Notes

Outline

Space Management in the Primary Dentition S.Lal, DDS

Space Maintainers “ A space maintainer is an intra-oral appliance used to preserve arch length following the premature loss of primary teeth/tooth.” This allows the permanent teeth to erupt unhindered into proper alignment and occlusion. A space maintainer is recommended after the untimely loss of a primary tooth.

Failure to maintain space results in Malocclusion Drifting / tipping of teeth Loss of arch length Midline shift Crowding of permanent teeth Impactions Orthodontic intervention including extractions

Types of Space maintainers: Unilateral vs Bilateral Anterior vs posterior Fixed vs Removable

Basic concepts…. Space closure occurs during the first 6 months after extraction. It is best to insert the appliance as soon as possible following the exttraction. Loss of space occurs primarily due to a tipping movement of teeth (mesially or distally). In the maxillary molar region, space loss occurs due to rotation (mesial-in) in conjunction with mesial tipping. Erupting premolars usually require 4-5 months to move through 1mm of bone as measured on a BWXR.

Space Management Space loss occuring from mesial tipping of primary second molar secondary to proximal caries

Space Management Space closure from an untimely loss of a maxillary primary first molar

Space management Impacted maxillary premolar due to space loss

Band and Loop Indication: Unilateral or bilateral loss of a primary molar.

Crown and Loop Restores a grossly decayed abutment tooth. Removal of appliance for adjustments is difficult.

Space Management The role of Chronological age and Dental age when considering space maintainance.

Distal Shoe space maintainer Indication: Loss of a primary second molar before the eruption of the first permanent molar. Contraindications: Poor oral hygeine Medically compromised pt.

Transpalatal Bar Indicated for bilateral loss of primary maxillary molars. Hygenic May not prevent the mesial tipping of teeth

Nance Appliance Indicated for loss of multiple primary teeth (bilaterally)in the maxillary arch. Acryllic button provides increased stability. Appliance  prevents tipping and rotation movt of molars. Acryllic button may cause difficulty in maintaining hygiene in the rugae area.

Lower Lingual Arch Indications: Bilateral loss of primary teeth in the mandibular arch during transitional dentition. Maintainace of arch perimeter and incisor positions. Contraindicated in primary dentition.

Lower Lingual Arch Modification of LLA with omega loops. Activation of loops help flare anteriors with some distalising of permanent molars.

Lower Lingual Arch Modified LLA with clasps to prevent distal tipping of lateral incisors.

Removable Space Maintainers Indications: Loss of multiple teeth bilaterally (anterior and/or posterior) In the absence of abutment teeth.   The acryllic resin or modified Hawley space maintainers restore esthetic, function and prevent supereruption of opposing teeth.

Fabrication of a Space Maintainer Selection of molar bands. Trial and error leading to a snug fit. # indicates mesial surface.

Fabrication of a Space Maintainer Seat band 1mm below marginal ridges with the aid of a band seater. Adapt bands to the contours of the tooth. Separators may be needed for tight contacts.

Fabrication of a Space Maintainer Take alginate impressions with the bands in the pts. mouth Remove and place bands onto the impression. Stablize bands with wire/paperclips. Pour the models with plaster and send to the lab with order form.

Space Management for the anterior region

Space Regaining Modified Band and Loop with spring coils.

Space Regaining Removable space regainer with jack-screw.

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