appliances in pediatric dentistry

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  • 1.A. VAMSI KRISHNA I M D S

2. Space maintainers Habit breaking appliances Removable appliances Myofunctional appliances Orthopaedic appliances Conclusion References 3. SPACE MAINTAINERS 4. This term was coined by JC Brauer in 1941. It is defined as the process of maintaining a space in a given arch previously occupied by a tooth or a group of teeth Boucher: it is a fixed or removable appliance designed to preserve the space created by the premature loss of a primary tooth or a group of teeth 5. If a child loses a primary tooth early through decay or injury, the child's other teeth could shift and begin to fill the vacant space. When the child's permanent teeth emerge, there's not enough room for them. The result is crooked or crowded teeth and difficulties with chewing or speaking. 6. This is a ideal case where a space maintainer would have helped 7. 1. If the space shows signs of closing. 2. If the use of space maintainer will make the future orthodontics less complicated. 3. If the need for treatment of malocclusion at a later date is not indicated. 8. 4. When the space should be maintained for two year or more. 5. To avoid supra eruption of opposing tooth. 6. To improve the masticatory system and restore dental health. 9. 1. If the radiograph shows that the succedant tooth will erupt soon. 2. When the space left is greater than the needed for the permanent as indicated from radiographically. 3. If the space shows no signs of closing. 4. When the succedenous tooth is congenitally absent. 10. It should maintain the entire space created by the tooth It must restore function Prevent supraeruption of opposing tooth It should be simple in construction 11. It should be strong enough to withstand occlusal forces Should permit maintenance of oral hygiene Must not restrict the growth of jaws It should not exert undue forces of its own 12. CLASSIFICATION OF SPACE MAINTAINERS 13. BAND & LOOP CROWN & LOOP LINGUAL ARCH HOLDING DEVICE NANCES PALATAL HOLDING DEVICE TRANS PALTAL DISTAL SHOE REMOVABLE SPACE MAINTAINER 14. Missing Tooth Treatment Treatment Unilateral loss of primary 1st molar Band / crown and loop Band/crown and loop Unilateral loss of primary 2nd molar No treatment until eruption of 1st permanent molar, later transpalatal arch Distal shoe until eruption of 1st permanent molars and permanent incisors, then lower lingual holding arch Bilateral loss of primary 1st molars Bilateral bands/crowns and loops. Bilateral bands/crowns and loop Bilateral loss of primary 2nd molars No treatment until eruption of 1st permanent molars, later Nance palatal arch. Bilateral distal shoes until eruption of 1st permanent molars and incisors, then lingual arch Multiple bilateral primary molars loss Saddle appliance until 1st permanent molars are erupted, later Nance. Saddle appliance until 1s permanent molars and incisors are erupted, later lingual arch. 15. Missing Tooth Treatment Treatment Unilateral loss of primary 1st molar No treatment unless leeway space is to be preserved No treatment unless leeway space is to be preserved Unilateral loss of primary 2nd molar Transpalatal Band and loop until eruption of permanent incisors, then lower lingual holding arch Bilateral loss of primary 1st molars No treatment unless leeway space is to be preserved No treatment unless leeway space is to be preserved Bilateral loss of primary 2nd molars Nance Bilateral bands and loops until eruption of permanent incisors, then lower lingual arch Multiple bilateral primary molars loss Nance Saddle appliance until eruption of permanent incisors, then lower lingual holding arch 16. Missing Tooth Treatment Treatment Unilateral loss of primary 1st molar No treatment unless leeway space is to be preserved No treatment unless leeway space is to be preserved Unilateral loss of primary 2nd molar Transpalatal Lower lingual holding arch Bilateral loss of primary 1st molars No treatment unless leeway space is to be preserved No treatment unless leeway space is to be preserved Bilateral loss of primary 2nd molars Nance Lower lingual holding arch Multiple bilateral primary molars loss Nance Lower lingual holding arch 17. They are unilateral, fixed, nonfunctional and passive Used when single tooth is missing in the posterior segment. Can also be given in bilateral posterior tooth loss 18. Indication: 1. Premature loss of one tooth. Contraindication: 1. Long span. 2. Space lost 3. Severe malocclusion. 4. Abutment tooth mobile 19. Advantages: 1. Simple and easy constructed. 2. Moderate chair time. 3. Give room for erupting permanent tooth. 4. Easy to clean. 5. Inexpensive. Disadvantages: 1. Not restore the function. 2. Not prevent the extrusion of opposing tooth. 3. Has to be replaced if the tooth anterior to space exfoliated. 20. Design It consists of a band fabricated from 0.005 steel band and a loop that extends from the band to the distal surface of the anterior abutment tooth. Loop is placed 1mm from the gingival surface. Construction Band two types- Preformed, Custom made 21. Custom made bands are made by taking the required amount of band material from the spool and pinching them to form the band. Fabricated using various pliers- Beak pliers, band adaptor and hows plier. Band pinching Festooning Trimming Folded flap method 22. Band is adapted on to the tooth Impression of the arch Cast is obtained with the band secure on the tooth Loop is prepared with 0.9 mm hard round stainless steel wire. Loop soldered to the band Cemented to the tooth 23. Modifications Loop made only on one side Occlusal rest Occlusal stop Crown loop Reverse 24. Controversy: Recently a study has shown that space changes with regard to arch width or arch perimeter 6 months following premature loss of a primary maxillary first molar was minimal. The early space changes in the maxillary dental arch consist mainly of palatal migration of the maxillary incisors indicating that the mesial movement of permanent molars might not occur as a consequence of the tooth extraction. There was statistically significant 1 mm of space loss detected; however, it is not likely to be of enough clinical significance for the use of a space maintainer. If palatal movement seems to be needed, a palatal arch was suggested instead of band and loop space maintainer. JADA 2007 vol 138:362-8 25. Lingual arch space maintainer Bilateral, fixed or semifixed, nonfunctional passive Indications 1. Bilateral loss of primary first or second molars after the eruption of permanent mandibular incisors, 2. If there is multiple loss of primary teeth. 3. In late mixed dentition stage, may be used to hold leeway space to allow sufficient space for permanent canines & premolars to erupt or to preserve space for later alignment of crowded incisors. 26. Advantages: Used with uncooperative patient. Used in children with bad oral hygiene. Can maintain the space through period of mixed dentition. Preserve the integrity of the whole arch. There is no breakage problem or retention problem. It allows free individual movement of teeth while maintaining space. It is easily removed, adjusted and replaced. Disadvantages: Not restore masticatory function. Not prevent over eruption of opposing teeth. 27. Construction The wire should be made to contact the cingula of the mandibular incisors In the edentulous ridge region wire curved down to the lingual 1 mm away from the soft tissue Should maintain 3-4 mm contact with the lingual surface of the band Konstantinos et al (1998) have suggested that in the canine region 2 omega bends need to be given ??? 28. Bilateral, fixed, passive and nonfunctional space maintainer Indicated when there is bilateral missing deciduous molars in the upper arch The first permanent molars are banded The arch wire extends from the palatal surface of one molar band to the other, anteriorly it extends upto the rugae area and is embedded in an acrylic button. 29. Can be made active- The acrylic button may irritate 30. Bilateral, fixed, passive and nonfunctional Used when there is unilateral loss deciduous molars The first permanent molars are banded The wire component extends from the palatal aspects of the bands to cross.. It prevents the mesiolingual rotation of the molars around.. It can be used in bilateral loss of posterior teeth !!! PEDIATRIC DENTISTRY V 29 / NO 3 MAY / JUNE 2007 31. Early version of distal shoe Willets distal shoe Present version Roches modified distal shoe appliance Unilateral, fixed, nonfunctional and passive An intraalveolar appliance INDICATION The distal shoe appliance is used to maintain the space of a primary second molar that has been lost before the eruption of the permanent first molar. The result of this mesial drift is loss of arch length and possible impaction of the second premolar 32. Contraindication: 1. Medically compromised pt. (because no complete epithelization around alveolare bone) lead to (subacute bact endocarditis). 2. Poor oral hygiene. 3. Long span. 4. Damaged abutment. 33. Construction The crown/band is adapted on the first deciduous molar and impression is taken An IOPA is taken.. On the cast position of the mesial surface of the first permanent molar is marked, then V shaped notch is made Loop is fabricated 34. Loop is soldered to the crown, appliance is sterilized.. Extract the tooth just before cementation.. Appliance tried in patients mouth and IOPA taken to confirm Final cementation. 35. REMOVABLE SPACE MAINTAINERS a. Non-functional types b. Functional types 36. It is like a removable partial denture, Not only Mesiodistal space but also the vertical space is maintained. Masticatory Function is restored in functional type Esthetics & speech improvement 37. removable unilateral space maintainers They are too small and present swallowing and choking dangers for children. 38. The esthetic and hygienic EZretainer maintains the mesiodistal dimension of an extraction space and c