PAEDIATRIC DENTISTRY - 3rd Ed. (2005)

(John Hannent) #1

dental implants as prostheses in children is contraindicated except under
circumstances where severe psychological stress merits such treatment. There are
three reasons for avoiding implants in young patients:



  1. The implant does not move with the growing alveolus⎯it acts as an ankylosed
    tooth. Thus implants should not be placed until vertical growth of the jaws is virtually
    complete (around 18 years of age). The exception to this rule is the lower intercanine
    region which can receive implants earlier in exceptional cases of hypodontia, for
    example, X-linked ectodermal dysplasia.

  2. Implants can interfere with normal growth of the jaws.

  3. Young bone does not behave in the same way as mature bone. Due to squashing
    and crushing, the axis of an inserted implant may deviate widely from the axis of tap.


In addition, the use of teeth for autotransplantation is often a viable alternative in
young patients.


15.7 SOFT TISSUE SURGERY


15.7.0 Introduction


The following short synopsis covers the important functional and orthodontic
problems in the child and adolescent.


15.7.1 Labial frena


A prominent mid-line frenum in the maxilla may be present in association with a
diastema. Whether or not the frenum is the cause of the diastema is open to question
as a fleshy frenum does not always produce an aesthetic defect. Nevertheless, the
excision of a mid-line maxillary frenum is often requested as part of an orthodontic
treatment plan. This procedure is very simply performed under local anaesthesia (1066HFig.
15.30 (a)-(d)). Before surgery a radiograph of the upper incisor area should be taken
to eliminate other possible causes of a mid-line diastema (such as a mesiodens). A
mid-line maxillary frenum should not be removed before the permanent canines have
erupted, as the space may close spontaneously when these teeth appear.


Surgical removal is achieved by dissecting the mid-line tissue via incisions parallel to
the frenum from the labial mucosa, at a point beyond the prominent fibrous tissue,
through the interdental space to palatal mucosa. The part of the incision in attached
gingiva is mucoperiosteal. The surface of the exposed bone in the interdental space
should be curetted or gently burred to remove residual fibrous attachments. Primary
closure of the labial part of the incision is achieved by suturing, and the defect in
attached gingiva is covered by either a periodontal dressing (Coe-Pack) or ribbon
gauze soaked in Whitehead's varnish, which is held in place by sutures. The pack is
removed 7-10 days after surgery.

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