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Space Management in thePrimary 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 eruptunhindered into proper alignment andocclusion.

A space maintainer is recommended after theuntimely loss of a primary tooth.

Failure to maintain spaceresults in Malocclusion1. Drifting / tipping of teeth2. Loss of arch length3. Midline shift4. Crowding of permanent teeth5. Impactions6. Orthodontic intervention including

extractions

Types of Space maintainers:1. Unilateral vs Bilateral2. Anterior vs posterior3. Fixed vs Removable

Basic concepts.1. Space closure occurs during the first 6

months after extraction. It is best to insertthe appliance as soon as possible followingthe exttraction.

2. Loss of space occurs primarily due to atipping movement of teeth (mesially ordistally). In the maxillary molar region,space loss occurs due to rotation (mesial-in)in conjunction with mesial tipping.

3. Erupting premolars usually require 4-5months to move through 1mm of bone asmeasured on a BWXR.

Space Management

Space loss occuringfrom mesial tippingof primary secondmolar secondary toproximal caries

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Space Management

Space closure froman untimely loss of amaxillary primaryfirst molar

Space management

Impacted maxillarypremolar due tospace loss

Band and Loop

Indication:Unilateral or bilateralloss of a primarymolar.

Crown and Loop

Restores a grosslydecayed abutmenttooth.Removal of appliance foradjustments isdifficult.

Space ManagementThe role of Chronological ageand Dental agewhen consideringspace maintainance.

Distal Shoe space maintainerIndication:

Loss of a primarysecond molar before theeruption of the firstpermanent molar.

Contraindications:Poor oral hygeineMedically compromisedpt.

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Transpalatal Bar

Indicated for

bilateral loss of primary maxillarymolars.HygenicMay not prevent themesial tipping of teeth

Nance ApplianceIndicated for loss of multiple primary teeth(bilaterally)in themaxillary arch.

Acryllic button providesincreased stability.

Appliance preventstipping and rotationmovt of molars.

Acryllic button maycause difficulty inmaintaining hygiene inthe rugae area.

Lower Lingual ArchIndications:

Bilateral loss of primaryteeth in the mandibulararch during transitionaldentition.Maintainace of archperimeter and incisorpositions.Contraindicated inprimary dentition.

Lower Lingual ArchModification of LLA with omega loops.

Activation of loopshelp flare anteriorswith some distalisingof permanentmolars.

Lower Lingual ArchModified LLA withclasps to preventdistal tipping of lateral incisors.

Removable Space MaintainersIndications:

Loss of multiple teethbilaterally (anteriorand/or posterior)In the absence of abutment teeth.

The acryllic resin ormodified Hawley spacemaintainers restoreesthetic, function andprevent supereruptionof opposing teeth.

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Fabrication of aSpace Maintainer

Selection of molarbands.Trial and errorleading to a snug fit.# indicates mesialsurface.

Fabrication of aSpace Maintainer

Seat band 1mmbelow marginal

ridges with the aidof a band seater. Adapt bands to thecontours of thetooth.Separators may beneeded for tightcontacts.

Fabrication of aSpace Maintainer

Take alginateimpressions with thebands in the pts. mouthRemove and placebands onto theimpression.Stablize bands withwire/paperclips.Pour the models withplaster and send to thelab with order form.

Space Management for theanterior region

Space Regaining

Modified Band andLoop with springcoils.

Space RegainingRemovable spaceregainer with jack-screw.

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