of pediatric dentistry - muthu & siva
kumar
● Textbook of pedodontics - finn
● Textbook of pedodontics - nikhil marwah
● Textbook of prosthodontics - rangarajan
● Net sources - national foundation of ectodermal dysplasia.org
Researchgate.org
BBCNews.net
Journal of interdisciplinary dentistry