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