Dr. Ravi B Patil Associate Professor, Vinayaka Misssions Shankarachariyar Dental College Aiyanoor, Salem, Tamilnadu, India.

Email- drpats72@yahoo.com

Dr Rachappa MM Senior lecturer Department of Pedodontics K M Shah Dental College & Hospital Sumandeep Vidyapeeth Piparia, Vadodara Email- mmrachappa@gmail.com

All correspondence to be sent to Dr.Ravi.B.Patil

ABSTRACT Fixed space maintainers are fixed appliances used to maintain space so as to guide the unerupted tooth into proper position in the arch. Fixed space maintainers with acrylic extension may cause food accumulation under the acrylic extension and cause tissue inflammation. Resin bonded retainers are costly and less durable. In the present case a simple modification of fixed space maintainers was considered.

TITLE A Simple Modification of Fixed Space Maintainers for Replacement of An Avulsed maxillary Primary Central Incisor: A Case Report

INTRODUCTION Traumatic injuries to primary teeth are common and especially 18 -30 months children are very prone to accidents1. In particular maxillary anterior teeth are susceptible for injuries and avulsion of primary teeth is seen around 9-12%2,3. Early loss of maxillary incisors can cause psychological, aesthetic, speech problems and can lead to functional problem due to development of tongue thrusting habit in edentulous space. Missing primary incisors are replaced for four reasons: space maintenance, function, speech and aesthetics4. Several methods of replacing primary maxillary anteriors are tried depending on the patient cooperation, cost, duration and status of dentition. Removable prosthesis requires patient compliance and frequent adjustments for retention4. Fixed prosthesis are limited by arch modification in primary and mixed dentition5,6. Fixed space maintainers with acrylic extension

may cause food accumulation under the acrylic extension and cause tissue inflammation4,5. Resin bonded retainers are costly and less durable7. In the present case a simple modification of fixed space maintainers was considered. CASE REPORT A 31/2 years old boy reported to our dental office with complaint of unpleasant look and alteration in speech. On examination it was found 51 was avulsed two months back and 52 appears to be tilted(figure 1). A intra-oral periapical radiograph was advised. On radiographic examination, a rotated 11 with no retained root segments of 51 were found (figure 2). Advantages and disadvantages of treatment options appropriate for this age group that is removable prosthesis, fixed prosthesis, resin retainers, fixed space maintainers and a modification of fixed space maintainer were explained to the parents. Parents agreed for fixed space maintainers and they finally requested for the modified fixed space maintainer. Preformed stainless steel orthodontic bands were adapted to the 55 and 65 followed by alginate impressions of upper and lower arches. 19 gauge stainless steel wire was adapted on the lingual surfaces of maxillary teeth without interfering the occlusion and then soldered to the bands. Stainless steel wire was roughened at the 51 area for better retention. Composite shade was selected and composite build up was done to replace the 51. Finishing and polishing was done and finally the modified fixed anterior space maintainer was cemented with luting glass ionomer cement (figure 3a and 3b). Post cementation instructions were given to patient and to the parent. Patient was recalled for check up every three months. DISCUSSION

Fixed space maintainers with proper design is less damaging to the oral tissues and more appropriate for long periods8. Modification of the fixed space maintainer was chosen in this case because of the long duration of the space maintainer required. Composite build up was done because it provided the best color match. Central incisor shaped build up was done with neatly polished cervical area to minimize the food accumulation and subsequent soft tissue inflammation. Simple modification of this type can easily reduce the disadvantages of fixed space maintainers and reduce patient discomfort there by increasing the durability of the space maintainers.

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Dentistry: Infancy Through Adolescence. 4th ed. St. Louis, Mo: Elsvier Saunders; 2005: 42330. 5. Dean JA. Management of the developing occlusion. In: McDonald RE, Avery DR, Dean JA, eds. Dentistry for the Child and Adolescent. 8th ed. St. Louis, Mo: Mosby; 2004:631-68. 6. de Sant'Anna GR, Guar Rde O, Rodrigues CR, Guedes-Pinto AC. Primary anterior tooth replacement with a fixed prosthesis using a precision connection system: a case report. Quintessence Int. 2002 Apr;33(4):303-8 7. Huber CT. Resin bonded retainer for replacement of an avulsed primary incisor: a case report. Quintessence Int. 1997 May;28(5):337-9. 8. Qudeimat MA, Fayle SA. The longevity of space maintainers: a retrospective study. Pediatr Dent. 1998 Jul-Aug;20(4):267-72.