8: Infraoccluded primary molars

8 Infraoccluded primary molars

Summary

Aileen is 11 years old. She is referred by her general dental practitioner for infraoccluded lower primary molars (Fig. 8.1). What is the cause and how would you treat it?

image

Fig. 8.1 Lower occlusal view at presentation.

History

Complaint

Aileen is unconcerned by the position of her back teeth.

History of complaint

Aileen and her mother were unaware of any problem with her molars until this was brought to their attention recently by their general dental practitioner. There is no discomfort associated with these teeth and they are not loose.

Medical history

Aileen is fit and well.

Dental history

She is a regular attender at the family’s general dental practitioner. No dental treatment has been required to date.

Family history

Aileen’s mother has several permanent teeth missing and these have been replaced by bridgework.

Examination

Extraoral examination

Aileen has a mild Class II skeletal pattern with average FMPA and no facial asymmetry. The lips are incompetent with the lower lip lying at the incisal edges of the upper incisors. There are no temporomandibular joint signs or symptoms.

Intraoral examination

Soft tissues of the tongue, floor of mouth, palate/oropharynx and the oral mucosa are healthy. The intraoral views are shown in Figures 8.1 and 8.2.

image

Fig. 8.2 (A) Upper occlusal view.

image

Fig. 8.2 (B) Right buccal occlusion.

image

Fig. 8.2 (C) Anterior occlusion.

image

Fig. 8.2 (D) Left buccal occlusion.

image What do you see?

Plaque deposits on many teeth with associated marginal gingival erythema.
Dentition appears caries-free; fissure sealants are present occlusally in the first permanent molars.
image erupted.
image
Uncrowded lower labial segment; image infraoccluded; uncrowded upper arch.
Mild Class II division 1 incisor relationship (overjet is 4.5 mm measured clinically); overbite slightly increased and complete.
Lower centreline to the right.
First molar relationship: right half unit Class II with image in crossbite; left Class I.

image What is the prevalence of infraocclusion of primary molars?

It is between 8% and 14%.

image Why does infraocclusion of primary molars occur?

Separate phases of resorption and repair occur in the exfoliation of primary teeth. Although resorption predominates in most cases, sometimes repair prevails temporarily leading to ankylosis of a primary molar. As alveolar growth and eruption of the adjacent teeth continue, the tooth infraoccludes.

Key point

Infraocclusion of a primary molar is due to ankylosis of the tooth while alveolar growth and eruption of the adjacent teeth continues.

Investigations

image What investigations would you undertake? Explain why.

Clinical

Assess:

1 Mobility of ē’s – if these are mobile this tends to indicate that they are close to exfoliation and that the permanent successors are present.
2 Extent of infraocclusion of ē’s – if these teeth are in danger of submerging below gingival level, their/>

Related posts:

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  2. 39: Gingival bleeding and enlargement
  3. 3: Absent upper lateral incisors
  4. 6: Palatal canines
  5. 14: Posterior crossbite
  6. 38: Dentinogenesis imperfecta

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Jan 2, 2015 | Posted by in Orthodontics | Comments Off on 8: Infraoccluded primary molars

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