Dental Problems

Individual Tooth Loss

TeethTooth loss may occur due to various risk factors. It can be due to poor hygiene, use of tobacco products, oral diseases, etc. Ultimately all of these may lead to tooth loss. In this article, there is a brief discussion on individual tooth loss.

A. Maxillary First Primary Molar Loss:

Though measurements of D+E show not much arch length loss after premature loss of D/D, in these cases the incidence of canine(permanent) being blocked out from the normal alignment is high.

Sequelae:

  • The primary canine shows a distal shift in the 1st year (if at all)
  • The deciduous second and the permanent first molars shift mesially depending on age and duration of absence.
  • The first premolar is mesially directed along the mesial surface of the second molar.
  • The permanent canine has no place and is blocked out of the arch.

B. Maxillary second primary molar loss:

Sequelae:

  • The molar shifts mesially.
  • It was observed that if the extractions were performed prior to the emergence of the first molars. It resulted in a permanent space loss, more in the upper than lower.
  • The second most deleterious period has been found to be after emergence of the second molar but after the emergence of the first bicuspid.
  • The period of emergence of the second molar is thought to be crucial, as distal to the first molar a growth centre exists.
  • The cuspid and the first deciduous molar shift distally.
  • The first bicuspid generally erupts first and erupts into this space distally, sometimes even causing impaction of the second bicuspid.

C. Maxillary first and second molar loss:

Under these circumstances, a host of factors exist and the outcome depends on the interaction between them.

D. Mandibular tooth loss:

  • The effect of mandibular extractions tends to be similar for all the 3 situations i.e -D loss, E loss and D+E loss.
  • The permanent molar tips forward. If D is lost, the E may tip as well.
  • The developmental orientation of bicuspid tooth buds is an important variable and so is the sequence of eruption.
  • In severe cases again, the second bicuspid has got a maximum chance of being impacted due to lack of space.

E. Anterior region:

  • Most studies agree that the loss of the anterior teeth are rarely associated with any space loss especially so when the primary canines have already erupted.
  • The premature loss of canine on one side of the arch, in the mandibular region, is associated with the shift of the midline in the same direction.
  • There is a linguo -distal inclination of the teeth, causing a collapse of the anterior lingually, apart from closure of the space and shift of midline.

Variables Influencing Space Control Programs

Most growth studies are in general agreement that once the primary dentition has been established, the arch length i.e., the measurement from the distal surface of the second primary molar around the arch to a similar position on the opposing side is constant until the permanent dentition is established. The preservation of the same in the primary and mixed dentition is of utmost importance, for it allows the dental units to ‘fit’ into their relative positions. Wright and Kennedy (1978) have discussed the following key variables and their importance.

  1. Oral musculature and habits:

    • Maxillary arch – Anterior teeth may be proclined and thus arch length or perimeter is increased. Thus, clinician should check and evaluate where the teeth should be as well as where they are at the initial examination.
    • Mandibular – In case where mandibular cuspid is extracted, an abnormally strong mentalis musculature may cause distal drifting of the lateral incisor shift of midline and a deepening of the bite.
  2. Time lapsed since extraction:

    The time elapsed since extraction must be considered, as a maximum space loss will occur in the first six months. Thus, when a choice exists, appliances must be placed immediately following extraction.

  3. Dental age, Eruption pattern and Bony covering:

    Decisions are to be based upon the norms associated with dental age rather than chronological age.

    • Eruption patterns may also vary and thus may impede the placement of the appliance as such. Also, ectopic eruption and root resorption (atypical) may also delay or hasten exfoliation time.
    • Eruption of the first molar causes a bodily space loss in maxillary and tipping in mandibular arch. It is observed that space in mandibular arch is difficult to regain.
    • In cases, where a tooth has been lost due to infection the overlying bone may not be a good guideline to follow. In such situations, the amount of root formation should also be considered (3/4 of root development).
  4. Available space:

    Though space loss may occur after the tooth has exfoliated prematurely, it might sometimes be present before due to interproximal caries. Thus, the amount of space available and required should be measured and thus space maintenance or regaining should be instituted.

  5. Interdigitation:

    Increased cuspal height along with proper interdigitation will help to stabilize the occlusion. Thus, it has bee postulated that these factors may help prevent the space loss.

  6. Anomalies:

    These may hamper the eruption of the teeth such as the supernumerary tooth and thus it is essential that a complete radiographic survey be done before the selection of the appliance.

  7. Sequence of eruption:

    A situation may arise where the second deciduous molar is lost prematurely and the eruption of the second molar is taking place. Though other factors may not warrant space maintenance, it may be required for this purpose.

The above article discusses about the individual tooth loss and the variables influencing space control programs

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