Space Maintenance Group 3

Dzhulhiyana Laili .T.

Devi Sarfina

Mirsa Herdiani

Handbook of clinical techniques in pediatric dentistryHandbook of clinical techniques in pediatric dentistry

SPACE MAINTENANCE

- Space maintenance may be necessary after premature tooth loss in the primary and mixed dentition to preserve arch length, width, and perimeter

- Space loss is considered to be one of the major contributors to malocclusion in the permanent dentition.along with ectopic eruptionor impaction of premolars

Sequence of eruption

In the mandible : - permanent molars erupt first - lateral incisors, - canines, - first premolars - second premolars

In the maxilla : - permanent molars - central incisors - lateral incisors - first premolars - second - canines

Dental age

Dental age and chronological age may differ. Typically,the permanent first molar erupts at the age of 5–7years, and mandibular incisors erupt at the age of 6–7years, but if eruption does not occur until the age of 8or 9 years, the child is dentally delayed.

Alveolar bone covering permanent successor

The amount of alveolar bone covering the permanentsuccessor should also be considered. which can be determined with a bitewing or periapical radiograph

Root development of permanent successorRoot length of the permanent successor should be evaluated. Premolars typically erupt when one-half to three-fourths of the root has formed If the primary molar is extracted due to an abscess, the permanent successor may erupt more rapidly than expected with less root formation.

Time elapsed since loss of primary tooth

Space maintainers should be inserted within a fewweeks after an extraction. Space loss usually occurswithin 6 months after premature loss of a primary molar.Space loss typically occurs more rapidly in the maxilla than in the mandible

Space maintenance appliances

The band and loop or crown and loop are used for premature loss of a maxillary or mandibular first primary molar. For premature loss of a second primary molar,the Nance or transpalatal arch appliances are used inthe maxillary arch and the lower lingual holding arch(passive lingual arch) are used in the mandible

Problems with space maintainers

If the primary molar banded for the appliance exfoliates, a second appliance may be indicated to maintain spacefor a second premolar. Fixed appliances may increasethe incidence of caries on the banded molar or adjacentteeth in children with high-caries risk

Lingual arch wire interfering with eruption of mandibular second premolar.

Primary incisors

After eruption of the primary canines, premature lossof one or more primary incisors due to trauma or cariesresults in negligible space loss. Space maintenance is necessary only for aesthetic concerns or parental desireA fixed partial denture can be fabricated for both the maxilla and mandible with one or more denture teeth

First premary molar

For premature loss of a first primary molar in the maxilla or mandible, the second primary molar is banded, and the loop extends mesially to the distal of the primary canine (Figures 16.4 and 16.5).

Second primary molar

If the first permanent molar is fully erupted, it is banded and the appliance is fabricated with a loop extending to the distal of the first primary molar or the first primary molar is banded with the loop extending distally to mesial of the first permanent molar

Band and Loop

Indication : Unilateral loss of the

primary first molar before or after the eruption of permanent first molar .

Bilateral loss of a primary molar before the eruption of the permanent incicors.

A 0.036-in. round wire is used to make a loop that extends to the abutment tooth.

Band and LoopConstruction

Band: stainless steel material 0.005 inches in thickness

Crib: portion of the wire spanning the edentulous space

Loop: portion of the wire contacting the abutting tooth 0.032 inches in diameter

Transpalatal arch/palatal arch bar

Indication : Prevents mesial tipping

of the first permanent molar.

Reducing the tendency of the maxillary first permanent molar to rotate around its palatal root causing space loss.

Some design incorporate omega loop: when active can prevent bodily movement of molars .

Nance appliance

Indication : for unilateral or bilateral

loss of maxillary second primary molars.

Acrylic button increased stability

Acrylic button may cause difficulity in maintaining hygiene in rugae area

Lower lingual holding arch/passivelingual arch

Indication : for bilateral loss of the

mandibular second primary molars after eruption of the permanent mandibular incisors to avoid interference with their eruptionA 0.036- or 0.040-in. round wire is soldered to the lingual surface of the molar bands.

Mandibular central incisor erupting in lingual position and lingual arch wire impeding eruption.

Lingual arch wire delivered 3 weeks later after spontaneous correction in arch of mandibularcentral incisor.

Distal Shoe

Indication : Loss of primary second

molar before the eruption of the first permanent molar.

A periapical radiograph is necessary to determine the position of the developing first permanent molar

Banding and Impression for Appliance Fabrication

Stainless steel bands, a band remover and a bite stick to seat the bands are required for fitting molar bands.

Impression material should be fast setting. Filling one-half of the tray with impression

material or using a half-tray facilitates obtaining the impression for a band and loop space

maintainer.

If the patient has a gag reflex, suggest that the he or she press a foot into the chair with a bent knee, while the impression is being taken.

The band remover is used to remove the band from the buccal and palatal sides after taking the impression.

Chairside Fabrication

Immediate repair or replacement of the appliance is possible, and performing fabrication at the time of the extraction eliminates laboratory fees and space loss with possible delay in delivery due to no show or cancellation.

After appliance delivery

Space maintenance requires supervision and parental/ guardian compliance.

Video

Thank You