Space maintainer

Pediatric Dentistry Seminar 1

1. SPACE MAINTAINER GLO ARBY D. ARGUELLES, DMD

2. BEST SPACE MAINTAINER?

3. SPACE MAINTAINERS Appliances that preserve the arch length following the premature loss of PRIMARY TEETH. Fixed or Removable Appliance

4. space maintainers The space of the prematurely lost teeth changes in 6 months period, a decrease in space occurs within days or weeks which may cause: Loss of arch length Crowding Impaction Esthetic difficulties Malocclusion

5. Functions: Maintains space Prevents movement of adjacent teeth Provide masticatory function Improve esthetics Improve speech

6. Factors to consider for placement of space maintainers Care of the appliance Oral hygiene of the child patient Caries risk of the patient Must be beneficial to the patient

7. Types of space maintainers REMOVABLE FIXED

8. BAND AND LOOP Used to maintain the space of a single tooth Inexpensive and easy to fabricate Requires continuous supervision and care

9. Band and loop indications Premature loss of primary second molars as the permanent first molar is erupted clinically. Bilateral loss of single primary molar before eruption of permanent incisors. In case of premature loss of primary molar in primary dentition or primary maxillary molar in transitional dentition with permanent successor not erupting clinically for the next 2 years and its root length is less than one third mature.

10. Band and loop contraindications High dental caries. Primary anterior teeth Replacement Extremely crowded Marked space loss

11. Band and loop fabrications Fitting of the Molar Band Impression Making .036 is formed into a loop and contoured to fit band and ridge Fit and adjust Cement using GIC Recall Patient every 6 months

12. CROWN AND LOOP Fixed unilateral space maintainer where stainless steel crown is necessary on the abutment tooth. Stainless steel wire is soldered to the crown

13. CROWN AND LOOP INDICATIONS Premature loss of primary first molar with a carious primary second molar in need of a crown to restore. Crown is used on abutment tooth instead of a band.

14. CROWN AND LOOP CONTRAINDICATIONS High caries S uccedaneous tooth is absent No sign of closing When the space left is greater than the needed space for the permanent as indicated radiographically. If the radiograph shows that the succedaneous tooth will erupt soon If the radiograph shows of the root is already calcified  

15. CROWN AND LOOP fabrication

16. NANCE APPLIANCE Unilateral or bilateral loss of maxillary2nd primary Molar. 1 st permanent molars are banded and a transpalatal wire embedded in an acrylic button contacting the rugae

17. NANCE APPLIANCE indications Loss of multiple primary teeth (bilaterally) Used only in the Maxillary Arch Acrylic button provides stability and prevents rotation and tipping

18. NANCE APPLIANCE CONTRAindications Rampant dental caries H igh plaque scores Crossbite Anterior Crowding E rupting succedaneous teeth (palatal)

19. NANCE APPLIANCE fabrication Bands : Stainless steel material 0.005 inches in thickness Palatal wire : Stainless steel round wire 0.36 inches in thickness. At the rugae area, a small U-shaped bend should be incorporated in the wire, which is approximately 1-2 mm away from the soft tissue. The acrylic button is placed usually on the descending portion of the palatal vault. The button is about 0.5 inch in diameter, rests against the palatal tissues

20. TRANSPALATAL ARCH Prevent mesial tipping of the 1 st permanent molar. Maxillary Molars are banded. 0.36 and round wire contoured to the posterior hard palate and soldered to the palatal side of the band.

21. TRANSPALATAL ARCH indications One side of the arch is intact, and several primary teeth on the other side are missing When primary molars are lost bilaterally, it cannot be used, as both permanent molars may tip anteriorly despite the transpalatal arch

22. TRANSPALATAL ARCH fabrications .036 round wire is bent to conform to the palatal contour and extending toward the palatal surface of the bands As it approaches the mesial part of the palatal side of the band, the wire should be bent to the distal part of the band to assure a better joint After soldering, the wire should be heated inorder to make it passive.

23. Lingual holding arch Bilateral loss of mandibular 2 nd primary molars After the eruption of the permanent anteriors . Mandibular first Permanent Molar or Mandibular 2 nd primary Molars are banded. .036-0.40 wire is soldered to the lingual surface Of the molar bands. Wire should contact the lingual surface of the anteriors

24. Lingual holding arch indications Bilateral loss of single/multiple primary lower molars, after eruption of lower incisors. Minor movement anterior teeth Maintenance of leeway space

25. Lingual holding arch contraindication Before the eruption of the permanent lower incisors.

26. Lingual holding arch fabrication Wire should contact the erupted permanent incisors at the cingulum Rest at the middle third of the molar band Molar bands Stainless steel round

27. DISTAL SHOE Used when 2nnd primary molar requires extraction and 1 st permanent molar has not erupted Used to prevent mesial migration of the unerupted permanent 1 st molar after premature loss of the primary 2 nd molar

28. DISTAL SHOE

29. DISTAL SHOE indications Advanced root resorption and periapical bone destruction of the second primary molar prior to eruption of the first permanent molar. Primary Second Molar with caries that is not restorable Ectopic Eruption of Permanent First Molar Ankylosis of Primary Second Molar

30. DISTAL SHOE contraindications Systemic Diseases Immunocompromised Individuals Missing Permanent Molar Inadequate abutments due to multiple loss of teeth

31. DISTAL SHOE fabrications

32. Hawley appliance Used to retain incisors and canines in their position after active orthodontic treatment.

33. HAWLEY APPLIANCE indications Hold teeth in a new position after dentition has been orthodontically corrected. Prevent relapse while bone fill occurs around the roots of the moved teeth. Minor tipping movement of teeth mesio -distally and buccally

34. HAWLEY APPLIANCE contraindication Severe Class II or Class III cases Rotation Severe proclination Bodily movement of tooth is required