As above. What signs to observe for poor prognosis primary teeth that are retained post permanent dentition stage?
Few of the factors you can look for prognosis of retained primary teeth are
Remaining root length, surrounding alveolar bone, relation of retained tooth with occlusal plane (weather it is submerged?), caries status and strategic location ( in high load bearing area like second molars, prognosis may be poor compared to low stress bearing areas), and caries risk of the individual.
The retention of primary teeth with prognosis is sometimes a necessity, rather than an option. The benefits of preserving primary teeth is of utmost importance. Primary teeth aid in mastication, phonation, swallowing, guidance of permanent tooth bud, harmonized temporal and spatial development of permanent teeth and prevents the detrimental psychological effects due to tooth loss. Despite repeated emphasis, prevention in primary teeth remains a much talked about and rarely practiced treatment modality and therapeutic approach mainly remains curative in nature. Restoration of a child’s dentition to a healthy, functional status is often complicated by the severity of dental caries, particularly in the primary dentition which often falls prey to the ravages of decay. Moreover, the primary dentition is often regarded as transient and hence, undeserving of much time or effort. The intervention is only sorted when the child experiences pain due to the tooth decay. Unfortunately, the delay incurred prior to seeking treatment for dental caries renders the tooth non amenable to conventional restorative procedures. Early loss of teeth in child not only causes problems in phonation and speech, but it also leaves a deep psychological trauma on the mind of a growing child. Therefore, grossly decayed teeth should be endodontically treated and retained for as long as possible as they serve as the best space maintainers.
Secondly in case of missing succedaneous tooth, the primary tooth should be retained. This can be accomplished by root canal treatment and obturation with a non resorbable material or with a material that induces mineralization (e.g.- MTA and Biodentine) so that these teeth can serve as templates onto with permanent prosthesis can be rendered. In addition to the maintaining the bone height, it provides the added advantage of psychological satisfaction to the patient that he/ she has a natural tooth instead of an artificial prosthesis.
valid points Dr. Damle. But even in permanent dentition phase? What if intervenes with space planning or is required to extract to reduce incisor proclination or overjet?
If i get you right. There is a place for the retention of primary tooth even in permanent dentition stage. For example, a child presents to a clinic, and x ray findings revealed that the succedaneous tooth is not in the bone. So all efforts should be aimed at preserving the primary tooth in place for as long as possible. If the primary tooth in question because infected, all efforts are made to treat it as though it is a permanent tooth. Advantages, maintains bone height and the psychological satisfaction the patient that has a natural tooth.
The worst case scenario, is that the said tooth becomes grossly mobile, then we can extract and replace with a prosthesis.