Space regaining procedure in pediatric dentistry

The process of gaining space lost by drifting of adjacent teeth following premature loss of deciduous teeth

1. Space regaining Enisha Agarwal Roll no. -38 3 rd /2 nd batch D

2. Space regaining The process of gaining space lost by drifting of adjacent teeth following premature loss of deciduous teeth

3. Considerations for the treatment include The alignment and space needs for other teeth in arch The relationship of teeth to denture base The transverse and sagittal dental relationship The vertical relationship The profile of soft tissue Diagnostic aids – study models, radiograph of periapical structures , clinical assessment of facial symmetry, cephalometric analysis

4. Dental and Skeletal Relations Clinical assessment is done determine the skeletal and facial pattern To evaluate face type and growth trend Assessment of the soft tissue profile To evaluate skeletal, sagittal , transverse and vertical relationship estimation of rotation, slipped contacts and faciolingual displacement of teeth from arch circumference

5. Radiographs and study models Important to recognize whether teeth have moved bodily into space or have tipped mesially Visualizing the proximity of adjacent erupting teeth and their potential impact on teeth Presence, location, status of eruption of unerupted teeth Accidental findings may influence the total plan of the treatment

6. Moyer’s Mixed dentition analysis- it will give an estimation of the amount of space to be regained Anchorage considerations Timing of d istalization – If child is treated before the age of 9 yrs the root of 1 st permanent molar has not completed its growth and orthodontic tipping and bodily movement to normalise its position is easier the age ranging between 7-10 yrs is best time for bodily movement or tipping to recover lost arch space

7. Commonly used appliances Mandibular Arch Active open coil space regainer Hotz lingual arch Lip bumper Gerber space maintainer Free end loop space regainer Split saddle /split block Sling shot space regainer Jack screw or expansion screw Anterior space regainer Maxillary arch Kloehn head gear Pendulum appliance Fixed sectional arch appliance

8. Active Open coil space regainer A reciprocal active space regainer used to regain lost space due to premature loss of 2 nd deciduous molar The first molar tend to migrate mesially Such situation may exist unilaterally or bilaterally For the purpose of anchorage, erupted first premolar is essential

9. Construction Molar band is fitted on 1 st permanent molar to which molar tubes are soldered horizontally both buccally and lingually. Impression is taken with alginate A stainless steel wire is bent into U shape which will fit in both buccal and lingual tube The base of U should contain a reverse bend to contact the distal surface of 1 st premolar

10. A stop should be placed on both the arms where straight part meets the bend of wire A spaced coil spring is selected which will slide on wire The band assembly is cemented on with coil springs compressed The compressed coil springs at mesial ends of buccal and lingual tubes exert continuous up-righting force on permanent 1 st molar causing a distal tip

11. Gerber space maintainer This appliance can be directly fabricated in mouth and requires no lab work Construction – A ‘u’ shaped assembly welded or soldered is fitted in the tube, the appliance placed and wire section extended to contact the tooth mesial to edentulous area push coil springs are used which is measured and cut adding 1-2mm extra to allow spring activation The spring are compressed enough to allow assembly to fit in edentulous area

12. Hotz lingual Arch It is best suited for a situation where lower 1 st permanent molar has drifted mesially , but the premolar or cuspid has not There must be an x-ray evidence of sufficient space between first molar and developing second molar Anchorage for movement is achieved as arch contacts all the teeth

13. Indications Unilateral or bilateral loss of space in the arch due to mesial migration of the first molars To maintain integrity of the arch where deciduous teeth have been lost To utilize leeway space to resolve the minor crowding Can also be used to expand a collapsed arch

14. Molar bands 0.036” lingual arch wire well adapted to lingual arch with incisor segment resting on cingulum of anterior teeth U loop Closed vertical loop Components

15. Lip bumper It is used in space regaining procedures when bilateral distal movement of molars is desired Indicated where lower lip is hyperactive leading to lingual collapse of incisors Can be used a lip biting or sucking inhibitor

16. Appliance design It consist of heavy labial arch wire over which acrylic flange is prepared in anterior region The length is adjusted in a way that it is away from lower incisors by 2-3 mm when buccal wires inserted in buccal molar tube.

17. the pressure exerted from lip is transferred onto the molars to upright them The lingually collapsed lower incisors once relieved from undue lip pressure tend to upright with pressure from tongue Mode of action

18. Pre treatment and Post treatment photograph showing distal movement of molars and alignment of incisor

19. Free end loop space regainer It utilizes a labial arch wire for stability and retention, and body of acrylic resin and active spring. the uprighting spring has helical which is activated to exert the force close to gingival margin of tooth it would require activation in 2-3 weeks until distal movement is achieved.

20. Split block/split saddle In this functional part of appliance consists of an acrylic block that is split bucco -lingually and joined by 0.025 wire in form of a buccal and lingual loop The appliance activated by periodic spreading of the loops The activator block split with disc after appliance has been processed.

21. Sling shot space regainer It is called sling shot since distalising force is produced by elastic stretched on middle of lingual and buccal surface of molars to be moved Instead of spring wire elastic holder with hooks are used to transmit the force against tooth to be distalized The elastic can be changed once daily

22. Jack screw It is used to cover loss of space caused by drifting of tooth in edentulous area it consist of split acrylic plate with a jackscrew in relation to edentulous space and retained using adams clasps space is opened by expanding the plates in Anteroposterior direction .

23. Sectional arch technique Upto 4 millimeters of space can be regained by this technique It can be bonded type or banded buccal tube or the molar and the bracket such as medium siamese twin edgewise bracket on mesial segment A sectional wire with increased arch length stops mesial to tube of molar and distal to bracket of anterior segment will be activated to upright mesially tipped molar

24. Anterior space regainer Bayardo in 1986 described an anterior space regainer utilizing direct bond technique To the lateral incisor was attached labial tubes A 0.014” round wire was then inserted in an open coil spring and activated.

25. Klohen head gear Used to restrain the growth of maxilla It has removable type of cervical face bow which has outer and inner bow Inner bow housed in round tubes attached on first molars The outer bow attached to cervical neck strap that has calibrated elastic module for exerting the force. The appliance worn for 12-14hrs/24hrs

26. Pendulum appliance This appliance uses the modified Nance acrylic button for anchorage The molar can be distalised by palatally placed spring that delivers a light continuous force to the upper first molars

27. Reference Paediatric Dentistry by Shobha Tandon Orthodontics, The Art and Science by S.I. Bhalaji Textbook of Pediatric Dentistry by Nikhil Marwah Textbook of orthodontics by Gurkeerat singh

28. THANK YOU