International Journal of Medical and Dental Case Reports (2015), Article ID 020615, 2 Pages

CASE REPORT

Avulsion of primary tooth-modified Essix retainer as a

space maintainer
H. A. Amitha1, T. Sunil2, Nisarga Kansar1, B. S. Kavyashree1, M. Kavitha1
1
Department of Pediatric and Preventive Dentistry, V.S Dental College, Bengaluru, Karnataka, India, 2Department of Orthodontics, V.S Dental College, Bengaluru,
Karnataka, India

Correspondence
Dr.H. A. Amitha, Department of Pediatric
and Preventive Dentistry, V.S Dental College,
Bengaluru, Karnataka, India.
Email: amithaprasanna@yahoo.in
Received 12 May 2015;
Accepted 21 June 2015
Abstract
Children who present with loss of anterior teeth due to trauma or caries pose a dicult
clinical problem. Traumatic injuries intend to be intensely assessed and managed. Rapid
restoration of the avulsed tooth is of prime significance to enhance esthetics as well as to
keep up the structure, function and form, and prevent any psychological trauma to the
children. A modified Essix retainer, simply constructed in the laboratory, can be used to
provisionally restore the primary anterior tooth lost due to avulsion or caries.

doi: 10.15713/ins.ijmdcr.28 Keywords: Avulsion, children, Essix retainer

How to cite the article:

Amitha HA, Sunil T, Kansar N, KavyashreeBS,
Kavitha M. Avulsion of primary tooth-
modified Essix retainer as a space maintainer.
Int J Med Dent Case Rep 2015:1-2.

Introduction A rare case of managing an avulsed tooth using a

Essix retainers were introduced as an esthetic, comfortable,
and inexpensive alternative to traditional bonded retainers and
removable appliances.[1] Sheridan was the first to describe the Essix
orthodontic retainer in 1993 and subsequently its use to provide a
provisional restoration. Some concern was raised regarding original
design, which only covered from canine to canine as a slight increase
in open bite was observed. Extending the retainer to cover all
occlusal surfaces has been recommended to prevent this.[2] Giving a
quick, esthetic, retentive, and agreeable replacement for avulsed or
grossly decayed or fractured deciduous teeth can be an ultimatum
in a restricted time period. Guaranteeing a substitution is accessible
promptly after extraction obliges arranging and contact with lab
support. This restoration is generally an interim restoration so is
ideally inexpensive. This technique gives a biological preference
during healing and providing almost a quick and economical
substitution of the extracted tooth. The restoration is independent
of the soft tissues and entirely tooth-borne, hence the retainer may
be worn during the healing stage when the bone and soft tissues are
remodeling, without loading the area and also it does not a ect the
growth of maxilla or mandible. This device is also easily removed
thus facilitating hygien[3]. There is no reduction in retention as
the supporting tissues remodel, negating the need for relining the
prosthesis.
thermoplastic orthodontic retainer as a provisional restoration
is presented.
Case Report
A 2 old boy was reported to the Department of Pediatric
and Preventive Dentistry V. S. Dental College, Bengaluru
with a history of avulsed upper anterior tooth 1-week ago
[Figure 1]. Intraoral periapical radiograph was taken to
confirm the missing tooth. Detailed medical and dental
history was taken and there was no significant medical and
dental history.
Based on the low level of evidence to support the procedure
and on the risk-benefit assessment of the outcomes, it is not
advisable to reimplant a deciduous tooth.[4] Hence, a modified
Essix retainer was fabricated to act a provisional restoration for
the avulsed 61 in the present case.
The following procedure was followed for the construction of
the modified Essix retainer.
An Alginate impression of the maxillary arch was made, and
the impression was poured with die stone. After the stone was
set, acrylic teeth were trimmed and secured onto the edentulous
space. A sheet of polypropylene (0.75 mm thick) was placed in
the frame of the vacuum forming machine.

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Amitha, et al.
Once it is adequately heated, the heater was turned o,
and the vacuum was turned on. Simultaneously, the heated
polypropylene sheet was lowered over the cast and allowed to
cool completely under vacuum for the maximum adaptation
of the material to the tooth portion of the cast [Figure 2]. The
retainer was trimmed using acrylic to eliminate sharp edges and
scallop the retainer to follow the gingival margins. The tissue
surface of the retainer was smooth and ideally convex to make
it cleansable. The retainer was fitted on the maxillary arch of
the patient [Figure 3]. Patient was made aware of the short-
term nature of this restoration and the need for meticulous oral
hygiene.
Figure 1: Clinical and radiographic image of missing 61 due to
avulsion
Figure 2: Modified Essix retainer on cast
Figure 3: Modified Essix retainer delivered
Modified Essix retainer for avulsion
Discussion
Traumatic dental injuries are frequent during childhood with a
frequency that varies from 4% to 30%. The most frequent types
of dental traumas in primary teeth are avulsion. The maxillary
teeth in both primary and permanent are most aected by
trauma, especially the central incisors due to its position.[5]
The management of avulsion in deciduous teeth is a clinical
challenge. Initially, it is necessary to provide emergency
treatment, but definitive cosmetic treatment must often be
delayed. The modified Essix retainer is an esthetic, cost-eective,
and ecient means of providing a provisional temporary
restoration during this period. It is a comfortable appliance to
wear and readily accepted by the patient. Some disadvantages of
the modified Essix retainer have been noted. It is a removable
restoration, and plaque retention and gingivitis can develop in
the presence of poor oral hygiene. The importance of good oral
hygiene must be stressed to the patient when a modified Essix
retainer is fitted.[6]
Dierent treatment alternatives have been recommended
to replace the loss of primary anterior teeth because of injury
or dental caries. This includes removable space maintainers,
bonded space maintainers using Ribbond or no treatment at all.
The choice of treatment depends upon various factors, which
include the age, cooperation level of the children, and demand for
esthetics. Considering the lack of cooperation and compliance
by children in the preschool age group, in this case, the modified
Essix retainer was considered as the treatment of choice.
Conclusion
This technique can be utilized as a quick short-term solution
after the loss of teeth due to injury or caries. Long-term use is not
advisable in patient with poor oral hygiene. This appliance can
be eortlessly evacuated to encourage in maintaining hygiene,
it is accessible very quickly, is cheap, comfortable to wear,
conservative of abutment teeth.
References
1. Lindauer SJ, Shoff RC. Comparison of Essix and Hawley
retainers. JClin Orthod 1998;32:95-7.
2. Sheridan JJ, LeDoux W, McMinn R. Essix retainers: Fabrication
and supervision for permanent retention. J Clin Orthod
1993;27:37-45.
3. Sheridan JJ, Ledoux W, McMinn R. Essix technology for the
fabrication of temporary anterior bridges. J Clin Orthod
1994;28:482-6.
4. Zamon EL, Kenny DJ. Replantation of avulsed primary incisors:
A risk benefit assessment. JCan Dent Assoc 2001;67:386.
5. Lenzi MM, Jacomo DR, Carvalho V, Campos V. Avulsion of
primary teeth and sequelae on the permanent successors.
longitudinal study. Br J Dent Traumatol 2011;2:80-4.
6. Blake M, Garvey MT, Fleming P. The use of an orthodontic
thermoplastic retainer as a provisional anterior restoration:
Acase report. Quintessence Int 1998;29:123-6.