SYNOPSIS

INTRODUCTION SPACE MAINTENANCE CHANGES FOLLOWING PREMATURE LOSS OF TEETH SPACE CLOSURE SPACE ANALYSIS SPACE MAINTAINERS TREATMENT PLANNING FOR SPACE MAINTAINERS CLASSSIFICATION OF SPACE MAINTAINERS BAND & LOOP SPACE MAINTAINER CROWN & LOOP SPACE MAINTAINER LINGUAL ARCH SPACE MAINTAINER NANCE PALATAL ARCH TRANS PALATAL ARCH APPLIANCE DISTAL SHOE APPLIANCE REMOVABLE SPACE MAINTAINERS SPACE MAINTENANCE IN DECIDIOUS DENTITION SPACE MAINTENANCE IN PERMANENT DENTITION CONCLUSION REFERENCE

INTRODUCTION-

SPACE MAINTAINERS

VESTA ENID LYDIA- R IV BDS

PEDODONTICS SEMINAR

SPACE MANAGEMENT

CHANGES FOLLOWING PREMATURE LOSS OF TEETH

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ETIOLOGY OF SPACE CLOSURE/CONTRIBUTING FACTORS

Inclination of the long axis of molar

Path of least resistance Influence of buccal

musculature Effect of the position of

center of rotation of mandible

PLANNING FOR SPACE MAINTAINANCE-FACTORS INVOLVED ARE

Time lapse since lost Dental age of patient Amount of bone covering the

unerupted tooth

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Sequence of eruption of teeth Delayed eruption of permanent

teeth Congenital absence of

permanent teeth Presence of oral habits Existing malocclusion

SPACE ANALYSIS

Commonly used mixed dentition analyses are

Hays & nance analysis Moyers analysis Tanaka johnston analysis

SPACE MAINTAINER

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TREATMENT PLANNING FOR SPACE MAINTAINER

PROPER EXAMINATIONCOLLECTION OF DIAGNOSTIC DATAANALYSIS OF TOOTH DEVELOPMENT

STAGEANALYSIS OF TOOTH SIZEANALYSIS OF SPACE AVAILABLEPREDICTION OF GROWTH & FUTURE

OCCLUSAL RELATIONSHIPS

CLASSIFICATION OF SPACE MAINTAINERS

ACCORDING TO HINRICHSEN (1962)

1.FIXED CLASS I

a.Non-functional types Bar type

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Loop type

b.Functional types Pontic type Lingual arch type

CLASS II

Cantilever type Distal shoe type Band and looptype

2.REMOVABLE

a.Non-functional types

b.functional types

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COMMONLY USED SPACE MAINTAINERS

BAND & LOOP CROWN & LOOP LINGUAL ARCH HOLDING

DEVICE NANCE’S PALATAL HOLDING

DEVICE TRANS PALTAL ARCH DISTAL SHOE REMOVABLE SPACE

MAINTAINER

BAND & LOOP SPACE MAINTAINER

Most commonly used

Unilateral fixed appliance

Used in posterior segments

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CROWN & LOOP SPACE MAINTAINER

Stainless steel crown is used as an abutment

Stronger than band and loop

Cementation failure or loss less likely

Excellent choice if tooth needs a restoration

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LINGUAL ARCH SPACE MAINTAINERS

MANDIBULAR ONLY Bands on first permanent

molars Mandibular incisors often

erupt lingually and are pushed forward by the tongue

LLHA should not be placed with primary incisors

NANCE PALATAL ARCH

MAXILLARY ONLYBands on first permanent molars

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It’s a simple maxillary lingual arch but does not contact anterior teethIt has an acrylic button in the mid palate

TRANS PALATAL ARCH APPLIANCE

Can be used like a Nance.AdvantageLack of acrylic button so less tissue irritation and more cleansibleDisadvantageLack of anterior stop = possible tooth shift

DISTAL SHOE APPLIANCE

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MAXILLARY or MANDIBULARUsed when second primary molar requires extraction and first permanent molar has not erupted

DISTAL SHOE SPACE MAINTAINER (contd)

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Should be evaluated with radiograph prior to cementation

– Length– Position

Will be replaced with another space maintainer when permanent teeth erupt.

REMOVABLE SPACE MAINTAINERS

a.Non-functional types

b.Functional types

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CLASSIFICATION OF REMOVABLE SPACE MAINTAINERS

REMOVABLE SPACE MAINTAINERS

It is like a removable partial denture

Not only Mesiodisatal space but also the vertical space is maintained

Mastigatory Function is restored in functional type

Esthetics & speech improvement is seen

SPACE MAINTENANCE IN MAXILLARY PRIMARY DENTITION

MISSIN SUGGESTED REASON

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G TOOTH

TREATMENT

Incisor No space maintenance required

No consequence.exception if incisors are lost prior to primary canine eruption

canine Band& loop space maintainer

Decrease possibility of midline shift

I molar

Band /crown & loop space maintainer

Prevents loss of arch dimmension

II molar

Distal shoe space maintainer

Guides I premolar into proper positionPrevents loss in arch dimension

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SPACE MAINTENANCE IN MANDIBULAR PRIMARY DENTITION

MISSING PRIMARY TOOTH

SUGGESTED TREATMENT

REASON

canine Band & loop space maintainer

Decreases possibility of midline shift

I molar

Band/crown loop space

Prevents loss of arch dimmens

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maintainer

ion

II molar

Distal shoe space maintainer

Guides I permanent molar into positionPrevents loss in arch dimmension

SPACE MAINTENANCE IN MIXED DENTITION –MAXILLARY

MISSING PRIMARY TOOTH

SUGGESTED TREATMENT

REASON

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Lateral incisor

Extract antimere

Decrease possibility of midline shift

canine Extract antimere

Decrease possibility of midline shift

I molar Prior to eruption of permanent lateral incisors removable space maintainers

After eruption of permanent lateral incisors extract antimere

Guides permanent lateral incisors into proper position and

Prevents midline shift

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II molar nance appliance

Prevents loss in arch diameter

SPACE MAINTENANCE IN MIXED DENTITION – MANDIBLE

MISSING TOOTH

SUGGESTED TREATMENT

REASON

Lateral incisor Extract antimere Decreases possibility of midline shift

Canine Prior to eruption of permanent lateral incisor removable space maintainer

After eruption of permanent incisors lingual arch space maintainer

1.Requires only minor adjustment to afford normal positioning of permanent incisors2.decreases possibility of midline shift

1.Decreases the possibility of midline shift2.prevents lingual tipping of permanent lateral incisors

I molar Prior to eruption of permanent lateral incisor r band/crown space maintainer

1.prevents loss in arch dimension2.does not interfere with eruption of permanent incisors

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After eruption of permanent incisors lingual arch space maintainer

1.prevents loss in arch dimension2.prevents distolateral repositioning of deciduous canine

II molar Prior to eruption of permanent lateral incisor r band/crown space maintainer

After eruption of permanent incisors lingual arch space maintainer

1.prevents loss in arch dimension2.does not interfere with eruption of permanent incisors

1.Prevents mesial tipping of permanent I molar2.prevents loss in arch dimension

CONCLUSION

It has been stressed that importance of healthy, properly aligned deciduous teeth lays a foundation for the future dental health of the child, and preservation of primary teeth incluates the habit of preventing of dental diseases such as malocclusion at an early age…….

So it is been said that

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PREVENTION IS BETTER THAN CURE…..

Hence extra care should be given for maintaining deciduous dentition…..

REFERENCES

MY SINCIERE THANKS TO

DR.XAVIER.MDS

DR.SARAVANAN.MDS

DR.SANGEETHA.BDS

DEPARTMENT OF PEDODONTICS

THANK ‘U’ HAVE A GREAT DAY….

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