https://doi.org/10.5272/jimab.2018243.

2172
Journal of IMAB
Journal of IMAB - Annual Proceeding (Scientific Papers). 2018 Jul-Sep;24(3)
ISSN: 1312-773X
https://www.journal-imab-bg.org
Review article

REMOVABLE PROSTHETIC TREATMENT IN

CHILDREN -LITERATURE REVIEW.
Mariana Dimova-Gabrovska1, Desislava Dimitrova2, Vladislav A. Mitronin3
1) Department of Prosthetic Dentistry, Faculty of Dental Medicine, Medical
University - Sofia, Bulgaria.
2) Department of Pediatric Dentistry, Faculty of Dental Medicine, Medical
University - Varna, Bulgaria.
3) Department of Gnathology and Prosthetic Dentistry, Faculty of Dentistry,
Moscow State University of Medicine and Dentistry, Russia.

ABSTRACT: turbances in the appearance of teeth and speech frequently

The defects of the dental arches, which are result of lead to a change in the psychological status, development
various genetic diseases, traumas, multiple and early child- of emotional disorders and difficulties in the social adapta-
hood caries can significantly impair speech, chewing func- tion of the affected child. These, in turn, may have an influ-
tion, aesthetics and normal development of orofacial struc- ence on the child’s overall well-being, self-esteem and qual-
tures. In such cases, different types of removable prosthetic ity of life [2]. This is evidenced by the studies of Feitosa et
treatments allow recovering the three medico-biological al. [3] and Martinz et al. [4] who found that 31.2% of the
indicators and support the correct physical and mental de- children, suffering from severe dental diseases, feel sad and/
velopment of the child. or ashamed of their teeth and smile, are significantly more
The purpose of this study is to present the current irritable, more likely to be absent from school, to avoid so-
scientific data on the use of the removable prosthetic treat- cial contacts, have more sleep problems, and perform less
ment in children. well in training activities than healthy and rehabilitated
The survey is conducted from December 2017 to children. Therefore, prosthetic constructions in childhood
February 2018. A total of 330 literary sources found by should meet both the anatomical requirements and the age-
keywords are subjected to critical analysis. related physiological and psychological features [5, 6].
The results show that in children aged 3 to 14, which
suffer from total or partial edentulism, prosthetic treatments OBJECTIVE:
are conducted with total dentures, partial dentures with The aim of this review is to present and analyze cur-
bent or plastic hooks or with tooth supported overdentures. rent literature data on the use of removable prosthetic con-
Plastic primary or permanent teeth are used following the structions in children.
routine clinical stages, and the constructions are continu-
ously modified according to age-related physiological and MATERIALS AND METHODS:
anatomical requirements. From December 2017 till February 2018, an electronic
Conclusion: Removable prosthetic treatments in search was conducted in the PubMed, Google, Lilac, Yandex,
children provide an opportunity for full masticatory and eLibrary.ru databases by using the following keywords:
speech function and improves the quality of life of the kids. “ñíåìàåìî ïðîòåçèðàíå”, “äåòñêà âúçðàñò”, “öåëè
ïðîòåçè”, “÷àñòè÷íè ïðîòåçè” and the corresponding terms
Keywords: removable prosthetic treatments, chil- in English, German, Russian and French: “removable pros-
dren, total dentures, partial dentures thetic treatment”, “children”, “childhood”, “complete den-
tures”, “partial dentures”, “herausnehmbareprothetische
INTRODUCTION: Behandlung”, “Kindheit”, “Vollprothesen”, “Teilprothesen”,
Causes of premature loss of deciduous and perma- “ñúåìíîå ïðîòåçèðîâàíèå”, “äåòñòâî”, “ïîëíûå ïðîòåçû”,
nent teeth may include various genetic diseases (ectoder- “÷àñòè÷íûå ïðîòåçû”, “prothèse amovible”, “enfance”,
mal dysplasia, Papillon-Lefèvre syndrome (PLS), amelo- and “prothèses partiellesamovibles”, “prothèses totales”. The
dentinogenesis imperfecta, etc.), traumas, early childhood final selection included 47 scientific researches, the data of
caries, multiple caries and its complications. In a number of which were analyzed, summarized and presented in the main
cases, defects in dental rows affect the three medical-bio- part of this review.
logical indicators - prophylaxis, function (speech and chew-
ing) and esthetics. Complications, such as tooth migration, RESULTS:
alveolar bone loss and impaired occlusion, affect the proper Healthy and maintained deciduous and permanent
and proportional development of orofacial structures [1]. dentition is vital for the overall well-being of any child [7].
Because of the over-sensitive nature of children, dis- Defects in dental rows and severe dental diseases frequently

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pose a challenge to the pediatric dentist because their treat- Ladda et al. [14] and Bani et al. [20] recommend the
ment requires a multidisciplinary approach, management of use of artificial teeth that are shaped as permanent teeth in
the child’s behavior, preservation of the other dental and children with mixed dentition. It is assumed that this pro-
oral structures, and the achievement of high-performance vides better static and dynamic occlusion and proportional
results in terms of parents’ satisfaction. restoration of the vertical dimensions of the masticatory
Planning and placement of removable prosthetic con- system.
structions should be consistent with a number of criteria, in There are data [21] on the use of artificial teeth that
order to restore the effective masticatory and speech func- are shaped as deciduous teeth in children aged 3 to 7 years.
tion, to achieve acceptable appearance and to ensure the The purpose of their use is to create an age-appropriate ap-
unimpeded development of the oral structures and the whole pearance and function. Because of the underdeveloped al-
organism [8, 9]. veolar ridges, it is recommended to increase the vertical
There are [10, 11] several different techniques for the dimensions by about 1 mm while arranging the artificial
treatment of children suffering from dental malformations teeth, in order to restore the balance of the temporoman-
and/or partial/total tooth loss. dibular joint/maxillary/mandibular relationships and the
Prosthetic treatment with removable total dentures face profile.
with acrylic denture base, partial dentures and tooth-retained To optimize the esthetic and functional performance,
overdentures is the most common choice for restoring the a standard tooth set is used by Pannu and Singh [22] in the
oral structures in childhood [12]. A major impetus for the treatment with complete dentures, which is duplicated and
development of alveolar bones is the eruption of teeth. In fabricated with the appropriate deciduous tooth-like color.
cases of hypo- and anodontia, therefore, there is atrophy of There is also a need for complete restoration in cases
the alveolar bone and decreased ability to retain removable of extraction of all deciduous teeth due to rampant caries.
constructions. However, partial and complete conventional An example of this is given by Hugar et al. [23], who sug-
dentures are successfully used for the oral rehabilitation of gest the use of conventional complete dentures as a method
children. According to Walsh [13], the removable prosthesis of temporary rehabilitation until the eruption of permanent
in young patients requires much more time and a more com- teeth takes place.
plex approach, compared to adults. Individual clinical stages in complete denture pros-
An advantage of the use of removable constructions thesis may turn difficult to be carried out, due to the age-
in children is the possibility for their easy modification and related characteristics of the patients. In order to increase
processing during the periods of growth and development the child’s cooperation, Dalkiz and Beydemir [24] suggest
of the maxillary and mandibular bones. Although consid- the use of motivation techniques. For example, children get
ered to be an inadequate alternative of the healthy denti- the opportunity to practice self-training - they insert and
tion by Ladda et al. [14], these dentures provide the possi- remove the impression tray by themselves and then bring it
bility for adequate nourishment of the growing children, for home between the clinical visits. The authors believe that
improving their social activities, raising their self-esteem this greatly reduces the stress during the stage of impression
and significantly benefit their quality of life. taking. The recording of inter-maxillary relationships may
Use of complete dentures in children also turn difficult to the dental practitioner. In order to bet-
There are literature data [15, 16, 17, 18, 19] that dis- ter control the child’s behavior when fixing the wax shafts,
cuss the successful use of complete removable dentures in it is advisable to avoid heated instruments or heat proce-
childhood. The need for such prosthesis is most commonly dures or, as a last resort, the heat source should be outside
seen in children with abnormalities in the development of the child’s field of vision.
jaws and the formation of dental follicles, systemic diseases According to Dominguez et al. [25], treatment with
(e.g. ectodermal dysplasia), genetic diseases, traumas, ram- removable dentures is a complex process that requires con-
pant caries, early childhood caries, etc. tinuous modification, correction, and refabrication of the
According to a number of authors [20, 21, 22, 23], constructions, in order to ensure unimpeded teeth eruption,
complete denture prosthesis in children aged 3 to 14 years normal growth and development of the maxillary bones and
follows the routine clinical steps: obtainment of a prelimi- facial skeleton.
nary impression and fabrication of an individual impres- According to Gupta et al. [26], the removable pros-
sion tray; obtainment of a functional impression of the pros- thesis is poorly tolerated by children aged between 3 and
thetic field; determination of the vertical and horizontal 14 years, but after an adaptation period of about 1-3 months,
inter-maxillary relationships by using wax shafts and mount- there is a significant improvement in children’s tolerance.
ing the casts on the articulator; arrangement of the artificial In their study, Ohno and Ohmori [27] indicate considerable
teeth according to the location of the alveolar ridges and a children’s satisfaction with complete dentures with regard
clinical evaluation of the wax trial denture. The prosthesis to masticatory efficiency (the ability to chew meat and rice
is finished by using a heat-polymerizing plastic and after crackers) and speech function (the ability to pronounce sibi-
their adjustment and articulation, is inserted into the mouth lants). All this is of essential importance for the child’s nor-
with the appropriate instructions to the patient. mal physical and mental development, which makes com-
There is a difference between the individual cases in plete denture prosthesis a suitable choice of treatment in
the selection of the artificial teeth for fabricating the pros- cases of total tooth loss.
thesis. In a number of cases, there is a need for combining

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complete and partial dentures or partial dentures and other Exploring the children and parents’ satisfaction is
prosthetic constructions. particularly important for the work of the dental practitioner.
Use of partial dentures and combined prosthetic The data obtained from this type of studies may determine
constructions in children the treatment success in the various aspects of function,
Partial dentures with or without bent/plastic clasps prophylaxis and esthetics and accordingly provide infor-
can be used in cases of hypodontia caused by various ge- mation to the dental practitioners on the possible shortcom-
netic and hereditary diseases. Examples of this are the stud- ings in these areas. The patient’s subjective assessment is an
ies of Jani et al. [28], Gupta and Tyagi [29], who apply this important part of each and every stage of the treatment and
method of treatment to children with partial tooth loss, aged is decisive for the ultimate success [43].
between 4 and 6 years. They recommend the arrangement of Rodd and Atkin [44] examined the clinical presenta-
more translucent and smaller teeth, with tremas between tion and the satisfaction with removable prosthesis in chil-
them. This creates conditions that correspond to the physi- dren. The results have shown that 36.2% of the applied pros-
ological increase of the jaws and the natural appearance, theses were corrected at least once after insertion. Approxi-
characteristic of this age. mately 60% of the patients required repeated fabrication of
The results of one-year study [30] on masticatory newly modified dentures.
strength in children with partial dentures have shown an To evaluate the patients’ satisfaction, the authors used
increase in the values of masticatory strength over the first a short questionnaire, completed by the children themselves,
three months. This suggests that this type of restoration is with the help of which the authors assessed the overall atti-
suitable for replacing the missing deciduous teeth, with the tude towards wearing of theprosthesis, the type of prosthe-
possibility for improving the function of the masticatory sis, nutrition, comfort and the perception by other children.
system. To evaluate the responses, the authors used the Visual Ana-
The scientific literature [12, 31, 32, 33] describes cases logue Scale (VAS). The study results have indicated a total
of combined prosthesis in early childhood caries, premature high score, with the most positive response being related to
tooth loss, or in the presence of irregularly shaped teeth in ease of eating. However, a relatively high degree of irrita-
combination with hypo- and oligodontia. tion, which tends to increase over the time, has been re-
Parisotto et al. [34] recommend combined pediatric ported.
prosthetic treatment with single metal crowns and partial
dentures with acrylic denture base. As a reason for choosing DISCUSSION:
metal constructions, the authors point out their high pro- The presented data allow us to summarize the basic
phylactic value regarding caries and its complications, res- requirements that are to be met by removable prosthetic
toration of occlusion, favorable prognosis over the time, treatments in childhood. Removable prosthetic construc-
and low cost. In the children with prostheses, significant tions should:
improvements have been reportedwith regard to mastica- · restore masticatory function and effectiveness within
tory and speech function, as well as psychological and so- the normal range, without injuring the adjacent and/or op-
cial development. posing teeth;
Some authors [35, 36, 37, 38, 39] suggest restoration · allow the creation of occlusion-articulation equi-
of large carious lesions and irregularly shaped teeth with librium and prevent from injury of the underlying dental
celluloid or composite crowns and restoration of partial follicles [1];
tooth loss with conventional partial dentures. · create the appropriate conditions for proper sound
The use of combined prosthetic dentures, suggested pronunciation and articulation of dental ([d], [t], [n], [l]),
by Shigli et al. [40] and Yenisey et al. [41], is also of interest. sibilant fricative ([s], [z], , ) and affricate consonants
)
)

Frequently, in the case of the hypodontia, underdeveloped ([ts], [dz], ) [45];

alveolar ridges are observed, which makes it difficult to re- · meet the esthetic requirements of parents and chil-
tain the constructions. Therefore, the authors suggest the dren. It is well known that children aged 3 - 5 years are
application of partial overdentures with additional retain- already well aware of how they should look and how they
ing devices, such as telescopic crowns and mechanical joints would like to be perceived by children of the same age and
made on the pre-prepared teeth available. This creates pre- adults [46];
conditions for alveolar bone preservation, stability of the · provide optimal and proper tooth eruption and
prosthesis and restoration of speech and masticatory func- growth of facial and maxillary bones, which requires peri-
tion. odic modification and processing of the constructions
Sometimes a huge effort is required by the dental against the developing tissues;
practitioner to encourage the child to cooperate during the · function as space-retainers with regard to orthodon-
treatment process. Most authors [26, 29, 32, 34, 38] recom- tic deformations. The lack of prosthesis in edentulous areas
mend the “tell, show, do” technique to manage the child’s may result in migration of the adjacent teeth, impaired erup-
behavior. In cases of negative mood, Bhargava et al. [42] tion, changes in dental rows and occlusal discrepancies [1];
suggest the existing, irregularly shaped, but intact decidu- · the materials used for the constructions must be
ous teeth not to be restored, but covered directly with biocompatible and hypoallergenic, and the performance
overdentures. This significantly reduces the stages of treat- technique minimally invasive and supportive.
ment and the time spent on the dental chair by the child.

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 An important feature of prosthetic treatment in child- quently lead to emotional and social problems. Typically,
hood is the work with sometimes too impatient and difficult such children avoid communicating and feel sad, shy and
to motivate patients, who are not able to understand the irritable. Ignoring these problems may lead to disturbances
needs and benefits of timely treatment [47]. This requires a in mental development.
clinical approach to work, requiring speed, painlessness and All this necessitates the development of modern meth-
effectiveness. ods of restorative or prosthetic pediatric dentistry. The use
of removable prosthesis as a method of oral rehabilitation
CONCLUSION: in young patients requires particular attention, due to the
Various genetic diseases, multiple caries and severe continuous growth processes, age-related anatomical, physi-
traumas may lead to partial or complete tooth loss in chil- ological and psychological characteristics. The application
dren. Impairment of oral structures results in ineffective of a removable construction requires a multidisciplinary
masticatory function and disturbance of basic vital proc- approach, a detailed knowledge of the stages of planning
esses such as eating and speaking. Generally, the affected and the means of managing the child’s behavior. Where nec-
children restrict their nutrition to only a few types, mostly essary, prosthetic treatment should be performed at the ear-
soft foods. This leads to insufficient intake and absorption liest possible moment in order to restore the speech and
of nutrients necessary for the proper development of the masticatory function and the normal appearance of the child
whole child’s organism. and hence, the possibility of the child’s normal physical,
Impaired appearance and sound articulation fre- mental and social development.

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Please cite this article as: Dimova-Gabrovska M, Dimitrova D, Mitronin VA. Removable Prosthetic Treatment in chil-
dren -Literature review. J of IMAB. 2018 Jul-Sep;24(3):2172-2176. DOI: https://doi.org/10.5272/jimab.2018243.2172

Received: 10/06/2018; Published online: 12/09/2018

Corresponding author:
Assoc. Prof. Dr Mariana Dimova-Gabrovska, PhD, DSc.
Department of Prosthetic Dentistry, Faculty of Dental Medicine, Medical Uni-
versity, Sofia,
1, St. G. Sofiiski Blvd.,1431 Sofia, Bulgaria
e-mail: marianadimova@abv.bg
2176 https://www.journal-imab-bg.org J of IMAB. 2018 Jul-Sep;24(3)