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Continuation….
Space management…By space maintainer….Device used to maintain or regain space following
loss of primary tooth. So as to guide the permanent to erupt in the proper position in the arch
Objective: Preservation of space Integrity of dental arch Normal occlusal plane esthetic
Requirement:do not interfere with the replacing permanent
toothmaintain the entire mesio-distal spacesimple constructionrestore functionprevent over-eruption of opposing toothdo not exert excessive stress on adjoining tootheasily cleansabledoes not restrict normal growth & dev of dental
arch
General consideration;Time elapsed since loss
Before 6 months after tooth loss Insert SM as soon as the tooth is removed
Dental age of the patient Permanent will erupt when 3/4 of root is completed
Amount of bone covering unerupted toothSequence of eruptionDelayed eruption of permanent toothCongenital absence of permanent toothPresentation of problems to the parents
Indication..Closure of space following premature lossIf the space after premature loss of deciduous
teeth shows signs of closing.If the need for treatment of malocclusion at a
later stage is not indicated.When the space for a permanent tooth should be
maintained for two years or longer.To avoid supra – eruption of a tooth from the
opposing arch.To improve the physiology of a child’s masticatory
system and restore dental health optimally.
Contraindication..If the radiograph of extraction region shows that
the succedaneous tooth will erupt soonIf the radiograph of extraction region shows one
third of the root of succedaneous tooth is already calcified
When the space left by prematurely lost primary tooth is greater than the space needed for the permanent successor as indicated radiographically
If the space shows no signs of closingWhen succedaneous tooth is absent
Appliance..Fixed
Band & loopCrown & loopLingual archPalatal archTranspalatalDistal shoeEsthetic antBand & bar
Removable Acrylic partial
dentureFull dentureRemovable distal
shoe
Fixed space maintainer…Fixed or fitted unto the teeth
Advantages:o Band & crown require minimum or no tooth
prepo Do not interfere with passive eruption of
abutment teetho Jaw growth is no hamperedo Permanent teeth are free to erupto Can be used in un-cooperative patiento Masticatory functions is restored
Disadvantages;o Elaborates instrumentation with expert skill is
needed. o They may result in decalcification of tooth
material under the bands. o If pontics are used it can interfere with vertical
eruption of the abutment tooth.
Removable appliance..Used when more than 1 tooth has been lost in a quadrant
The only alternative when there are no suitable abutment teeth
Can replace occlusal function
Advantages: Easy to clean Restore vertical dimension Can be worn part time allowing circulation of the blood to the ST Room can be made for permanent teeth to erupt without
changing app Stimulate eruption Help in preventing dev of tongue thrust habit into the extraction
space
Disadvantages;Lost or brokenUncooperative patient may not wear the appLat jaw growth may be restricted, if clasps are
incorporatedMay cause irritation of the underlying ST
Indication;EstheticAbutment cannot support fixed appCleft palate require obturation of the palatal
defectUnerupted permanent is not going to erupt in
less than 5 month timeDifficult to adapt bandsMultiple loss of primary which require functional
replacement
Contraindication;Lack of patient cooperationAllergic to acrylicEpileptic patient
Acrylic Partial Dentures:Bilateral removable functional passive space
maintainerBilateral removable non-functional Space
maintainer Used successfully in patients who have
undergone multiple extractions. The inclusion of artificial teeth in the denture
restores masticatory function. Clasp can be fabricated on deciduous canines
& molars for retention.
Full or complete dentures:In primary teeth of a pre school child where
extraction is indicated for rampant Caries. These denture restore masticatory function
and esthetics. Guide the first permanent molars into their
correct position. Denture will have to be adjusted and a portion
of it cut away as the permanent incisor erupt.
Removable Distal shoe space maintainer: An ‘immediate’ acrylic partial denture with an
acrylic distal shoe extensionguide the 1st permanent molar into position
when the deciduous second molar is lost shortly before the eruption of the first permanent molar
The tooth to be extracted is cut away from the stone model and a depression is cut into the stone model to allow the fabrication of the acrylic extension.
Band & loop Used to maintain space of a single toothCheapEasy to fabricateDo not restore the occlusal function of the
missing tooth
Indication;Unilateral loss of the primary first molar before
or after the eruption of permanent 1st molarBilateral loss of a primary molar before the
eruption of the permanent incisors
Crown and loopBonding the first primary molar for guidance.used in cases where the second primary
molar is lost before the eruption of the first permanent molar.
Lingual arch
IndicationBilateral loss of primary teeth on the
mandibular arch during transitional dentitionMaintenance of arch perimeter and incisor
positions
contraindicated in primary dentition
Modification of LLA with omega loopsActivation of loop helps flare anteriors with
some distalising of permanent molarsModifies LLA with claps to prevent distal
tipping of lateral incisors
Nance applianceNance(1947) described the ‘preventive lingual
wire’Consist of bands on the upper molars, with
the arch wire extending forward into the vault.
Indicated for loss of multiple primary teeth in the maxillary arch
Acrylic button increased stabilityPrevent tipping and rotation movements of
molarsAcrylic button may cause difficulty in
maintaining hygiene in the rugae area
Transpalatal archPrevent rotation around the lingual root,
prevent loss of space.Indicated for bilateral loss of primary
maxillary molarsHygienicMay not prevent the mesial tipping of teeth
Distal shoeIndication;
Loss of primary 2nd molar before the eruption of the 1st permanent molar
Contraindication; Poor oral hygiene Medically compromised patient
DisadvantagesOver extension causes injury to the permanent
tooth bud i.e. second premolar. if under extended it may allow the molar to tip
into the space or over the band.Prevents complete epithelization of the
extraction socket.
Reference…1. Dentistry for the child and adolescent;
Ralph E. Mc Donald; David R. Avery; eigth edition 2004. Mosby company
2. Gurkreet Singh; Text Book of Orthodontic3. http://bhbodeezy.com/csharp/space-
maintainers/4. http://www.docstoc.com/docs/16933642/
space-maintainers-ppt