space maintainers

SPACE MAINTAINERS

SUBMITTED BYSUBINA NAZRIN

3rd BDSDEPARTMENT OF PEDIATRIC DENTISTRY

SPACE MAINTAINER

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DEFINITION•This term was coined by JC Brauer in 1941.It is defined as the process of maintaining a space in a given arch previously occupied by a tooth or a group of teeth

•Boucher :it is a fixed or removable appliance designed to preserve the space created by the premature loss of a primary tooth or a group of teeth

Space maintainers are devices used to maintain or regain the space following the loss of deciduous tooth or teeth

Five milk teeth

Permanent(1,2,3,) Teeth are Erupted & Milk Teeth (D,E)

This is a case of decay in Milky Tooth

Witout treatment the milk tooth starts breaking

Removing the decayed tooth

Because of open space the first permanent molar will start tilting forward

6 Has Tilted Closing The Spacement For 5

The Second Premolar is trapped now

A space maintainer can be used to prevent such a situation

W hy is it necessary to use a space maintainer?

If a child loses a baby tooth early through decay or injury, the child's other teeth could shift and begin to fill the vacant space. When the child's permanent teeth emerge, there's not enough room for them. The result is crooked or crowded teeth and difficulties with chewing or speaking.

This is a ideal case where a space maintainer would have helped

The best space maintainer is a primary tooth

Causes…..•Premature loss of teeth• Interproximal caries•Ectopic eruption of 1st permanent molars

•Delayed eruption•Ankylosis of primary molars•Disproportionate tooth size,etc

INDICATIONS1. If the space shows signs of

closing.2. If the use of space maintainer

will make the future orthodontic less complicated.

3. If the need for treatment of malocclusion at a later date is not indicated.

INDICATIONS(contd….)4. When the space should

be maintained for two year or more.

5. To avoid supra eruption of opposing tooth.

6. To improve the masticatory system and restore dental health.

CONTRAINDICATIONS1. if the radiograph shows that the

succedant tooth will erupt soon.2. If the radiograph shows one third

of the root of is already calcified.3. When the space left is greater

than the needed for the permanent as indicated from radiographically.

4. If the space shows no signs of closing.

5. When the succedenous tooth is absent.

Requirements• It should maintain the entire space created by the tooth

• It must restore function

•Prevent supraeruption of opposing tooth

• It should be simple in construction

Contd……• It should be strong enough to withstand occlusal forces

•Should permit maintenance of oral hygiene

•Must not restrict the growth of jaws

• It should not exert undue forces of its own

CLASSIFICATION OF SPACE MAINTAINER

The classification of the space maintainers can be summarized in the following

According to function: FunctionalNon-functional

According to activity:ActivePassiveAccording to retention:FixedSemi fixedRemovable

Commonly used Space maintainers

BAND & LOOP CROWN & LOOP LINGUAL ARCH HOLDING DEVICE NANCE’S PALATAL HOLDING

DEVICE TRANS PALTAL DISTAL SHOE REMOVABLE SPACE MAINTAINER

BAND AND LOOP

Most commonly used

Unilateral fixed appliance Used in posterior segments

CROWN AND LOOP

CROWN AND LOOPStainless steel

crown is used as an abutment

Stronger than band and loop

Cementation failure or loss are less likely

Excellent choice if tooth needs a restoration

LINGUAL ARCH HOLDING DEVICE

DEVICE Bands on first

permanent molars

Anteriorly it rests at the cinguli of the Incisors

LINGUAL ARCH HOLDING DEVICE

Mandibular incisors often erupt lingually and are pushed forward by the tongue

LLHA should not be placed with primary incisors

NANCE PALATAL ARCH SPACE MAINTAINER

It’s a simple maxillary lingual arch but does not contact anterior teeth

Bands on first permanent molars

It has an acrylic button

in the mid palate

TRANSPALATAL ARCH

TRANSPALATAL ARCH Can be used like a Nance.

Advantage Lack of acrylic button so less tissue irritation and more cleansable

Disadvantage Lack of anterior stop = possible tooth shift

DISTAL SHOE SPACE MAINTAINER

Used when second primary molar requires extraction and first permanent molar has not erupted

Primary canine and first molar (c,d)

DISTAL SHOE SPACE MAINTAINER

Primary second molar (e),has

been extracted and permanent

first molar has not been erupted

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

It is like a removable partial denture Not only Mesiodistal space but also the vertical space is maintained. masticatory Function is restored in functional type Esthetics & speech improvement is seen

removable unilateral space maintainers

They are too small and present swallowing and choking dangers for children.

SPACE MAINTENANCE IN MAXILLARY PRIMARY DENTITION

REASON SUGGESTED TREATMENT

MISSING TOOTH

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

No space maintenance required

Incisor

Decrease possibility of midline shift

Band& loop space maintainer

canine

Prevents loss of arch dimension

Band /crown & loop space maintainer

I molar

Guides I premolar into proper position Prevents loss in arch dimension

Distal shoe space maintainer

II molar

SPACE MAINTENANCE IN MANDIBULAR PRIMARY DENTITION

REASON SUGGESTED TREATMENT

MISSING PRIMARY TOOTH

Decreases possibility of midline shift

Band & loop space maintainer

canine

Prevents loss of arch dimmension

Band/crown loop space maintainer

I molar

Guides I permanent molar into position Prevents loss in arch dimension

Distal shoe space maintainer

II molar

Our Objective….Our primary objective is to make a study model for better understanding of the use of Space maintainers.

We have 3 instances….The first one is the normal situation,where we have the deciduous teeth harbouring the permanent teeth

Our Objective….The 2nd one is when we have a

premature loss of Deciduous teethThe 3rd one shows the space

maintainer incorporated into the space

Thankyou