Regrading Space maintainer in Pediatric dentistry this is for free u can read about it and understand the importance of space maintainer.

1. Space Maintainers

2. The premature loss of primary teeth due to caries,
infection, trauma, ectopic eruption, or crowding deviates
from the normal exfoliation pattern and may lead to loss
of arch length
Arch length deficiency can produce or increase the
severity of malocclusions with crowding, rotations,
ectopic eruption, crossbite, excessive overjet, excessive
overbite, and unfavorable molar relationships
Early tooth loss can result in overeruption of the
opposing teeth, mesial drifting of the teeth located distal
to the lost tooth, and distal drifting of the teeth located
mesial to the lost tooth.

3. Space maintainers:
• To reduce the prevalence and severity of malocclusion following premature loss of
primary teeth
Treatment objective:
• Prevent loss of arch length
• Width and perimeter by maintaining the relative position of existing dentition.
A
B

4. FACTORS INFLUENCING SPACE MANAGEMENT
• Time elapsed since tooth loss (T)
 Space closure- evident in first 6 months after extraction.
• Dental age of patient (A)
 As age increases → Tendency of space closure ↓ (Linder & Aronson, 1960)
 Loss of Primary molar before 7 years of age → Delayed eruption of
successor.
 Loss of Primary molar after 7 years of age → Early Emergence.

5. • Amount of bone covering unerupted tooth (B)
4 to 5 months to erupt through 1mm of bone (Mc Donald).
6 months to erupt through 1mm of bone (Pinkham).
• Sequence of eruption of teeth (E)
Observe for the developing and erupting teeth adjacent to space created by loss of teeth.
e.g. loss of 1st primary molar during eruption of permanent lateral incisor → distal movement
of primary cuspid & “falling in” of anterior segment.

6. • Delayed eruption of permanent teeth (D)
Partially impacted or deviation in the eruption path → abnormal eruption.
Extract primary tooth followed by space maintenance.
• Congenital absence of permanent tooth (C)
Congenital missing of permanent tooth → hold the space until fixed replacement or
allow the space to close.

7. • Amount of space closure (A)
Loss of maxillary second primary molar, up to 8 mm of space loss in a
quadrant.
Loss of mandibular second primary molars, up to 4 mm in a quadrant
Loss of upper or lower first primary molars show almost equal amounts
of space closure(Davey 1967)

8. • Eruption timing of permanent successors (E)
Eruption timing of a permanent successor may be delayed or accelerated after
premature loss of a primary tooth depending on the developmental status, bone
density of the area.
• Direction of closure (D)
Maxillary posterior-by mesial bodily movement and mesiolingual rotation around the
palatal root of the first permanent.
In contrast, mandibular spaces close primarily by mesial tipping of the first
permanent molars along with distal movement and retro inclination of teeth anterior
to the space.

10. Space Maintainers:
Band and loop
Lingual arch
Transpalatal arch
Nance holding arch
Distal shoe space maintainer
Functional space maintainer

11. Band and Loop space maintainer
• Unilateral,
• Fixed
• Non-functional &
• Passive space maintainer
• INDICATIONS (Currier & Austerman, 1992,Moyers 1988)
 Premature loss of single primary molar in primary dentition
 Premature loss of primary 2nd molar as Perm first molar is erupting clinically.
 B/L loss of single primary molar before eruption of permanent incisors

12. • CONTRAINDICATION
Extreme space loss.
High caries activity.
Replacement of primary anterior teeth.
Replacement of primary 2nd molars in primary dentition without eruption of PFM.
Richardson J. Mathewson and Robert E. Primosch. Fundamentals Of Pediatric Dentistry. 3rd Ed.. London: Quintessence Publishing Co, Inc.
Band and Loop space maintainer
Christiansen Jr FHJ Space maintenance in the primary dentition, in Pediatric dentistry infancy through adolescence. 4th ed. In:Pinkham Jr
CP, McTigue DJ, Fields HW Jr, Nowak AJ (eds) Mosby, St Louis pediatric dentistry infancy through adolescence, 2005. p. 423–430.

13. •ADVANTAGES:
Can be used bilaterally.
Simple to fabricate.
Well tolerated by patients.
•DISADVANTAGES:
Plaque retentive.
Increased risk of caries.
Unaesthetic

14. Band and Loop space maintainer
• Limitations
Requires minimum of two sittings for final delivery
After band formation, impression making is required which may be difficult in:
o Young patient
o Uncooperative patient
o Patient with severe gag reflex
While transferring band on impression, band displacement during cast pouring is
common, resulting in ill-fitting appliance
Requires laboratory work

15. Modifications
Band and bar, Crown and bar
Crown and loop
Reverse band and loop
Long Band and loop
Mayne’s space maintainer
Tube and loop (Nikhil appliance)
Prefabricated loop-single sitting
3D printed band and loop