space ma int teach

8/2/2019 Space Ma Int Teach

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Space maintainers are appliances usedto maintain space or regain minor

amounts of space lost,so as to guidethe unerupted tooth into a properposition in the arch.


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considerationsa)Time elapsed since lossspace closure usually takes place during the first 6

months after the extraction.

b)Dental age of the patientc)Amount of bone covering the unerupted tooth

e)Delayed eruption of the permanent tooth

f) Congenital absence of the permanent toothg) Presentation of problems to parents


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Evaluate Arch Length Has the space already been lost?

Is there excess space? Appropriate Radiographs

Succedaneous tooth?

Time to Eruption?


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Fixed S.M

Band & loop spacemaintainer.Crown & loopappliance.Lingual arch.

Palatal arch appliance.Transpalatal arch.Distal shoe.

Removable S.MAcrylic partial dentures.

Full or completedentures.

Removable distal shoespace maintainer.


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NANCE (Transpalatal Arch with AcrylicButton Stop on Palate)

TRANSPALATAL ARCH

LOWER LINGUAL HOLDING ARCH (LLHA)

BAND/CROWN and LOOP

DISTAL SHOE


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Two types of lingual arch designs are used tomaintain maxillary space-

the Nance arch.the Transpalatal arches.

The Nance arch incorporates an acrylic

button that rests directly on the palatalrugae.The Transpalatal arch(TPA) is made from awire that traverses the palate directly

without touching it.


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MAXILLARY ONLY

Bands on firstpermanent molars

acrylic button that

rests directly onthe palatal rugae.


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Can be used like aNance.

Advantage Lack of acrylic button

so less tissue irritationand more cleansible

Disadvantage Lack of anterior stop =

possible tooth shift (?)


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PASSIVATION-

The lingual archwire should be

completely passive.


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MANDIBULAR

ONLY Bands on first

permanent molars

Anterior Stop


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Mandibular incisors

often erupt linguallyand are pushedforward by thetongue

LLHA should not beplaced with primaryincisors


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Indications:

Bilateral loss.

Loss of more than

one unit in aquadrant.

Loss of primary

canines.


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It consist of a round stainless steel orprecious alloy wire,0.32 to 0.40 inches indiameter closely adapted to the lingual

surfaces of the teeth & anchored to bandson the first permanent molars.The means used to anchor the archwire tothe bands will define whether the lingual

arch is of a removable or fixed type.Because the permanent incisor tooth budsdevelop & erupt somewhat lingual to theirprimary precursors,a conventionalmandibular lingual arch is not recommended

in the primary dentition(bilateral band & loop appliances arerecommended in this situation.)


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It is used to maintain the space of a singletooth.

Inexpensive & easy to fabricate.

It does not restore the occlusal functionof the missing tooth.


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IndicationsUnilateral loss of the primary firstmolar before or after eruption of the

permanent first molar.Bilateral loss of a primary molar beforethe eruption of the permanent incisors.


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MAXILLARY orMANDIBULAR

Unilateral mosttypical

Can be bilateral if

permanent teethare not present

Single tooth span


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Stronger than bandand loop

Cementation failureor loss less likely

Excellent choice iftooth needs arestoration


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MAXILLARY orMANDIBULAR

Used when secondprimary molarrequires extractionand first permanentmolar has noterupted


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Should be evaluatedwith radiograph priorto cementation Length

Position

Will be replaced withanother space

maintainer whenpermanent teeth erupt.


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DISADVANTAGESo Because of its cantilever design & the fact it isanchored on the occlusally convergent crown ofthe primary first molar the appliance can

replace only a single tooth & is somewhatfragile.

o No occlusal function is restored because of this

lack of strength.o Histologic examination shows that complete

epithelialization does not occur after placementof the appliance.


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Yes, they are possible, however.. High failure rate due to breakage and loss Parent and patient compliance must be exceptional


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This results in little spaceloss if canines and

molars are present.

A prosthesis may be

constructed if desired:

Space maintenance

questionable

Esthetics Development of speech


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Fixed

Bands on secondprimary molars

0.9 mm wire

Teeth fixed to thewire

Patient < 3 orquestionablecooperation


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Removable

Posterior Adams

clasps or ball

clasps

Patient > or = 3years old


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Requiresimmediate spacemaintenance.

Space loss &midline shift iscommon.


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Distal Shoe = 2nd Primary Molar Extractionwith unerupted 1st Permanent Molar

Nance or Band/Crown Loop = Maxillaryproblem with 1st Permanent Molars present

Lower Lingual Holding Arch = MandibularProblem with 1st Permanent Molars and

Permanent Incisors present Band/Crown and Loop= Primary 1st Molar

Extraction


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Avoid Hard/Sticky foods (toffee, hardcandy, gum, popcorn, etc.).

Teeth should be brushed after eachmeal and the teeth with bands aroundthem should be cleaned especially well.

A 3 monthly review is appropriate.


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Inform the patient not to try to bendthe wire for any reason with finger or

tongue. Patient to come in for an emergency

appointment if the bands come

loose or if the space maintainer isdamaged in any way.

If a tooth erupts under the wire this

also needs to be checked.


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It is usually safe toremove the spacemaintainer after

the permanentteeth haveerupted.

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