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Children's prosthetics. Prosthetics of baby teeth in children

Prosthetics of baby teeth involves restoring damaged or damaged teeth using artificial materials. extracted teeth in children. In this case, you can install either one denture or a bridge of several crowns. It used to be that only adults needed dentures. But relatively recently, doctors came to the conclusion that premature loss of baby teeth seriously impairs chewing function and negatively affects the child’s overall health. In addition, the absence of baby teeth significantly spoils the baby’s appearance and, as a result, undermines his self-confidence. Therefore, today parents, concerned about their spiritual and physical condition their children are increasingly turning to clinics for prosthetics of baby teeth, thereby ensuring the continuously growing popularity of this area in dentistry.

Indications for dental prosthetics in children

Only a pediatric dentist can give an accurate answer to the question of whether your child needs prosthetics for baby teeth. Typically, prosthetics of baby teeth in children is carried out if the following indications exist:

Destruction of a baby tooth by caries and the impossibility of its restoration. The absence of molars negatively affects the chewing of food, leads to stomach diseases and unwanted weight loss in children. The loss of frontal teeth can provoke the occurrence of speech defects or psychological complexes.
Tooth decay due to fluorosis. This chronic illness develops even before teeth erupt, and subsequently causes stains to appear on them and leads to their destruction. Dentures for baby teeth help prevent this process and preserve the aesthetics of a child’s smile.
The need for tooth extraction due to inflammation of the periosteum. This disease often causes the appearance of neoplasms accompanied by pain. Often in such cases, the tooth must be removed.
Loosening or loss of teeth due to periodontitis. This is a disease that affects connective tissue between the bone of the dental socket and the root cement. It can also lead to unwanted tooth loss in a child, and therefore is another indication for dentures for baby teeth.
Early loss of baby teeth. Loss of a baby tooth a year or more before the appearance of a permanent one leads to shortening of the dentition in the permanent dentition in children and abnormal eruption permanent teeth and significant disorders in the dental system.
Tooth injury. Children, by virtue of their active image In life, people are much more likely to be injured than adults. And the premature loss of even one baby tooth, as noted above, can lead to undesirable child's body consequences.
Involuntary grinding of teeth (bruxism). At untimely treatment this disease can lead to tooth deformation or premature loss.
Edentia. Is this complete or partial absence teeth, which can be either congenital or caused by objective reasons.

Features of dental prosthetics in children

Children's dental prosthetics has its own nuances. Firstly, in adults the jaw is formed, while the child is growing all the time, and the dentist must do everything possible to ensure that the prosthetics of baby teeth does not disrupt the development processes in the body. Therefore, dentures for children must be hypoallergenic, safe, comfortable, and resistant to chemicals. Therefore, for the manufacture of children's dentures, materials such as acrylic, chrome-plated steel, stainless steel, silver and tin alloys are used. Secondly, children's structures should not interfere with jaw development.

According to their purpose, dentures for children are divided into the following groups:

therapeutic – restore functions and correct the structure of teeth;
preventive – prevent deformations and pathologies in the development of teeth and jaws;
fixing – used for fastening orthodontic appliances and therapeutic materials.

Interesting fact!

Hippocrates called children's teeth milk teeth. He was convinced that the first set of human teeth developed from the milk that infants fed.

Types of dentures for children

Typically, children are fitted with fixed, removable or conditionally removable dentures. Removable (temporary) dentures are made according to individual jaw impressions, sometimes with additional elements (screws, springs, arches). In children's dental prosthetics, they are installed when several teeth are missing to widen the jaw or correct the position of the teeth, and they must be regularly replaced as the child grows. Fixed dentures are installed for long-term wear and are removed along with the falling out milk teeth.

Dentures for teeth

Type of prosthesis	Material	Characteristics
Crowns	Stainless steel, metal alloys, acrylic (Strip crowns) Metal alloys	They are used for partial dental caries damage, trauma, and bruxism. The procedure for installing such prostheses is much faster and easier than conventional filling. In this case, the pulp is preserved, and the tooth is ground according to the method for “adult” prosthetics. During the installation of the crown, the doctor must carefully ensure that the crown does not extend beyond the edge of the gum. Fixed crowns can be placed on children aged 1 to 12 years, as they do not affect natural process loss of baby teeth.
Pins	Metal alloys	Pin design for children's prosthetics teeth is similar to the pin design in adults. The children's pin differs only in a special element for more reliable fixation. As a rule, pins are installed in the roots of the front teeth in upper jaw and fangs lower jaw. According to generally accepted methodology, preparation of the supragingival part of the root for subsequent prosthetics with a pin is carried out with carborundum stones.
Tabs	Metal alloys	Microprostheses, which are installed in place of missing tissues and recreate the anatomical shape of the tooth. In prosthetics, baby teeth are used to eliminate defects with the obligatory preservation of the dental pulp.
Bridges	Stainless steel, metal alloys	A structure consisting of several crowns that is attached to natural teeth. Restores chewing function and preserves the aesthetics of the smile.
Immediate dentures	Acrylic, nylon	The most popular type is partially removable dentures. Used to replace one lost tooth. Almost invisible. It takes some getting used to. It is characterized by the absence of contraindications and is suitable for all patients without exception.
Clasp dentures	Nylon	Comfortable, ensure even distribution of load between all teeth. They exactly follow the contours of the gums and are therefore quite complex to manufacture and require several visits to the dentist. Elastic and flexible, they are fixed to adjacent teeth with soft nylon clasps. It takes some getting used to. They do not rub the gums and are almost invisible due to their transparency.
Complete overdentures	Acrylic, nylon	Completely replace all teeth on one or both jaws. They are attached to the palate by suction or using a special cream. They are durable and do not require special care.

How to choose a clinic for prosthetics of baby teeth?

When choosing a clinic for prosthetics of primary teeth, it is necessary to study information about institutions performing this procedure, and, in particular, find out whether they have licenses to provide dental services children. There are not many such clinics, but you should still be puzzled by finding exactly the dentistry where your child will receive professional help specialists with appropriate qualifications for prosthetics of primary teeth.

How to care for children's dentures?

Children should care for dentures in the same way as natural teeth. You should brush your teeth twice a day and after every meal. If there are no necessary conditions for this, rinsing is acceptable. clean water and use of dental floss. In some cases, depending on the material of the dentures, it is necessary to carry out regular professional cleaning dentures in the dental office.

Prevention of dental prosthetics in children

Premature loss of baby teeth, and therefore dental prosthetics in children, can be avoided if you promptly and regularly visit a dentist who diagnoses the condition of the teeth, identifies possible bite defects and diseases of the oral cavity. Proper care taking care of your teeth and attending preventive examinations will help eliminate the problem initial stage, avoid tooth loss and the need for dentures. The child’s nutrition also plays an important role in the preservation of baby teeth. After all, if there is a lack of substances necessary for a growing body, teeth are destroyed on their own, without mechanical impact on them. Currently, with parents being busy, unfavorable environmental and economic factors The condition of children's teeth is deteriorating every day and prosthetics of baby teeth is becoming increasingly important. Therefore you should take preventive measures to maintain dental health from an early age.

Prices for dental prosthetics for children

The cost of prosthetics for primary teeth depends on the category of the clinic, the qualifications of the specialist, the amount of work of the dental technician and the material from which the prosthesis will be made. Moreover, the initial consultation with a pediatric dentist in most clinics is free.

First of all, children's prosthetics are indicated for early loss(removal) of baby teeth. Adults often doubt whether children need dental prosthetics.

Consequences of premature removal of baby teeth:

A decrease in chewing function leads to problems in the functioning of the gastrointestinal tract.
Incorrect distribution of chewing load leads to facial asymmetry.
Delayed development of the lower jaw due to reduced chewing activity causes a lack of space for the growth of permanent teeth. An incorrect bite is formed.
Impaired diction.

To prevent tooth displacement, it is recommended to replace the lost tooth with installation of a removable plate, which can be made of plastic, nylon or silicone.

Crown installation for baby teeth is recommended in case of severe tooth decay due to caries, chipping/breaking of the tooth crown or congenital abnormalities in the shape of the tooth. The interdental distance between the small primary incisors is quite sufficient to install children's dentures without grinding. For children, special sets of ready-made crowns of various sizes are provided. All that remains for the doctor to do is make a small correction and fix the structure. Treatment is carried out under local anesthesia and takes 20 minutes. Installed crowns do not interfere with the process of natural loss of baby teeth and their replacement with permanent ones.

In case of loss of a baby tooth, installation using the same technology as single crowns is recommended.

Dental prosthetics in children are performed when molars fall out as a result of serious systemic diseases body. The task is complicated by the fact that the installation of permanent dentures is possible only at the age of 21, after the completion of the formation of the dental system. Before this, a temporary prosthesis is fixed, which will change as the jaw grows.

Long procedure - long lasting effect. New tooth, identical to natural, with a lifetime guarantee

You will learn

Which technologies are best suited for your case?
What are the treatment times?
How much does implantation cost and savings options?
What equipment is used to perform the operation?

Reviews from our clients

Tatyana Vladimirovna Ch.

Since the end of last year, I have been looking for help in solving my situation - there was a need to install molar implants in the lower jaw, 5 in total. I chose the Implant City clinic and am very glad that I was not mistaken! I immediately found myself in an atmosphere of care, attention and, of course, professionals! It was decided to divide the treatment process into several stages, which is very correct and good. Of course, patience is required. The actual operation to install the implants was carried out by Eremin Dmitry Aleksandrovich! 5 implants were installed at once: 3 on the left and 2 on the right. Everything went well, the surgeon’s hands were light, simply golden, constant attentive attitude and a team of assistants at the highest level. No negative emotions. This was the first stage of treatment. Then the period of implant engraftment and continuation of treatment. Everything is excellent, without negativity! And yesterday the treatment ended completely with the installation of crowns. Orthopedist Maxim Gennadievich was already involved in the process of installing crowns. Gorgeous, pleasant! I express my deep gratitude to all the staff who dealt with my issue! Special heartfelt gratitude to doctors Eremin Dmitry Aleksandrovich and Boblin Maxim Gennadievich! What great guys, they chose the right professional path! Good health to them and success in all their endeavors!!! THANK YOU!!! THANK YOU!!! THANK YOU!!!

Svetlana

I am very pleased with the results of the work of the center’s specialists. I pulled it out at the clinic complex teeth wisdom, treated, made implants for 4 teeth. I was especially struck by the staff of the clinic: professional, young, promising, truly caring and humane specialists. I would like to say special thanks to A.V. Tsupikov. for professionalism, sparkling humor, amazingly fast and precise work, quick and easy implantation compared to the implants of a friend who had them done for a long time and painfully in another clinic; Eremin D. for quick and clear removal the most complex teeth wisdom; Dubovik P.I. for his attentive, careful attitude during the installation of the formers and fast, well-coordinated work; and, of course, Popov N.A. for special tact, care, humanity, clear instructions and recommendations for last stage work.

May God grant prosperity to your center, and to these wonderful doctors with the same kind, humane attitude towards clients and professionalism, and much grace!
I am very pleased and will recommend you to my friends and family!

Zdorovenin Valery Vladimirovich, 79 years old

On July 6, 2018, I had a sinus lift with the simultaneous installation of two implants. This is a complex and not short-term operation.
The surgeon was Pavel Igorevich Dubovik, he was assisted by his assistant Faride.
I was left with the impression that the way this pair of specialists worked is probably how astronauts work, where the cost of error or delay is too high. Faride understood the boss’s commands perfectly and carried them out instantly. Of course, I could not understand that every this moment is done by a doctor, but I felt and understood that I was in the hands of professionals top class. Clear, economical movements and words of commands without any repetitions, no slipping of the tool and no cursing about it. A refined algorithm of actions with a natural successful result.
And, of course, I must gratefully mention the Treatment Coordinator Natalia Brazhnik - beautiful, friendly, always ready to help. A wonderful “face of the company”!

Pediatric dentistry is actively developing and provides an opportunity to solve a lot of problems. Dental prosthetics in children allows you to combat dental defects, restore chewing function, and has a beneficial effect on the development of the dental system and on the growing body of the young patient.

Many people believe that dentures are only given to older people. There is an explanation for this confidence, because restoration of the dentition is most often required by people in old age, when teeth become less strong and brittle. However, there is no age limit for prosthetics.

Causes of missing teeth in children

Dental defects in young dental patients occur due to the following reasons:

Caries and its complications.
Dental injuries.
Edentia.
Inflammation of the oral cavity and the appearance of neoplasms.
Retention.

Most often, prosthetics are required for the front teeth located on the upper jaw. These teeth are most often affected by caries, and injuries occur in most cases from the front. Adentia and inflammatory diseases also occur in the anterior part of the dentition.

Slightly less often, prosthetics are required for molars and premolars. For specified teeth greatest danger also represents caries, less often trauma and other causes. If a child has edentia, then these teeth may be missing.

To date, the causes of caries have been well studied. With prosthetics for injuries, everything is also quite clear. The causes of adentia are still completely unknown. While some experts associate a small number of teeth with the body’s adaptation to life changes, others insist on congenital developmental disorders.

Classification of edentia

The classification is carried out into four groups:

Almost complete absence of teeth. As a rule, such children have common basic and additional signs of the disease.
Reduced number of teeth, accompanied by some anomalies, e.g.
Edentulous with missing incisors in the lower part of the jaw and upper lateral incisors. At the same time, the lower canines are noticeably larger than the upper ones, and the lower part of the face is reduced.
The fourth group of adentia is most easily identified and is expressed in the absence of part of the upper and lower incisors. The bite in such cases is not disturbed.

With any degree of edentia, it is necessary to perform prosthetics as quickly as possible. Otherwise, children will lag behind in development due to difficulties in chewing food. The only exception is the fourth group. Prosthetics for children with mild degree edentulism is performed in individually in agreement with the parents.

In what cases is dental prosthetics required in children?

Absence or loss of natural teeth childhood is enough big problem. Moreover, the aesthetic side fades into the background, since all children have no teeth at one time or another. First of all, it is necessary to restore the chewing function of the body and obtain all essential vitamins and microelements for proper development body.

Installation of dentures is necessary if:

The teeth are severely damaged by caries, and it is not possible to install a filling.
Tooth decay due to fluorosis.
Appearance inflammatory processes in the periosteum.
Periodontitis.
Early loss of baby teeth.

Most often, the front teeth are replaced with prosthetics. At the same time, the installation of prostheses for children and adults has certain differences. If in adult patients the jaw is fully formed, then the child’s body is constantly growing. The dentist must have extensive experience and knowledge so that when prosthetizing baby teeth in children, the development processes of the body are not disrupted.

Children's dentures

If it is necessary to install a prosthesis for a child, it should be taken into account that his oral tissues are not fully formed, so the product should be as simple, comfortable, hypoallergenic, safe and resistant to aggressive substances as possible, and not interfere with the natural growth of the jaw. When choosing a design, you should take into account the materials, design, and purpose.

Materials:

Acrylic.
Stainless steel.
Chrome plated steel.
Silver and tin alloys.

Purpose:

Therapeutic - allow you to minimize dental defects.
Preventive – help prevent deformations and anomalies of the dentition.
Fixing - fix orthodontic devices and materials in the oral cavity for the treatment and prevention of teeth.

Dentures for children are:

Temporary and permanent.
Removable and permanent.

Bridges.
Crowns.
Pins.
Tabs.

The design of the pin for children's prosthetics is similar to the adult product. The exception is the presence of a special device in a children's product, with the help of which the fixation is more durable and reliable.

Inlays are designed to preserve pulp and eliminate enamel defects; they fit tightly to the tooth root and are securely fixed.

Bridges

Often used for dental prosthetics in children and adolescents, they can be:

Preventive.
Medicinal.

In the first case, the products make it possible to minimize the displacement of existing teeth. As a result, with growth permanent tooth the child will not experience problems or inconvenience. The use of a preventive bridge structure is justified in the absence of one tooth.

The bridge consists of two parts that have a movable connection with each other. As a child matures and grows, his jaw enlarges. Thanks to the movable connection, the parts of the prosthesis move apart, restoring chewing function and without interfering with the growth of the body. The prosthesis continues to perform its functions without additional appeal to the dentist. In addition, when chewing food, part of the load is transferred to the jaw, which accelerates the appearance of molars.

Fixation methods

Despite the fairly simple manufacturing technology, children's bridges have a certain design. Fixing a bridge on two crowns is not allowed, since this disrupts the growth of the dentofacial apparatus, therefore bridge It is attached to only one tooth, which explains its design.

If no more than one tooth is missing, unilateral fixation is suitable. If there is a root that limits the defect on one side, a pin is suitable for installing the prosthesis.

When installing a pediatric bridge supported on both sides the best option is a sliding design. Such dentures hold very firmly, and the functionality of the dentition does not suffer at all. For installation, pins, temporary or permanent crowns are used.

Crowns

With the help of crowns, it is possible to restore partially destroyed teeth and minimize their displacement during the growth of a child or treatment of the oral cavity. Crowns are placed for fixation medications for injuries to the cutting part of the tooth.

Installation of temporary crowns is performed without tooth preparation. The edge of the temporary crown and gums are located at the same level. This installation feature allows you to avoid damaging the tooth and gums.

When making crowns, material with a wall thickness of up to 0.15 millimeters is used. During the turning process, the wall becomes no more than 0.12 millimeters thick. The installation is accompanied by a change in the bite, which returns to normal after two days. Crown removal is performed using a special device and is painless for the child.

Removable prosthetics

Removable dental prosthetics in young children has proven its effectiveness in practice. Patients of any age quickly get used to the structures and use them without complaints or dissatisfaction.

Removable appliances are the preferred option for restoring chewing function in a child. If you install standard non-removable structures, they will have to be changed quite often.

Removable dentures serve as orthodontic devices and are used for injuries and abnormalities of the jaw structure. Prosthetics are mandatory in case of complete absence of teeth, since otherwise the pathology will continue to develop, which will lead to disruption of the functions of growth and development of the body.

Removable plate structures do not use clasp fastening. The base of the prosthesis is made without artificial gum, which allows not to limit the growth of tissues and jaws. Installation of clasps is required only in extreme cases.

The use of modern technologies has made it possible to significantly improve children's dental prosthetics. Various options designs make it possible to choose necessary option for a child with injuries, dental diseases and edentia.

Only the most experienced dentists deal with children's dental prosthetics, whose main task is to restore chewing functions and appearance. Modern designs allow children to calmly chew food without experiencing inconvenience or discomfort.

Your mark:

Children's dental prosthetics is a relatively young area in dentistry. For many years, it was believed that this procedure for baby teeth was not only inappropriate, but also contraindicated because it delayed jaw development. At the same time, many factors were not taken into account, such important ones for the child as impaired diction, the development of an abnormal bite, deformation of the dentition and the formation of specific bad habits.

But over time, it was proven that prosthetics of baby teeth in children is necessary. It not only solves certain problems, but also provides positive impact for the entire dental system.

An orthodontist performs prosthetics on baby teeth. Modern dentures for children are made from special materials that are completely safe for children's health. They do not interfere with jaw development. But due to the fact that the child has bones facial section skulls are in the process of growth, dentures last no more than a year, after which they are replaced with new ones. And so on until the permanent teeth erupt.

Indications for prosthetics

The main indications for the procedure are:

deep caries with complicated course;
fluorosis in erosive or destructive form;
periodontitis;
gross mechanical trauma to the crown of the tooth, as a result of which a serious chip appeared on it;
neoplasms in the oral cavity;
various congenital pathologies, including primary adentia (absence of a tooth);
cosmetic defects of the front teeth, bringing a child a feeling of psychological discomfort.

And yet, some parents have formed a strong opinion that there is no need to get dentures for baby teeth, since they will fall out anyway. This is wrong. The absence of even one tooth can negatively affect the child’s entire dental system, not to mention several at once.

Types of dentures for children

There are two types of dentures that are used in pediatric practice: removable and fixed.

Fixed structures for children are installed in cases of loss of one or two teeth. They are spacers whose purpose is to prevent the displacement of adjacent dental units.

Removable dentures in the form of a plate with artificial teeth made of high-quality materials are recommended if three or more teeth are missing in a row. They are made in dental laboratory according to an individual cast. In some cases, they can be additionally equipped with special orthodontic elements to correct the bite.

Materials used in the manufacture of children's dentures

Today in pediatric dentistry, several types of materials are used to make dentures.

Nylon. Designs made from it are particularly soft, so they do not injure the gums. The material is hypoallergenic. But it is used only for the base. Artificial molars and incisors are made of plastic.
Acrylic. This material is used quite rarely due to the high risk of causing allergic reaction. But in the absence of contraindications, acrylic is excellent for tooth restoration, since it is a cheap and at the same time durable material.
Acry-Free. Absolutely new material- Akron, which recently began to be used in pediatric dentistry. It is highly hypoallergenic, soft and completely safe for children.

Features of children's prosthetics

Thanks to modern technologies Prosthetics of baby teeth in children is a quick and painless process. All materials from which the structures are made are lightweight and highly resistant to various mechanical damage And chemical exposure. They are fastened mainly with the help of special devices - clasps - white hooks in the shape of an arc. Occasionally, a special adhesive composition is used for prosthetics.

The designs of dentures used in the pediatric prosthetics clinic have features determined by the characteristics of the child’s body and their purpose.

The main indication for their use is the normalization of the function of chewing, swallowing, speech, breathing, prevention of morphological and functional disorders in the dentofacial region, inflammatory diseases gastrointestinal tract and etc.

The designs of prosthetics should be simple, so as not to complicate the process of their manufacture, and be accessible to all children who need prosthetics. In the practice of dental prosthetics for children, the following designs of dentures are used: inlays, crowns, pin teeth, removable plate dentures, bridges and spacers, as well as prosthetic devices.

According to their purpose, they are divided into therapeutic, preventive and fixative. Therapeutic treatments restore morphological and functional disorders.

Preventive measures prevent the formation of anomalies and deformations during the development and formation of the dental system.

Fixing - for fixing other designs of dentures, orthodontic devices, therapeutic and cushioning materials.

According to the method of fixation, they are divided into fixed and removable.

According to the time of application (use) - temporary and permanent, although the concept of permanent in childhood is relative, because With the growth, development and formation of the dental system, all denture designs must be periodically replaced.

Artificial crowns

For ease of presentation, crowns used in pediatric prosthetics clinics are conventionally divided into “temporary” and “permanent.”

Temporary crowns include preventive or fixing crowns. They do not cover carious teeth, but are used, for example, on front teeth in case of a traumatic fracture of a corner or incisal edge for fixing therapeutic material, using the biological method of treating pulpitis, for fixing preventive devices (prostheses) in children with defects in the dentition, preventing tooth displacement, for fixation of orthodontic appliances.

When using temporary crowns, the teeth are not prepared; standing teeth physiological separation is carried out using elastic rings or spacers, and in some cases it is enough to slightly thin the proximal surfaces.

A feature of temporary crowns is that their edge should be located at the level of the gingival margin because:

1) if a crown is made for a temporary tooth, then, based on its anatomical feature - the location of the equator in the area of the gingival edge - the crown will tightly cover the tooth, and when you try to insert it into the periodontal pocket, it will injure the edge of the gum;

2) if the crown is made for a permanent tooth, then in the neck area it will be much wider than the tooth, since it must pass through the unprepared equator, and, therefore, when trying to insert its edge into the periodontal pocket, it will also injure the gum.

For the manufacture of temporary crowns, thin-walled sleeves with a thickness of 0.14 - 0.15 mm are used. During technological process When making a crown, its thickness is reduced to 0.11 - 0.12 mm. Based on this, after applying such a crown, a slight overbite appears, which corrects itself after 1 - 2 days, and therefore is not the cause of pathological conditions.

After performing its function, the temporary crown can be easily removed using the Kopp apparatus, since the surface of the tooth enamel is smooth.

If it is necessary to make permanent crowns, generally accepted medical rules and technical methods are applied, depending on their design (Fig. 156).

Pin teeth

For prosthetics with pinned teeth in childhood, the roots of the upper front teeth and premolars, which have one root, as well as the lower canines are mainly suitable. The roots of the lower incisors and premolars are flat and thinned, and during mechanical preparation of the root canal for the pin, its walls become thinner, which leads to perforation or breakage of the root by the pin.
The requirements for the root for a pin tooth are fully consistent with the requirements for adults.

Considering anatomical features roots and canals in childhood (thin walls and wide canal), as well as the most common complication When prosthetics with pinned teeth results in decementing and possible root breakage, a special design of a pinned tooth has been developed for children.

Ilyina - Markosyan L.V. proposed a pin tooth design, the peculiarity of which is that it contains a device that improves fixation and sealing of the mouth root canal and is a shock absorber of lateral loads unfavorable for the root. This device is a cast insert at the mouth of the root canal of a cubic shape with a cross-section of 2-3 mm.

A diagram of a variety of inlays is shown in (Fig. 157), where you can see how the force directed at the tooth at any angle to it vertical axis, having reached the obstacle in the form of the walls of the tab, it splits into two: vertical and horizontal. Of these, only the horizontal one can be practically dangerous, which is significantly weakened by counter resistance.

So, this pin tooth design has the following positive properties:

1. It fits tightly to the root surface and hermetically seals the mouth of the root canal.
2. Securely fixed to the root.
3. The presence of a tab spreads (redistributes) all types of load over a large surface area of the root, performing a shock-absorbing function.
4. Does not provide negative influence on the root and tissue of the tooth.
5. Effective in aesthetic terms.
6. Easy to manufacture.

Design of the pin tooth by Ilyina - Markosyan L.V. has a significant drawback that as a result of the formation of a cavity under a cuboid-shaped tab, the root walls become unevenly thinner, which reduces their strength. Therefore, D.N. Citrin proposed forming the cavity in the form of two opposing triangles, with their apices facing the mouth of the root canal. The base of one triangle faces the vestibular surface, and the second one faces the oral surface. This shape of the cavity for the tab weakens the strength of the root walls to a lesser extent.
The disadvantage of this design is that it is labor-intensive to form a cavity for the inlay.

We have proposed the design of a pin tooth with an inlay at the mouth of the root canal diamond-shaped. The formation of such a cavity is not labor-intensive; the preserved root walls have a relatively uniform thickness, which does not weaken its strength (Fig. 158).

Bridges

In pediatric practice, bridges are usually divided into preventive and therapeutic. The function of preventive bridges (devices) is to preserve space in the dentition in the area of the defect for subsequent normal eruption of the permanent tooth, preventing the displacement of the teeth limiting the defect and the antagonist. They are used only when one tooth is missing.

To this end, a number of designs have been proposed that are easy to manufacture and use.

Conventional bridges, fixed on two crowns, are not applicable in childhood, as they retard the growth of the jaws. The harm from such prosthetics will become noticeable after some time, even after appearance. For example, if a teenager does not have four upper incisors, if a bridge-like prosthesis of a conventional design is attached to the canines, the growth of the corresponding section of the upper jaw will stop. As a result, a progenic bite and aesthetic disturbances in the form of a flattened face may form.

Bridges with unilateral strengthening are used in case of loss of one tooth. If there is a tooth root limiting the dentition defect on one side, a pin tooth can serve as a means of fixing the prosthesis.

When restoring dentition defects in children with bridges with one-sided support (cantilever). An integral part of a children's cantilever bridge prosthesis is a cast occlusal overlay or process on the oral surface of the front teeth, extending from the body of the prosthesis to the tooth not covered by the supporting crown. It protects an insufficiently stable supporting tooth from dislocation and rotational movements under the pressure of the tongue, biting and chewing food. The occlusal overlay is located in a fissure on the intact enamel surface, and if there is a carious cavity in the tooth, an inlay with a recess for it is made. When using this type of bridge prosthesis, it is necessary to constantly monitor that during jaw growth the occlusal lining does not come off the abutment tooth; if, from observations, this factor becomes clearly unavoidable, the prosthesis must be replaced.

If the bridge is to be strengthened with a pin tooth, it is prepared according to the method described above. An inlay located at the mouth of the canal provides fixation of the artificial tooth, and the palatine process prevents rotation and loosening of the supporting root.

When prosthetic dental arches are used in children with bridges with bilateral support, to prevent delayed growth of the jaw bone, the design of the prosthesis must be sliding.

Sliding bridges are one of the most successful designs used in pediatric practice. Dentures are complete and effective in functional and aesthetic terms, as they are fixed on natural teeth and are very stable. The fixing elements of a sliding bridge prosthesis can be temporary or permanent crowns, pin teeth, and solid cast or artificial teeth with plastic facets replacing missing natural teeth. The use of ceramics and metal-ceramics at this age is not advisable, since these prostheses are temporary and are replaced with permanent ones after the cessation of jaw growth.

The prosthesis consists of two parts, movably connected to each other. As the jaw grows, the parts of the prosthesis gradually move apart (a gap forms between them), thus the development and growth of the jaws continues unhindered.

The principle of movable connection of prosthetic links is put forward by many modern authors and is justified by the desire to provide the prosthesis and supporting teeth with the possibility of independent mobility in the process of development, growth and formation of the morphofunctional and aesthetic optimum of the dental system.

For the first time, the design of a sliding bridge prosthesis for the practice of pediatric dentistry was proposed by Ilyina-Markosyan. The body of the prosthesis consists of two parts connected to each other by a latch, represented by a trapezoidal process (in the form of a swallowtail), extending from one half of the body, and in the second half, on the oral surface, there is a groove of the appropriate shape and size for this process. Both halves of the prosthesis body are connected by sliding the process into the groove and in the assembled position it is soldered to the supporting elements of the prosthesis.

The disadvantage of the proposed design is that when the prosthesis moves apart during jaw growth and the process exits the groove, a void is formed, which becomes clogged with food and is poorly cleaned.

We have proposed the design of a sliding prosthesis, when the groove for the process - the valve - is located inside the body and when its halves are moved apart, it constantly remains closed by the process - the valve rectangular shape and the hygienic properties of the structure do not deteriorate (Fig. 159).

Kopp Z.V. proposed a design of a prosthesis with hinged locks that allow the mobility of parts of the prosthesis within a certain amplitude.
The movable connection of the prosthesis provides its links with greater stability and at the same time gives them the opportunity to move apart to the sides following the natural expansion of the dental arch during growth.

Removable dentures

For a long time, there was an opinion that a removable prosthesis for a child could be a moral injury and he would not be able to use such a prosthesis. However, such a belief is unfounded. As the practice of prosthetics for children with removable plate prostheses shows, even children younger age(3 - 4 years old), are interested in their “artificial teeth”, willingly use dentures and quickly adapt to them.

The designs of removable dentures for children, restoring the integrity of the dentition and maintaining the articulatory balance of the dental system, must also have their own characteristics that meet the requirements of the growing child's body. In addition, the base of the prosthesis, transmitting chewing pressure to the toothless area of the alveolar process, stimulates the development of the jaw bone in this area and eruption of permanent teeth.

For the first time, partial removable lamellar dentures with design features for a growing child’s body were proposed by Ilyina - Markosyan L.V. (1947), which are: 1. Dentures, as a rule, are made without clasps. 2. The base of the prosthesis does not have artificial gum (it does not overlap the alveolar process from the vestibular surface), but ends at the level of the crest of the alveolar process. This design of plate prostheses does not retard the growth of the jaw bones, and the fixation of the prosthesis is achieved through anatomical retention, adhesion and cohesion. Under unfavorable conditions for fixing the prosthesis, it becomes necessary to make a clasp or cover the alvelar process with a base; in such cases, the base of the prosthesis must be sliding, i.e. have a free connector (Fig. 160). 3. Artificial teeth placed on the inlet. 4. The distal boundaries of the base are maximally expanded: on the upper jaw up to line “A”, on the lower jaw the base overlaps the retromolar space.

Sharova T.V. (1983) considers it appropriate to end the edge of the prosthesis base in the area of the transitional fold, justifying this by the fact that in the presence of sufficient physiological irritation, the most active oppositional growth of the jaw bones, especially the lower jaw, occurs from the vestibular surface of the alveolar process. In addition, a dense bone scar forms at the base of the alveolar process, which prevents the timely eruption of permanent teeth. Premature atrophy of the alveolar process occurs.

The design feature of such a prosthesis is that from the vestibular surface, along the entire slope of the “toothless” section of the alveolar process, where the base of the prosthesis should be located, there is a template space between the mucous membrane of the alveolar process and inner surface a base of 1 - 1.5 mm for oppositional growth of the alveolar process and the apical base. The edge of the base on the vestibular surface at the level of the transitional fold should be thickened in the form of a roller and rounded throughout. It plunges into the transition zone and stretches the mucous membrane in this area. Due to the fact that there is an organic connection between the mucous membrane of the vestibule of the oral cavity and the periosteum, the latter through the mucous membrane receives corresponding irritation, in response to which increased appositional growth occurs bone tissue alveolar process and apical base.

The development, growth and formation of an anatomically and functionally complete dental system is possible under the condition of normal morphological development in the embryonic period, full biological potency of the growing organism and the performance of all physiological functions with adequate load.

The complete absence of teeth and their rudiments in children is a consequence of developmental disorders of organs of ectodermal origin (ectodermal dysplasia). This congenital pathology leads to disturbances in the development and growth of the alveolar processes and jaw bones of varying severity, and consequently, all the main functions of the dental system are disrupted. A child with complete absence of teeth (Fig. 161).

In order to bring the development and growth of the jaw bones as close as possible to physiological conditions with such a pathology, it is necessary to create articulatory balance and conditions for the formation of undeveloped functions of the dental system due to congenital pathology. This justifies the need for timely, rational dental prosthetics already in early childhood, which is one of the components of a complex of measures for the sanitation of the oral cavity and the prevention of various dental diseases.

To successfully solve this problem, it is necessary to simultaneously consider three very important aspects, taking into account the patient's age:

1. Registering patients with such pathology with an orthodontist and providing timely specialized assistance in full;
2. Conducting a qualified analysis of the patient’s psycho-emotional state and his intellectual ability to adequately perceive the need for medical procedures;
3. When using prosthetics, not only eliminate as much as possible the possibility of delaying the natural growth of the jaw bones, but also create articulatory balance and conditions for the formation of undeveloped functions of the dental system, stimulating their development and growth.

In order to restore the functions of the dental system, and primarily the chewing function, it is necessary to provide children with complete removable dentures.
Maximum early age We consider the age of possible dental prosthetics for children to be 3 - 3.5 years, which corresponds to the research data of L.M. Demner, P.S. Flisa, T.V. Ball. At this age, a child can already be expected to have an adequate, age-appropriate understanding of the need for prosthetics itself, as well as the entire complex of medical procedures carried out at various stages of prosthetic manufacturing. Moreover, considering psycho-emotional state child with complete absence of teeth, correctly performed psychological preparation and qualified, accessible recommendations for children, will allow him to develop basic rules and techniques for using complete removable dentures and avoid possible complications.

Taking into account the growth of the child’s body, and therefore the constant increase in size and change in the shape of the jaw bones, the problem of combining two mutually exclusive factors arises when using complete dentures:

1. For the manufacture of functionally complete removable dentures a necessary condition is a tight fit of the prosthesis base to the entire surface of the prosthetic bed and the creation of a valve zone in the area of the transitional fold;

2. At the same time, a necessary condition for the possibility of constant growth of the jaw bones in children is that the entire vestibular surface of the alveolar process is free from the base of the prosthesis.

Solving this problem, for prosthetics for children with complete absence of teeth, we have proposed the design of a complete removable denture with an elastic lining. The prosthesis, due to its design features, does not retard the natural growth of the jaw bones, but at the same time, a valve zone is created, ensuring its good fixation and stabilization during function.

We used this design of a complete removable denture for prosthetics for children from the age of three. In all cases, a good therapeutic result was noted (Fig. 162).

Orthodontics
Edited by prof. IN AND. Kutsevlyak