Key Engineering Materials ISSN: 1662-9795, Vol. 752, pp 41-45 doi:10.4028/www.scientific.net/KEM.752.41 © 2017 Trans Tech Publications, Switzerland Submitted: 2016-12-21 Revised: 2017-03-21 Accepted: 2017-05-09 Online: 2017-08-28 The Assessment of Acrylic Infantile Overdenture during the Treatment of Anodontia in Children: A Case Study Anca Porumb1,a*, A. Almasi1,b, S. Cavalu1,c, C. Ratiu1,d 1 University of Oradea, Faculty of Medicine and Pharmacy, P-ta 1 Decembrie 10, Oradea, Romania a firstname.lastname@example.org*, email@example.com, firstname.lastname@example.org, d email@example.com Keywords: biomaterials, orthodontic, acrylic infantile overdenture, anodontia. Abstract. Anodontia or dental agenesis in children is difficult to treat, as the child is smaller. The treatment of anodontia is a complex one, it is important to mention that the children’s body is upgrowing and, also, the psychological implications that could appear in children without teeth. The materials used in acrylic infantile overdenture must be non-toxic and shouldn’t have any negative influence in upgrowing children. The base of acrylic infantile overdenture is made of acrylic resin. The aim of the present study is to highlight the changing of regular acrylic infantile overdenture, at the age of 1 and a half, in order to allow the physiological growth of the children’s bones. Introduction As presented in literature, the prosthetic treatment in children is difficult [1,2,3]. It shouldn’t be a fixed one, but only mobile [4,5]. There are many possibilities of orthodontic treatments [6,7,8,9], but infantile overdenture is the best solution . They are made of many kinds of acrylates: self-, baro-, thermo- or photo polymerisables acrylates. The most commonly used in technique laboratory is the manufacturing of the base of the infantile overdenture using baro polymerisable acrylate, using one of the following techniques: the liquid-powder technique (spray technique) or the paste technique . The aim of this paper is to highlight the changing of acrylic regular infantile overdenture at the age of 1 and a half, so we will allow the physiological growth of the children’s bones and we will treat successfully the malfunctions of the mastication, phonation, physiognomy and, also, major mental changes, manifested by severe complex inferiority in social relationships of these children. The base of the infantile overdenture is the element that keeps together all the other components of the device. The base of the infantile overdenture can be palatinal, lingual or bimaxillary . It is made of many kinds of acrylates: self-, baro-, thermo- or photo polymerisables acrylates. Self-polymerisabile acrylic resins have a limited indication due to material quality, having a low degree of polymerization and being porous. These acrylates are duller and thus less elastic. Self polymerisable acrylate is more frequently used for small imprints in dental clinic or in the laboratory to repair some damaged items. Acrylic baro polymerisabile resins have completely revolutionized the technology of manufacturing orthodontic appliances. These materials are widely used in dental technique laboratory. Acrylate is an appropriate one in terms of quality, resulting in high precision devices with a high translucency and superior aesthetics. Using these resins requires a relatively simple technique, does not require the execution of the wax model, the achieving time being reduced. Thermo polymerisable acrylic resins are qualitatively superior, but have the disadvantage of a more laborious procedure that requires prolonged time of appliances achievement. They require the manufacturing of the wax model of the future device, this being packed and the pattern is created. The acrylate is filled in the polymerized pattern, is disassembled and passed to processing and finishing the device obtained. This technique is reserved for special situations. All rights reserved. No part of contents of this paper may be reproduced or transmitted in any form or by any means without the written permission of Trans Tech Publications, www.scientific.net. (#103303193, University of Auckland, Auckland, New Zealand-11/11/17,21:16:37) 42 BiomMedD VII Photo polymerisable acrylic resins consist of an organic matrix and inorganic filler (colloidal silica). The phases of production consist in adapting the plate on the model, followed by photo polymerization. Materials and Methods The most commonly used in dental technique laboratory is the manufacturing of the base of the infantile overdenture using baro polymerisable acrylate. There are two techniques: • The liquid-powder technique (spray technique) that consists of alternative placement, directly on the model of a layer of powder (polymer) and the liquid (monomer). The model is inclined so that the surface the acrylic substance is applied on to be horizontal. The powder is sprinkled, and then the liquid is dripped, alternately, until the desired thickness is achieved, so as to be sufficient liquid, but not in excess. Liquid saturation continues slowly until translucent appearance is slightly opaque. At this point baro polymerization may be used. • The paste technique: In a bowl the appropriate amount of acrylate is prepared by mixing the powder with the liquid. The mixture must be saturated in liquid, so when it starts to ”pull in wires” it is spread with the spatula on the surface of the model. Care should be taken in difficult areas such as those under the retention of wire elements or the lateral bolt sides so that no air gaps remain, therefore, in these areas, the material can be applied by spray technique. The last stage consists in shaping the acrylate with an excess of liquid, then the base plate can be polymerized. Baro polymerization consists of introducing the model in a pressure vessel at a temperature of 40 degrees Celsius and a pressure of 2.1 to 2.5 atmospheres, for 20-30 minutes. The advantage of this technique is to obtain a more compact structure, of a higher quality. The base of the infantile overdenture is extended only on the palate, closely following its morphology, enters the interdental triangles, below the point of contact, increasing the stability of the device. Previously, the plate is extended on the palatinal faces of the teeth up close to the incisal edge. Distal, the base plate extends up to a line that connects the distal faces of the first permanent molars, but sometimes it can be modified up to a line that unites the mesial faces of the first premolar or first temporary molar. Vertically, the base covers the oral faces of the teeth up close to their occlusal surface. The base of the mandibular infantile overdenture is in intimate contact with the alveolar upstand, following gingival crest until the last molar. It extends until the bottom paralingual bag. Previously it modifies in order to allow the movements of the tongue not to cause decubital injury to the oral cavity palate. If all of the steps of production technology were respected, in the end it is obtained an infantile overdenture which has the following roles: it must be resistant, but should not exceed 2-3 mm thickness to ensure the patient's comfort, the edges should be slightly thickened in order not to cause decubital damage, if there are edentulous spaces, the plate will cover these areas, having also a role of space maintainer, the mucosal face is in intimate contact with the mucous of the maxillary area, the oral face should be smooth and shiny. Modern acrylates allow better plate aesthetics, getting a variety of different colors and color combinations, as well as the introduction in the base plate of stickers (stars, figurines, glitter) depending on the patient's preferences. The base plate can be sectioned into two or more fragments. At the upper jaw, it can be sectioned in sagittal plane, on the midline or asymmetrical, or can be sectioned in ”L”, ”Y”, “trapeze” or “sectorial”. At the lower jaw, sectioning the plate can be done on the midline or Para median, unilaterally or bilaterally. Sectioning the plate is done with a metal disk type Horico, with a thin cylindrical cutter or a saw with a narrow strip. The sectioned fragments can be joined with one or more springs or orthodontic screws. Prosthetic treatment in total and subtotal anodontia involves similar aspects to edentations of large amplitude, except that we are talking about an organism in growing period and the prosthetic Key Engineering Materials Vol. 752 43 field is very unfavorable in terms of maintenance and denture stability and transmission of forces. Prosthetic treatment goals are getting a masticatory efficiency to ensure the child feeding in good conditions and obtaining a vertical dimension and of a lower floor profile that improves the appearance, these children having a clinical aspect of ”old man”. So infantile dentures will have to be changed periodically in order not to stop the jaw development and to allow the physiological development of the child patient's jaw bone, the best period for changing being every one and a half years. It is recommended creating an artificial paradentium, by introducing a layer of acrylic between teeth and denture base, on the mucosal face of the infant overdenture (total lining). Infantile overdenture will be anchored through orthodontic hooks. These infantile overdentures are quickly and easily assimilated by children [12,13]. An edentation in the front area, both in temporary dentition as well as in the permanent one, involves malfunctions of the main functions of the maxillary: mastication, phonation, physiognomy and, also, major mental changes, manifested by severe inferiority complex in social relationships, even psycho neurotic syndromes against a background of labile nervous system. Considering all exposed disorders, the treatment of these cases has to be of an urgent nature [12,13,14,15]. Experimental Results A girl with the age of 8 came into the dentistry office because of physiognomic disturbances, both of smiling and talking, observed by her mother. Endo oral we can see, that in addition to many odontal problems, a parodontal trauma at 3.2; we, also, can notice both temporary and permanent teeth, a late appearance of several permanent teeth at the age when they supposed to be erupted. Fig. 1 Exo oral aspect of the clinical case: face and profile Fig. 2 Endo oral aspect of the clinical case: front occlusion and half profile occlusion left-right Orthopantomography shows us the absence of: 1.2. 2.2, 3.1, 4.1. The orthodontic diagnosis was agenesis of 1.2. 2.2, 3.1, 4.1. Different diagnosis was given with extraction (through anamnesis) and with inclusion (through dental radiography). We take into consideration the position of the apex at teeth 3.2 and 4.2 . We started with pedodontic treatment of all cavities and oversee the process of eruption of permanent teeth. The aims of orthodontic treatment are, in upper jaw: closure of the space between the 2 central incisors, keeping the space for the lateral incisors up to 18 years old when she will receive an implant and the maintenance of the results. In lower jaw, the orthodontic aims are: extraction of lateral temporary incisor and closure the front space through mesial migrations of lateral teeth. 44 BiomMedD VII Fig. 3 Orthopantomography of the clinical case We made an infantile overdenture from acrylic baro polymerisabile resins, anchored with hooks on 1.6 and 2.6 and with 2 palatal arches, distal of 1.1and 2.1, in order to close the space. Fig. 4 First infantile overdenture and their positioning inside the mouth We will change it in about one year and a half, in order to allow the growth of upper maxillary. After the space between 11 and 21 will be closed, the next infantile denture will be providing with 2 acrylic elements. Fig. 5 Second infantile overdenture, with 2 acrylic teeth and their positioning inside the mouth Conclusions The present study underlines the major role of changing the regular acrylic infantile overdenture, during the treatment of anodontia in children, at 1 year and a half, so we will allow the physiological growth of the children’s bones and successfully treat the malfunctions of the mastication. Taking into consideration the existent malposition at this 8-years-girl, we can refer to different treatment concepts: in upper jaw treatment was to restore the neighbor teeth axes as a preimplant measure and in lower jaw was to close the space. A team work in this rare case between pedodontist, orthodontic and the dental technique laboratory offered us the perfect solution and taking the necessary measure at the right moment. 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