Space maintainers


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Pedodontics - preventive orthodontics,
a simple outline about space maintainers.. needs,indications,contra indications,types

Published in: Health & Medicine

Space maintainers

  3. 3. DEFINITION • This term was coined by JC Brauer in 1941.It is defined as the process of maintaining a space in a given arch previously occupied by a tooth or a group of teeth • Boucher :it is a fixed or removable appliance designed to preserve the space created by the premature loss of a primary tooth or a group of teeth
  4. 4. Space maintainers are devices used to maintain or regain the space following the loss of deciduous tooth or teeth
  5. 5. Five milk teeth
  6. 6. Permanent(1,2,3,) Teeth are Erupted & Milk Teeth (D,E)
  7. 7. This is a case of decay in Milky Tooth
  8. 8. Witout treatment the milk tooth starts breaking
  9. 9. Removing the decayed tooth
  10. 10. Because of open space the first permanent molar will start tilting forward
  11. 11. 6 Has Tilted Closing The Spacement For 5
  12. 12. The Second Premolar is trapped now
  13. 13. A space maintainer can be used to prevent such a situation
  14. 14. W hy is it necessary to use a space maintainer?
  15. 15.  If a child loses a baby tooth early through decay or injury, the child's other teeth could shift and begin to fill the vacant space. When the child's permanent teeth emerge, there's not enough room for them. The result is crooked or crowded teeth and difficulties with chewing or speaking.
  16. 16. This is a ideal case where a space maintainer would have helped
  17. 17. The best space maintainer is a primary tooth
  18. 18. Causes….. • Premature loss of teeth • Interproximal caries • Ectopic eruption of 1st permanent molars • Delayed eruption • Ankylosis of primary molars • Disproportionate tooth size,etc
  19. 19. INDICATIONS 1. If the space shows signs of closing. 2. If the use of space maintainer will make the future orthodontic less complicated. 3. If the need for treatment of malocclusion at a later date is not indicated.
  20. 20. INDICATIONS(contd….) 4. When the space should be maintained for two year or more. 5. To avoid supra eruption of opposing tooth. 6. To improve the masticatory system and restore dental health.
  21. 21. CONTRAINDICATIONS 1. if the radiograph shows that the 2. 3. 4. 5. succedant tooth will erupt soon. If the radiograph shows one third of the root of is already calcified. When the space left is greater than the needed for the permanent as indicated from radiographically. If the space shows no signs of closing. When the succedenous tooth is absent.
  22. 22. Requirements • It should maintain the entire space created by the tooth • It must restore function • Prevent supraeruption of opposing tooth • It should be simple in construction
  23. 23. Contd…… • It should be strong enough to withstand occlusal forces • Should permit maintenance of oral hygiene • Must not restrict the growth of jaws • It should not exert undue forces of its own
  24. 24. CLASSIFICATION OF SPACE MAINTAINER The classification of the space maintainers can be summarized in the following According to function: Functional Non-functional
  25. 25. According to activity: Active Passive According to retention: Fixed Semi fixed Removable
  27. 27. BAND AND LOOP Most commonly used Unilateral fixed appliance Used in posterior segments
  28. 28. CROWN AND LOOP
  29. 29. CROWN AND LOOP  Stainless steel crown is used as an abutment  Stronger than band and loop  Cementation failure or loss are less likely  Excellent choice if tooth needs a restoration
  31. 31. Bands on first DEVICE molars permanent
  32. 32. Anteriorly it rests at the cinguli of the Incisors
  33. 33. LINGUAL ARCH HOLDING DEVICE  Mandibular incisors often erupt lingually and are pushed forward by the tongue  LLHA should not be placed with primary incisors
  34. 34. NANCE PALATAL ARCH SPACE MAINTAINER It’s a simple maxillary lingual arch but does not contact anterior teeth
  35. 35. Bands on first permanent molars
  36. 36. It has an acrylic button in the mid palate
  38. 38. TRANSPALATAL ARCH  Can be used like a Nance.  Advantage Lack of acrylic button so less tissue irritation and more cleansable  Disadvantage Lack of anterior stop = possible tooth shift
  39. 39. DISTAL SHOE SPACE MAINTAINER Used when second primary molar requires extraction and first permanent molar has not erupted
  40. 40. DISTAL SHOE SPACE MAINTAINER Primary canine and first molar (c,d)
  41. 41. Primary second molar (e),has been extracted and permanent first molar has not been erupted
  42. 42. Should be evaluated with radiograph prior to cementation – Length – Position
  43. 43. Will be replaced with another space maintainer when permanent teeth erupt.
  44. 44. REMOVABLE SPACE MAINTAINERS a.Non-functional types b.Functional types
  45. 45. It is like a removable partial denture Not only Mesiodistal space but also the vertical space is maintained. masticatory Function is restored in functional type Esthetics & speech improvement is seen
  46. 46.  removable unilateral space maintainers  They are too small and present swallowing and choking dangers for children.
  47. 47. SPACE MAINTENANCE IN MAXILLARY PRIMARY DENTITION MISSING TOOTH SUGGESTED TREATMENT REASON Incisor No space maintenance required No consequence. Exception if incisors are lost prior to primary canine eruption
  48. 48. canine Band& loop space maintainer Decrease possibility of midline shift I molar Band /crown & Prevents loss of loop space arch dimension maintainer II molar Distal shoe space maintainer Guides I premolar into proper position Prevents loss in arch dimension
  49. 49. SPACE MAINTENANCE IN MANDIBULAR PRIMARY DENTITION MISSING PRIMARY TOOTH SUGGESTED TREATMENT REASON canine Band & loop space maintainer Band/crown loop space maintainer Decreases possibility of midline shift Prevents loss of arch dimmension I molar
  50. 50. II molar Distal shoe space maintainer Guides I permanent molar into position Prevents loss in arch dimension
  51. 51. Our Objective….  Our primary objective is to make a study model for better understanding of the use of Space maintainers.  We have 3 instances….  The first one is the normal situation,where we have the deciduous teeth harbouring the permanent teeth
  52. 52. Our Objective….  The 2nd one is when we have a premature loss of Deciduous teeth  The 3rd one shows the space maintainer incorporated into the space