By,Kavitha Shaji Paul

3rd yr B.D.S

CONTENTSINTRODUCTION

CLASSIFICATION

ADVANTAGES & DISADV.

BANDSTYPES

RECENT ADVANCES

CONCLUSION

GALLERY

INTRODUCTIONSpace maintainers : are defined as

appliances that prevent loss of arch length & which in turns guides the permanent teeth into a correct position in the dental arch

Fixed Space Maintainers: are space maintainers which are fitted onto the teeth.

They can be unilateral or bilateral , functional or non functional , active or passive space maintainers that are designed to be cemented on to the tooth.

CLASSIFICATIONAccording to Hinrichson(1962), CLASS I

CLASS II Non Functional Types

Cantilever Type eg:Bar type,Loop type

eg:distal shoe, Functional Type

Lingual arch type eg:Pontic type,lingual type

ADVANTAGESEasy manipulationJaw growth is not hamperedCan be used in uncooperative patients Masticatory function is restored if pontics

are placedDoes not interfere with passive eruption

of abutment The bands are used without or with

minimum tooth preparation

DISADVANTAGESElaborate instruments with expert skill is

needed Decalcification of tooth under the bands may

occur Increased risk of cariesMay be harmful to the abutment tooth due to

development of torque causing breakageSupra eruption of the opposing tooth may occur

if pontics are used Pontics can interfere with eruption of abutment

& may prevent eruption of succedaneous permanent teeth

BANDSSome bands used in fixed space maintainers are:

Loop band, Tailored band, Preformed Seamless bands etc.

Mostly made of precious metal, chrome alloy etc.REQUIREMENTS:1.Should fit the contour of the tooth as close as

possible & therefore enhance placement of attachment.

2.Material should resist tarnish & deformities3.Cause no occlusal interference 4.Should not impinge the buccal mucosa or tongue

FABRICATION OF BANDS:Selection of band – trial & error procedure and

continues until band can be seated with just finger pressure

Band Pusher is used to seat the band to a nearly ideal position.(finger rest has to be maintained)

Band Biter is used to achieve the final occlusolingual position.

Band is removed using a Band Remover.Band is fixed on to the cast made of the patient.The necessary attachments are then contoured

on to the band.

TYPESI. BAND AND LOOPo It is a unilateral,passive fixed appliance o The tooth distal to the extraction space is

banded & a loop of thick stainless steel wire is soldered to it with its mesial end touching the tooth mesial to the extraction

o The loop is placed 1mm from the gingival surface & it should not be very wide so that it doesn’t interfere with tongue and cheek movements

INDICATIONS & CONTRAINDICATIONS

Indications:1. In bilateral posterior tooth before the eruption of permanent anteriors in the mandible2. Also used when single tooth is missing in the posterior segment.

Contraindications:1. High caries activity2. Marked Space Loss3. More than one adjoining tooth missing

ADVANTAGES AND DISADVANTAGES OF BAND

& LOOPADVANTAGES:

It is economical & construction is simple Takes little chair side time(preformed bands)Can be adjusted to accommodate changing dentition

DISADVANTAGES:Caries check & oral hygiene

maintenance is difficultLoop may slip from the position and impinge on the gingiva ( occlusal rests)

MODIFICATIONS OF BAND AND LOOP

A. CROWN AND LOOP: They are similar to the band & loop

space maintainers in all respects except that a stainless

steel crown is used for the abutment tooth

Crown is used in preference when the

tooth is 1. Highly carious 2. Exhibits marked hypoplasia 3. Pulpotomized

B. REVERSE CROWN AND LOOP:• If the distal abutment tooth cannot

be banded or crowned,a reverse crown &loop

• The mesial abutment tooth is banded or crowned and the loop is extended distally

• This situation usually arises when the distal abutment tooth is not fully erupted

C. BAND AND BAR SPACE MAINTAINERS:

• It is called as crown and bar space maintainer

• Both the abutment teeth are bonded and a bar is placed between them

• Adv : it is sturdier

• Disadv : may interfere with the eruption of the permanent tooth as the bar is positioned on the centre of the ridge

II. LINGUAL ARCH SPACE MAINTAINERMost effective appliance for space maintenance in the lower arch.

It is a bilateral,fixed or semi fixed,non functional,passive space maintainer.

Indicated when there is bilateral loss of molars after eruption of permanent incisors.

Helps in maintaining the archperimeter by preventing both mesial drifting of the molars &lingual collapse of the anterior teeth.

ADVANTAGES & DISADVANTAGES OF LINGUAL

ARCH SPACE MAINTAINERAdvantages

1.Less bulkier than removable sp. Maintainer2.Maintaines space of more than one

succedaneous tooth in the arch.3.It allows free individual movement of teeth while

maintaining space in the desired areas.

Disadvantages:1.Arch wire may become embedded in the soft

tissue.2.Wire maybe distorted by masticatory forces.

MODIFICATIONSA. SEMI FIXED OR FIXED REMOVABLE TYPE OF

LINGUAL ARCH• It’s similar to the fixed lingual arch,except that

the wire is not soldered on to the lingual aspect of molars.

• Tubes are welded on to the bands into which the lingual arch wire fits.

• If there’s no deep bite, it can be given on the maxillary arch.

A U-Loop can be incorporated in the arch wire to make it active,which aids in distalising the molars and in proclination.

Spurs can be added to the arch at the distal end of canine to prevent distal collapse of the canine.

III. NANCE PALATAL ARCHIt is a maxillary lingual arch that does not connect

the anterior teeth.It’s a bilateral,fixed,passive,non-Functional space

maintainer.The first molars are banded and an arched wire

extends from the palatal surface of one molar band to the other.

Anteriorly, it extends upto the rughae area and is embedded in an acrylic button.

Indications: Used in maintaining the position of maxillary

1st molar when there’s premature bilateral loss of primary teeth, with no loss of arch space and a favorable mixed dentition analysis.

Advantage:If premature loss is combined with oral

habits like tongue thrusting, it is used to break the habit by incorporation of spurs in the acrylic button.

Disadvantages:The acrylic button can cause soft

tissue irritation & can get embedded in the tissue if the palatal tissue hypertrophies or if the appliance is distorted.

D. BONDED SPACE MAINTAINER :• In this design,no band is placed• A loop that is bonded with resin on the

buccal and lingual surfaces of both the abutment tooth

• The wire passes from one abutment to the other crossing the alveolar ridge.

• Adv: 1.Economical & Simple construction 2.Takes little chair-side time

(Preformed bands) 3.Can be adjusted to accommodate

changing dentition.

IV. TRANSPALATAL ARCH

It is a bilateral,fixed,passive , nonfunctional space maintainer.

it is best indicated when one side of the arch is intact and several teeth are missing on the other side

The molars (permanent)are banded and the arch wire extends from the palatal aspect of the band to cross the midline transversely at right angles to the mid palatine raphe.

It prevents the mesiolingual rotation of the permanent molar around the palatal root and prevents mesial movement of molars.

V. DISTAL SHOE APPLIANCE:Also called intra alveolar appliance.It a unilateral,fixed,non-functional

and passsive space maintainer.It consists of a metal crown and a

horizontal arm,which extends into the alveolus.

The arm maintains leeway space for the second premolar and guides the eruption of perm 1st molar.

It requires regular follow-up.

INDICATIONS & CONTRAINDICATIONSIndications:

1.When there’s premature loss of primary 2nd molar before eruption of perm 1st molar.2.When only one tooth is lost on one quadrant as the strength of the appliance is limited.

Contraindications:1.Multiple missing teeth2.Poor oral hygiene3.Medically compromised patients(Cong. heart disease,SABE,kidney diseases,juvenile diabetes,etc.)

RECENT ADVANCEMENTSUNIVERSAL SPACE MAINTAINER:- It is a modified bonded space maintainer- It consists of a *stainless steel tubing *round retainer wire *solid steel foil pad base- Adv: no bands or impressions are required- Can be completed with one appointment- Is esthetic & can be used on partially erupted

tooth

COICAN MODIFIED SPACE MAINTAINER:

- It is functional- It is used in case of partially erupted

permanent molar and premature loss of primary 2nd molar

- A wire is bonded on the permanent molar and the primary 1st molar

- A pontic is used to maintain space and function

FIXED ESTHETIC SPACE MAINTAINER USING FIBER REINFORCED COMPOSUTE(RIBBOND)

- It is a fixed esthetic space maintainer using glass fiber reinforced composite

- Advantages:1.Saves time & cost2.Used in metal allergy3.Easy to clean4.No cast model required & thus no 2nd visiting- Disadvantage:1.High failure rate(94%)2.Can only be used for short periods

CONCLUSION I hereby conclude that fixed space maintainers are very effective in space maintenance especially in uncooperative patients

GALLERY

BIBLIOGRAPHYTextbook of Orthodontics – M S RANIOrthodontics Art and Science – S I BHALAJITextbook of Pediatric Dentistry – S G DAMLEPrinciples and practice of Pedodontics – ARATHI RAOTextbook of Orthodontics – GURKEERATH SINGHTextbook of Orthodontics – GRABER,VANERSDAL & VIGTextbook of Pedodontics – SHOBHA TENDONTextbook of Pediatric Dentistry– PINKHAM,CASAMASSIMO