SHORT COMMUNICATION |
https://doi.org/10.5005/jp-journals-10005-2717 |
Three-dimensional Printed Esthetic Innovative Space Maintainer for Children with ADHD: Short Communication
1,2Department of Pedodontics & Preventive Dentistry, Dr DY Patil Dental College & Hospital, Dr DY Patil Vidyapeeth (Deemed to be University), Pimpri, Maharashtra, India
3Dr Sawarkar Dental Clinic & Implant Center, Pune, Maharashtra, India
Corresponding Author: Sunnypriyatham Tirupathi, Department of Pedodontics & Preventive Dentistry, Dr DY Patil Dental College & Hospital, Dr DY Patil Vidyapeeth (Deemed to be University), Pimpri, Maharashtra, India e-mail: dr.priyatham@gmail.com
ABSTRACT
This current clinical technique describes the case report regarding single-visit fabrication, three-dimensional (3D) printing, and delivery of space maintainers in two children with severe attention-deficit hyperactivity disorder.
How to cite this article: Rathi N, Tirupathi, Sawarkar S. Three-dimensional Printed Esthetic Innovative Space Maintainer for Children with ADHD: Short Communication. Int J Clin Pediatr Dent 2023;16(6):908–910.
Source of support: Nil
Conflict of interest: None
Keywords: Attention-deficit hyperactivity disorder, Children, Single visit, Space maintainer, Three-dimensional printing
Attention-deficit hyperactivity disorder (ADHD) is a prevalent mental health condition marked by an extremely limited ability to focus, impulsive behavior, and resultant problematic conduct.1 Children with ADHD are prone to injury and recurrent dental trauma. The behavioral difficulties, cognitive impairments, and fleeting focus present obstacles for the dental care team. Successfully tending to these children necessitates making multiple adjustments in tactics across all stages of prevention and treatment.2 Primary teeth with a proper mesiodistal diameter serve as the best space maintainers, but in the clinical scenarios where premature extraction cannot be circumvented due to deep caries and extensive crown damage, space maintainers are deemed to be essential.3 Band and loop is one of the most commonly used space maintainers indicated in the scenarios where there is unilateral tooth loss or in bilateral tooth loss scenarios where lingual/palatal arch is not indicated. Conventional band and loop is a multistep and multivisit process that involves adapting and trimming the band, band pinching, impression making, transfer of band material onto impression, stabilizing the band onto impression, duplicating cast and soldering the loop, and further in the second visit transferring the final band and loop intraorally.4 The main disadvantages of this conventional space maintenance are the time and tedious workflow process, and moreover, it requires cooperation from the child patient. Failure can occur at any stage, such as improper band pinching, improper welding, and/or solder joints.5 This current report space management was done in digital technology by taking digital impressions, and a customized three-dimensional (3D) printed band and loop space maintainer was fabricated and delivered to two children with ADHD.
CASE DESCRIPTION
Case 1
A 6-year-old boy with prediagnosed ADHD with a chief complaint of pain and mobility of teeth in the mandibular right first primary molar. Intraoral radiographic evaluation revealed pulp involvement, resorbed roots about two-thirds with furcal radiolucency. Extraction was planned for the patient. The child was not able to cooperate, and the parents were not willing to get the treatment under general anesthesia. Extraction was carried out in the first appointment under the papoose board. Direct digital space maintainer was planned and delivered in the second appointment.
Case 2
A 5-year-old girl with prediagnosed ADHD with a chief complaint of grossly decayed right first mandibular primary molar. The root status was similar to that mentioned in case 1. Extraction was planned for the patient. As the parents were not willing to undergo general anesthesia, a direct digital space maintainer was planned and delivered in the second appointment.
Direct Digital Impression and Design and Fabrication of Band and Loop
A direct digital impression of the child was performed using an intraoral 3D Medit scanner (Medit T500, Medit Corp, Seongbukgu, South Korea) (Fig. 1). Designing of the band and loop was accomplished using exocad, the dental CAD 2.2 Valletta (Exocad GmbH, Darmstadt, Germany) (Figs 2 and 3). The 3D designed space maintainer was printed using titanium–gadolinium-based alloy powder (Ti64 Gd23; LPW Technology Limited, Cheshire, United Kingdom) (Figs 4 and 5). The printed band and loop were powder coated with the opaquer, and then firing was performed to make the band and loop more esthetic (Figs 4 and 5). The printed space maintainer was checked in the patient’s mouth, and occlusion was verified. Further permanent cementation was carried out using glass ionomer cement (Type 1, GC, Fuji, Tokyo, Japan) (Figs 6 and 7). The child’s parents were instructed not to avoid consumption of food and liquids for 30 minutes. Follow-up was performed after 6 months.
Fig. 1: Intraoral scanned images
Fig. 2: Digital planning of space maintainer (case 1)
Fig. 3: Digital planning of space maintainer (case 2)
Fig. 4: Three-dimensional (3D) printed space maintainer (case 1)
Fig. 5: Three-dimensional (3D) printed space maintainer (case 2)
Fig. 6: Intraoral delivery of 3D printed space maintainer (case 1)
Fig. 7: Intraoral delivery of 3D printed space maintainer (case 2)
DISCUSSION
The present design of the space maintainer offers a multitude of advantages over the conventional space maintainer and eludes the steps of pinching and transferring the band on the impression. The usage of an intraoral scanner reduces the patient’s gag reflex. The use of 3D printing technology minimizes the time required for laboratory procedures. The main advantage of 3D printing is the band and loop are printed in a single unit, which eliminates the solder joint and hence reduces the fracture of the appliance. Within the limitations of the current case report, we believe that ours is the first case report that presents the 3D direct-printed esthetic space maintainer. Previous cases of 3D printed space maintainers have already been reported in the literature, but they were different in a few aspects. Other authors reported the fabrication of 3D printed space maintainer previously, but this case report was different as it used an indirect impression technique (a physical impression was taken, the cast was scanned, and intraoral direct scanning was not performed), and space maintainer was planned and fabricated.6,7
ORCID
Nilesh Rathi https://orcid.org/0000-0003-0595-5191
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