Primary and Early Dentition Treatment

Primary and Early Dentition Treatment The function of primary dentition is to provide mastication, as well as to maintain the occlusion, and to maintain space for permanent teeth eruption. The primary teeth exfoliation and permanent successors eruption is a physiological process (Rao and Sarkar, 1999). In recent decades even after the advanced dental care that increased with intact dentition, early loss of primary teeth still remain a major concern (Bach and Manton, 2014). Early loss of primary teeth result majorly from dental caries. Other causes include trauma, infection, ectopic eruption, arch length deficiencies leading to resorption of primary teeth and congenital disorders (Brothwell, 1997).   Consequences of early loss of primary teeth includes unwanted tooth migrations of primary or permanent teeth with associated loss of arch length. Deficiency in arch length can lead to malocclusion with crowding, rotations, ectopic eruption, unfavourable molar relationship, overbite, overjet, and cross bite (Brothwell, 1997) . The problems accompanying with early loss of primary teeth have been a subject of concern in many studies. Early loss of teeth in the primary dentition has different impacts depending on which teeth are lost, childs age, existing alignment and occlusion (Rock and British Society of Paediatric, 2002). Potential consequences must be considered during the clinical examination and treatment planning to determine whether space maintenance is required and what type of space maintainer would be most appropriate (Ngan et al., 1999) Early loss of a primary incisor has little effect upon  the permanent dentition although it does detract  from appearance. Early loss of primary canines or molars is more  serious since space loss may follow. In each quadrant  the primary canine and molars together are larger than  the succeeding permanent canine and premolars, the  difference in tooth sizes between the two dentitions  being the Leeway space [10]. This can be assessed  with reasonable accuracy by the size difference  between first and second primary molars, since the  primary first molar is equal in size to the premolar  that will replace it, while the primary second molar is  much larger than the second premolar. For this reason  the Leeway space is also known as the E space.   Extraction of a primary canine or molar may  cause mesial drift of teeth behind the space and  distal drift of anterior teeth, with resultant displace-  ment of permanent teeth and centreline disturbance.   Early loss of a primary incisor has little effect upon  the permanent dentition although it does detract  from appearance. Early loss of primary canines or molars is more  serious since space loss may follow. In each quadrant  the primary canine and molars together are larger than  the succeeding permanent canine and premolars, the  difference in tooth sizes between the two dentitions  being the Leeway space [10]. This can be assessed with reasonable accuracy by the size difference between first and second primary molars, since the primary first molar is equal in size to the premolar  that will replace it, while the primary second molar is  much larger than the second premolar. For this reason  the Leeway space is also known as the E space.  Extraction of a primary canine or molar may  cause mesial drift of teeth behind the space and  distal drift of anterior teeth, with resultant displacement of permanent teeth and centreline disturbance. Early loss of a primary incisor has little effect upon  the permanent dentition although it does detract  from appearance.   Early loss of primary canines or molars is more  serious since space loss may follow. In each quadrant  the primary canine and molars together are larger than  the succeeding permanent canine and premolars, the  difference in tooth sizes between the two dentitions  being the Leeway space [10]. This can be assessed  with reasonable accuracy by the size difference  between first and second primary molars, since the  primary first molar is equal in size to the premolar  that will replace it, while the primary second molar is much larger than the second premolar. For this reason  the Leeway space is also known as the E space. Extraction of a primary canine or molar may  cause mesial drift of teeth behind the space and  distal drift of anterior teeth, with resultant displacement of permanent teeth and centreline disturbance. Impact of early loss of primary molars: Primary second molar is most often prone to get caries and results in early loss. Early loss of primary second molars can   lead to decrease in arch length prominently in maxilla than in mandible (Ngan et al., 1999). The loss of second primary molar lead to mesial migration of adjacent first permanent molar, loss of space for second premolar eruption and early eruption of second permanent molar. The decrease in arch length is more severe when primary second molar loss occurs prior to eruption of first permanent molar as second primary molar serve as a guide for erupting first permanent molar (Ngan et al., 1999). However no substantial change in midline coincidence (Rock and British Society of Paediatric, 2002). Henceforth, it is generally agreed that reduction in space after early loss of primary second molar is more significant than primary first molars and require space maintenance (Ngan et al., 1999). A long term study conducted in Canada to investigate the effects of early loss of primary molars in 107 children over six years of age, 66% of these children had early loss of primary molars majorly because of caries. These children were followed for approximately six years with yearly assessment   for space loss. This study reported that loss of space was more when second molar was lost early and its effect is more in maxilla than in mandible, and had detrimental effect on molar relationship.   When first and second molars are lost, the arch length was significantly effected in maxilla than mandible. The space loss was mainly due to the drifting of first permanent molar while canine distal migration was significant until 9 years in mandible and 8-11 years in maxilla. Relatively more space was lost in first year following the extraction with rate of space loss age related in maxilla but not in mandible (Northway et al., 1984). Macena et al., 2011, conducted a study to evaluate the space changes after premature loss of deciduous molars among 55 Brazilian children of age between 6 and 9 years and followed for 10 months. This study reported that early loss of second primary molar lead to significant changes in the space left in both arches. The major decrease in space occurred in the first 3 months after the extraction of the deciduous molars. The decrease in space after second primary molar occurred majorly because of mesial movement of first permanent molar and which may lead to impaction of permanent second premolar or future crowding. They suggested that a space maintainer is needed in such cases especially when it occurs in children with malocclusion and crowding (Macena et al., 2011). Recently a study conducted to determine the space loss after early loss of second primary molar before eruption of permanent molar and after eruption of permanent molar in 87 children and followed for 48 months. They reported that significant space loss occurred in the first six month (P