SPACE REGAINERS IN TOOTH LOSS (PEDIATRIC DENTISTRY)

NAVEEN GOKUL R, BDS IV(2022)
PRIYADARSHINI DENTAL COLLEGE AND HOSPITAL, TN

credits -Dr Aravindhan, JR-2

Space Regainers in Space Loss: Overview

**Introduction**
Space loss refers to the premature loss of a primary tooth, commonly due to factors such as dental caries, trauma, or congenital absence. This condition can lead to significant complications in dental development, including misalignment and malocclusion, as adjacent teeth migrate into the vacant space.

**Importance of Space Maintenance**
Maintaining the integrity of the dental arch is crucial for the proper eruption of permanent teeth. If space is not preserved, it can lead to crowding, which may necessitate future orthodontic interventions. Space maintainers are typically employed immediately following tooth loss to prevent this undesirable shifting.

**Role of Space Regainers**
When space loss has occurred and teeth have shifted, space regainers become essential. These appliances are specifically designed to create space for the proper eruption of permanent teeth that may be compromised due to prior shifting. They are particularly valuable in cases of significant arch collapse.

**Types of Space Regainers**
Space regainers can be categorized into fixed and removable types. Fixed regainers are usually bonded to adjacent teeth, providing a stable solution, while removable regainers allow for patient autonomy in maintaining oral hygiene. The selection of the appropriate appliance is determined by the clinical scenario and individual patient needs.

**Clinical Application**
The application of space regainers requires a thorough assessment of the dental arch and the patient's growth patterns. Careful treatment planning is essential, as successful implementation can enhance dental alignment and reduce the necessity for extensive orthodontic treatment in the future.

**Challenges and Considerations**
Challenges associated with the use of space regainers include ensuring patient compliance and addressing potential discomfort. Regular follow-up appointments are critical to monitor progress and make necessary adjustments to the appliance.

**Conclusion**
Timely intervention with space maintainers and regainers is vital for maintaining optimal oral health in pediatric patients. By effectively managing space loss, dental professionals can facilitate proper alignment and minimize the risk of future orthodontic complications.

1. SPACE REGAINERS IN TOOTH LOSS -NAVEEN GOKUL R, BDS IV YR, PRIYADARSHINI DENTAL COLLEGE , TN 1

2. SPACE LOSS IN PRIMARY DENTITION Primary teeth are a determining factor for the development of occlusion. The early loss of deciduous teeth can lead to a temporary movement of adjacent teeth and loss of space for the permanent teeth It is necessary to use space maintainers to continue the normal development of the dental arches and the occlusion 2 NAVEEN GOKUL R, BDS IV, PDCH

3. ETIOLOGY – SPACE LOSS 3 NAVEEN GOKUL R, BDS IV, PDCH

4. 4 AMOUNT OF SPACE LOSS • Maxillary spaces close faster as compared to mandibular spaces. • Pederson et al . 1978 documented a frequency of 50% population who underwent changes owing to premature extractions . • Olsen 1959 stated that greater loss occurs in mandible owing to a mesial axial orientation of 1st molar. • Cohen (1941), Seipel (1949), Richardson (1965) stated that loss of 2nd deciduous molar will cause greater space loss. • 1 mm of bone resorbs in 4 to 5 months and so if the bone is present over the succedaneous tooth it is an indicates appliance. NAVEEN GOKUL R, BDS IV, PDCH

5. 5 WHY SPACE LOSS ? In 1965, Steward used serial cephalometric radiographs to determine whether space closure occurs by mesial or distal movement from teeth adjacent to the extraction site. In the maxilla all the spaces were closed by mesial migration of posterior teeth into the extraction site. In the mandible for space losses greater than 2 mm, the spaces were closed mainly by distal movement of the teeth mesial to the extraction site. NAVEEN GOKUL R, BDS IV, PDCH

6. SPACE REGAINERS Definition : “A fixed or removable appliance capable of moving a displaced permanent tooth into its proper position in dental arch.” Generally, used to regain the space lost by drifting of teeth and may be either extra oral or intra oral fixed or removable appliances. Distalisation of first permanent molar is required for correction of other misaligned teeth. 6 NAVEEN GOKUL R, BDS IV, PDCH MESIAL DRIFTING OF FIRST PERMANENT MOLAR – culprit for space loss

7. 7 IMPORTANCE OF SPACE REGAINERS When the space is progressively lost , the therapy should be considered to regain it so that additional disharmonies do not develop. For regaining space or any movement of teeth, the most important procedure is the diagnosis . Alignment and space needs of other teeth in the arch, the relationships of teeth to denture base, the transverse , s agittal and vertical , skeletal relationships of denture base, cranium and profile of the soft tissue s . NAVEEN GOKUL R, BDS IV, PDCH

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10. GENERAL PROCEDURES FOR FABRICATION 10 😂 NAVEEN GOKUL R, BDS IV, PDCH

11. 11 SLING SHOT SPACE REGAINER NAVEEN GOKUL R, BDS IV, PDCH Sling shot space regainer distalizes molar with a wire elastic holder with hooks as an alternative to spring which transmits a force against the tooth to be distalized . It is termed as sling shot appliance, as the forces to distalize tooth were produced by the elastic which was stretched on the middle of the lingual and the buccal surface of the molar to be moved.

12. It differs from other types only in the design of the spring activation. This appliance resists breakage and provides a satisfactory method of moving the molar distally. The mesial portion of the spring loop is embedded in the resin and passed out through the edentulous space, followed by a loop. FIXED LOOP SPRING SPACE REGAINER 12 NAVEEN GOKUL R, BDS III, PDCH

13. 13 An expansion screw is embedded in resin base of removal appliance by expanding the screw, the distal movement of the first permanent molar is achieved. The expansion of screw is done by the patient once a week. The permanent first molar can be distalised by maximum opening width of screw . EXPANSION SCREW SPACE REGAINER eg. JACKSCREW NAVEEN GOKUL R, BDS IV, PDCH

14. 14 LIP BUMPER Lip bumper is used where bilateral movements are desired . It consists of heavy labial arch wire over which an acrylic flange is prepared in anterior region such that it does not contact lower anterior. NAVEEN GOKUL R, BDS IV, PDCH

15. 15 JAFFE’S APPLIANCE An appliance for certain minor tooth movement was described by Paul E Jaffe in 1963. It is useful in the presence of ankylosed tooth, early loss of a deciduous molar or an extraction result in filling of adjacent segments into proximal dental area. Movement is obtained by the use of light spring pressure against a sliding section or arch. NAVEEN GOKUL R, BDS IV, PDCH

16. 16 GERBER’S APPLIANCE This type of appliance may be fabricated directly in the mouth . • In this a U shaped assembly is used into which the U shaped wire can be fitted. • It is soldered onto the mesial aspect of the band . • The coiled spring is fitted onto U shaped wire which is fitted into U assembly and cemented to the teeth NAVEEN GOKUL R, BDS IV, PDCH

17. 17 HOTZ LINGUAL ARCH It is another method for distalization of molars. This is appropriate in a situation where the lower 1st permanent molar has drifted mesially , but the premolar or cuspid has not drifted distally NAVEEN GOKUL R, BDS IV, PDCH

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20. 20 CONCLUSION : The time is a significant factor for the loss of space. The space increases when the premature extraction especially in children with severe orthodontic deformations. The type of premature extracted tooth is another significant factor for the loss of space. The lack of space is bigger when second primary molars are extracted , because of the mesial movement of the first permanent molars. The use of space maintainers/ regainers must be considered according to the time and the type of the prematurely extracted teeth. The space maintainer should be used less than 2 month after tooth extraction to maintain the correct occlusal relationship. NAVEEN GOKUL R, BDS IV, PDCH

21. REFERENCES Marwah N. Textbook of Pediatric Dentistry. 3rd ed. Jaypee Brothers Medical Publishers; 2014. Graber TM, Rakosi T, Vig K. Orthodontics: Principles and Practice. 6th ed. Elsevier; 2020. McDonald F, Avery DR. Dentistry for the Child and Adolescent. 9th ed. Mosby; 2011. Moyers RE, Dean JA. Handbook of Orthodontics. 5th ed. C.V. Mosby; 1990. Proffit WR, Fields HW, Sarver DM. Contemporary Orthodontics. 7th ed. Mosby; 2016. American Association of Orthodontists. Clinical Practice Guidelines for Orthodontic Treatment. 2021. Available at: https://www2.aaoinfo.org/practice-management/cpg/

22. THANK YOU ! 22