Space supervision and gross discripency

Orthodontics-Spacing

1. Space supervision and gross discrepancy Dir. HANA PERVEZ 3 RD year resident (FCPS) Department of orthodontics

2. SPACE RELATED PROBLEMS In the mixed dentition stage, space related problems are of two types Lack of space causing the permanent teeth to erupt an abnormal position Interferences with eruption preventing a permanent tooth from erupting on a normal schedule and secondarily lead to space problems due to teeth drifting

3. Different scenarios in space related problems are Excess space Premature tooth loss with adequate space Localized space loss (3mm or less) SPACE regaining Mild to moderate crowding of incisors with adequate space Moderate and severe generalized crowding

4. EXCESS SPACE Generalized spacing of permanent teeth Maxillary midline diastema Maxillary dental protusion and spacing Missing permanent teeth EXCESS SPACE

5. GENERALIZED SPACING OF PERMANENT TEETH It could be due to small sized teeth in normal sized arches or normal sized teeth in large arches Infrequent finding in mixed dentition stage Allow the eruption of all the permanent teeth before closing space with fixed appliance MAXILLARY MIDLINE DIASTEMA Due to superior and distal positioning of permanent canines in relation to lateral incisor roots forces central and lateral roots toward the midline while their crowns diverge distally This stage known as ugly duckling stage of development Corrects spontaneously as canines erupt

6. Ugly duckling phase of dental development

7. Treatment of diestema (2mm or less ) A maxillary removable appliance with finger spring

8. Treatment of diestema (greater than 2mm ) Suspect any supernumerary tooth or intrabony lesion 2x4 appliance therapy Treatment of dental protusion and spacing In case where only tipping is required as in cases of sucking habits HAWLEY APPLIANCE is indicated Where bodily movements and rotation corrections required fixed appliance therapy is indicated

9. MISSING PERMANENT TEETH Missing second premolars Keep deciduous second molar as longsas possible to maintain alveolar bone If profile is somewhat protrusive extract deciduous at the age of 7 to 9 yrs It allows first molar to drift into the space Should be done when extractions are planned in opposing arches Missing maxillary lateral incisors Canine substitution for laterals Prosthetic replacement of laterals Auto transplantation When two third root is formed, means in the mixed dentition stage Commonly used to move premolars for incisors and or to replace first molar with third molar

10. PREMATURE TOOTH LOSS WITH ADEQUATE SPACE Band and Loop space maintainer Indication:Unilateral or bilateral loss of a primary molar

11. Partial denture space maintainer Indication M issing anterior teeth Greater than one tooth per segment

12. DISTAL SHOE SPACE MAINTAINER Indications When E’s are lost prior to eruption of first permanent molar Consists of guide plate along which 6 erupts Guide plate must extend 1 mm below MMR ( mesial marginal ridge)

13. LINGUAL ARCH SPACE MAINTAINER

14. LOCALIZED SPACE LOSS (3mm or less) SPACE REGAINING Maxillary space regaining Mandibular space regaining

15. Maxillary space regaining A removable appliance with a fingerspring can be used to regain space by tipping a permanent first molar distally

16. A fixed appliance can also be used to distalize the molar with the help of open coil spring

17. Mandibular space regaining For unilateral space regaining lingual arch and for bilateral lip bumper is indicated

18. MILD TO MODERATE CROWDING OF INCISORS WITH ADEQUATE SPACE Irregular incisors, minimal space discrepency 3- 4 mm of anterior space is gained by disking the interproximal enamel surface of remaining primary incisors and canines

19. Space deficiency largely due to allowance for molar shift Using leeway space by disking to increase arch length in conjunction with space maintainence

20. Moderate and severe generalized crowding EARLY TREATMENT OF SEVERE CROWDING Maxillary dental or skeletal expansion , moving the teeth facially or opening the midpalatal suture Mandibular buccal segment expansion by facial movement of the teeth Advancement of incisors and distal movement of molars in either arch

21. Moderate arch length increase with multiple bonded and banded and a mechanism of expansion

22. In maxilla expansion achieved with the help of jackscrew appliance to open midpalatal suture

23. LATE MIXED DENTITION TREATMENT FOR SEVERE CROWDING Options available to treat crowding in the late mixed dentition stage Distal molar movement Extraoral appliance(headgears) Serial extraction

24. DISTAL MOLAR MOVEMENT S everal approaches to distalize molars are Helical spring ( Pendulum appliance) Magnets TAD Steel and superelastic coil springs

25. Temporary anchorage device for molar distalization not indicated for patients younger than 12 years due to bone density and TAD instability

26. EXTRA ORAL APPLIANCE (HEADGEARS) Force = 100g/side Duration = 14 to 16 hrs Rate of tooth movement = 1 mm/month

27. EARLY SERIAL EXTRACTION Indication: Space discrepency is greater than 10mm No skeletal discrepency of jaws Normal overjet and overbite Class 1 molar relation Straight profile

28. A : Severe space deficiency and marked incisor crowding B : Primary canines are extracted to align the incisors

29. C : Primary first molars are extracted when ½ to 2/3 rd roots of premolar is formed to speed up its eruption D : Extraction of first premolars after their eruption and canines erupt into the extraction space

30. ALTERNATIVE APPROACH A : A n alternative approach B : B egins with extraction of primary molar to speed up eruption of first premolar

31. C and D: When first premolars are erupted they are extracted and canines erupt into their space

32. E NUCLEATION : premature eruption of canine is a complication of serial extraction resulting in the impaction of first premolar when this happens surgically removal of premolar is done by a procedure known as enucleation

33. THANK YOU