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Basic Space Maintainers
Teaching Module and
Competency
INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.ind...
Basic Space Maintainers
• Are PASSIVE
– .036 wire is very heavy and should not be
used to actively move teeth

www.indiand...
Before Placing a Space
Maintainer
• Evaluate Arch Length
– Has the space already been lost?
– Is there excess space?

• Ap...
Space Maintainers are
Simple!
Name the 4 most basic pediatric
space maintainers

www.indiandentalacademy.com
Basic Space Maintainers
• NANCE (Transpalatal Arch with Acrylic
Button Stop on Palate)
• LOWER LINGUAL HOLDING ARCH
(LLHA)...
Distal Shoe
• MAXILLARY or
MANDIBULAR
• Used when second
primary molar
requires extraction
and first permanent
molar has n...
Distal Shoe
• Should be evaluated with
radiograph prior to
cementation
– Length
– Position

• Will be replaced with
anothe...
Distal Shoe
• Example of use in
partial eruption case.

www.indiandentalacademy.com
Nance Appliance

• MAXILLARY ONLY

• Bands on first
permanent molars

www.indiandentalacademy.com
Nance Appliance

• Cross Palatal Bracing prevents rotation #3 and
#14 around palatal root- this starts mesial
migration of...
Transpalatal Holding Arch (TPA)
• Can be used like a
Nance.
• Advantage
– Lack of acrylic button
so less tissue irritation...
Lower Lingual Holding Arch

• MANDIBULAR
ONLY
• Bands on first
permanent molars
• Anterior Stop =
Cinguli of #23-#26

www....
Lower Lingual Holding Arch

• Mandibular incisors
often erupt lingually
and are pushed
forward by the tongue
• LLHA should...
#K and #T Extractions : LLHA
Indicated?
• NO- note lingual
eruption #23 and #26
• Option: Reverse
Crown and Loops
#L-19 an...
LLHA Omega Loops

• Omega Loops in area
of premolars allow
slight adjustment to fit
appliance
• Should not be used
to acti...
Appliance Activation Features
• Can be added by
attaching light wire
features
• This is beyond routine
space maintenance

...
Band/Crown and Loop
• MAXILLARY or
MANDIBULAR
• Unilateral most typical
• Can be bilateral if
permanent teeth are
not pres...
Crown and Loop
• Stronger than band
and loop
• Cementation failure or
loss less likely
• Excellent choice if
tooth needs a...
What About Removable
Appliances?

• Yes, they are possible, however………..
• High failure rate due to breakage and loss
• Pa...
Which Space Maintainer?
• Distal Shoe = 2nd Primary Molar Extraction with
unerupted 1st Permanent Molar
• Nance or Band/Cr...
Must I Plan to Replace a
Band/Crown and Loop ?
• All depends on ERUPTION SEQUENCE
– No, in maxillary arch
– Yes, in mandib...
Space Maintainer Competency
• The following cases require space
maintainer consideration. Assume that
radiographs have bee...
Question 1

• What tooth was extracted? How old is this child?
• What is the appropriate space maintainer?
• Will it have ...
Question 2

• What tooth was extracted? How old is the child?
• What is the appropriate space maintainer?
• Will it have t...
Question 3

• Which teeth were extracted? How old is the patient?
• What is the appropriate space maintainer?
• When can t...
Question 4

• Which teeth were extracted/
• What is the appropriate space maintainer?

www.indiandentalacademy.com
Question 5

• Which teeth have been extracted? How old is the child?
• What is the most appropriate space maintenance?

ww...
“Cheyenne” Case
• Cheyenne presented for an initial visit at
the COD. She has had dental treatment on
and off throughout l...
How old is Cheyenne assuming
normal dental development?

www.indiandentalacademy.com
Cheyenne‟s Bite Wings

www.indiandentalacademy.com
Mandibular Arch Only: Chart
Dentition on the Odontogram

www.indiandentalacademy.com
Cheyenne
• Mandibular Arch Only : Chart
abnormalities and pathology (including
caries ) from the Panorex and Bite Wing
Rad...
www.indiandentalacademy.com
Cheyenne
A Moyer‟s space analysis predicted there
to be 2.3 mm of excess space in the
mandible.
Make a treatment plan and ...
www.indiandentalacademy.com
Cheyenne
• Assuming normal dental development, at
what age will the space maintainer you
placed no longer be needed?

www....
“Justin” Case
• Justin was referred by his general dentist
for „ tooth decay and crowding.‟
• The family does not believe ...
Justin: Chart Maxillary Dentition
Only on the Odontogram

www.indiandentalacademy.com
Justin‟s Bite Wings

• Chart any pathology or abnormal findings
(including caries) for the maxillary arch only on
the odon...
Justin

www.indiandentalacademy.com
Justin
A Moyer‟s space analysis predicts 1.2 mm
of space shortage in the maxilla
Treatment plan and sequence appointments
...
Justin

www.indiandentalacademy.com
Discussion

www.indiandentalacademy.com
Question 1

• 5 or 6 y.o. child. Tooth #I extracted.

www.indiandentalacademy.com
Question 1

• Band/Crown and Loop #J-H
• Will not need replacement. #12 should erupt
before #H or J exfoliate
www.indiande...
Question 2

• Tooth #L extracted. 3-5 y.o. child.
• What is the appropriate space maintainer?
• Will it have to be replace...
Question 2

• Band/Crown Loop #K-M
• May need to be replaced by LLHA later. Tooth
#M should exfoliate prior to eruption #2...
Question 3

• Teeth #A and #J extracted. Patient 8-9 y.o.

www.indiandentalacademy.com
Question 3

• Nance #3-#14
• Can be removed when #4 and #13 erupt-around age 12

www.indiandentalacademy.com
Question 4

• Teeth #K and L extracted

www.indiandentalacademy.com
Question 4

• Lower Lingual Holding Arch (LLHA) #19-#30

www.indiandentalacademy.com
Question 5

• Teeth #K and #S extracted. 5-6 y.o. child.
• Because permanent incisors are not erupted, LLHA not
recommende...
“Cheyenne”
• Cheyenne presented for an initial visit at
the COD. She has had dental treatment on
and off throughout life. ...
Assuming normal dental development,
Cheyenne is 8 years old.

www.indiandentalacademy.com
Cheyenne
• Mandibular Arch Only : Chart
abnormalities and pathology (including
caries ) from the Panorex and Bite Wing
Rad...
www.indiandentalacademy.com
Cheyenne
• Teeth Present:
19, K,L,M,23,24,25,26,R,S,T,30
Restorations: SSC #L
Pathology/Caries: #L and #S abscessed,
#28 s...
Cheyenne
A Moyer‟s space analysis predicted there
to be 2.3 mm of excess space in the
mandible.
Make a treatment plan and ...
www.indiandentalacademy.com
Cheyenne Tx Plan
• Extract #L,S and T and Place LLHA
• #L and S due to abscess
• #T due to ectopic #28

– Appt #1: Fit ban...
Cheyenne
• Assuming normal dental development, at
what age will the space maintainer you
placed no longer be needed?

• An...
“Justin” Case
• Justin was referred by his general dentist
for „ tooth decay and crowding.‟
• The family does not believe ...
Justin

www.indiandentalacademy.com
Justin
A Moyer‟s space analysis predicts 1.2 mm
of space shortage in the maxilla
Treatment plan and sequence appointments
...
Justin
• Teeth Present:
#3,A,B,C,7,8,9,10,H,12,J,14
• Restorations: #A-MO, #B-DO.
• Pathology/Caries: #3-M; #A-D; #B-M;
#H...
Justin

www.indiandentalacademy.com
Justin Tx Plan
• Extract all maxillary primary teeth
– #A,B,J- Multiple caries and near exfoliation
– TE #C and #H due to ...
Justin Tx Sequence
• Appt 1
– Fit bands #3 and #14 and Impress for Nance
– Restore #14
– TE #H and #J

• Appt 2
– Restore ...
Please Evaluate This
Teaching Module
Thank You!

www.indiandentalacademy.com
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Space maintiners /certified fixed orthodontic courses by Indian dental academy

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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.

Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078

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Space maintiners /certified fixed orthodontic courses by Indian dental academy

  1. 1. Basic Space Maintainers Teaching Module and Competency INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  2. 2. Basic Space Maintainers • Are PASSIVE – .036 wire is very heavy and should not be used to actively move teeth www.indiandentalacademy.com
  3. 3. Before Placing a Space Maintainer • Evaluate Arch Length – Has the space already been lost? – Is there excess space? • Appropriate Radiographs – Succedaneous tooth? – Time to Eruption? • Patient/Family Compliance www.indiandentalacademy.com
  4. 4. Space Maintainers are Simple! Name the 4 most basic pediatric space maintainers www.indiandentalacademy.com
  5. 5. Basic Space Maintainers • NANCE (Transpalatal Arch with Acrylic Button Stop on Palate) • LOWER LINGUAL HOLDING ARCH (LLHA) • BAND/CROWN and LOOP • DISTAL SHOE www.indiandentalacademy.com
  6. 6. Distal Shoe • MAXILLARY or MANDIBULAR • Used when second primary molar requires extraction and first permanent molar has not erupted www.indiandentalacademy.com
  7. 7. Distal Shoe • Should be evaluated with radiograph prior to cementation – Length – Position • Will be replaced with another space maintainer when permanent teeth erupt. www.indiandentalacademy.com
  8. 8. Distal Shoe • Example of use in partial eruption case. www.indiandentalacademy.com
  9. 9. Nance Appliance • MAXILLARY ONLY • Bands on first permanent molars www.indiandentalacademy.com
  10. 10. Nance Appliance • Cross Palatal Bracing prevents rotation #3 and #14 around palatal root- this starts mesial migration of #3 and #14 • Acrylic Button provides additional stop www.indiandentalacademy.com
  11. 11. Transpalatal Holding Arch (TPA) • Can be used like a Nance. • Advantage – Lack of acrylic button so less tissue irritation and more cleansible • Disadvantage – Lack of anterior stop = possible tooth shift (?) www.indiandentalacademy.com
  12. 12. Lower Lingual Holding Arch • MANDIBULAR ONLY • Bands on first permanent molars • Anterior Stop = Cinguli of #23-#26 www.indiandentalacademy.com
  13. 13. Lower Lingual Holding Arch • Mandibular incisors often erupt lingually and are pushed forward by the tongue • LLHA should not be placed with primary incisors www.indiandentalacademy.com
  14. 14. #K and #T Extractions : LLHA Indicated? • NO- note lingual eruption #23 and #26 • Option: Reverse Crown and Loops #L-19 and #S-30. **LLHA will be placed 2-3 years later, prior to loss of #L and #S. Simply cut off loop and leave SSCs. www.indiandentalacademy.com
  15. 15. LLHA Omega Loops • Omega Loops in area of premolars allow slight adjustment to fit appliance • Should not be used to activate appliance www.indiandentalacademy.com
  16. 16. Appliance Activation Features • Can be added by attaching light wire features • This is beyond routine space maintenance www.indiandentalacademy.com
  17. 17. Band/Crown and Loop • MAXILLARY or MANDIBULAR • Unilateral most typical • Can be bilateral if permanent teeth are not present • Single tooth span www.indiandentalacademy.com
  18. 18. Crown and Loop • Stronger than band and loop • Cementation failure or loss less likely • Excellent choice if tooth needs a restoration www.indiandentalacademy.com
  19. 19. What About Removable Appliances? • Yes, they are possible, however……….. • High failure rate due to breakage and loss • Parent and patient compliance must be exceptional www.indiandentalacademy.com
  20. 20. Which Space Maintainer? • Distal Shoe = 2nd Primary Molar Extraction with unerupted 1st Permanent Molar • Nance or Band/Crown Loop = Maxillary problem with 1st Permanent Molars present • Lower Lingual Holding Arch = Mandibular Problem with 1st Permanent Molars and Permanent Incisors present • Band/Crown and Loop= Primary 1st Molar Extraction www.indiandentalacademy.com
  21. 21. Must I Plan to Replace a Band/Crown and Loop ? • All depends on ERUPTION SEQUENCE – No, in maxillary arch – Yes, in mandibular arch- may need LLHA later – Why? Canine should exfoliate prior to eruption of 1st premolar, making space maintainer defunct. www.indiandentalacademy.com
  22. 22. Space Maintainer Competency • The following cases require space maintainer consideration. Assume that radiographs have been taken, there is no abnormal pathology (other than dental caries), and a successor is developing. • Please answer the questions on your worksheets. www.indiandentalacademy.com
  23. 23. Question 1 • What tooth was extracted? How old is this child? • What is the appropriate space maintainer? • Will it have to be replaced with a different space maintainer in the future? If so, with what? www.indiandentalacademy.com
  24. 24. Question 2 • What tooth was extracted? How old is the child? • What is the appropriate space maintainer? • Will it have to be replaced with a different space maintainer in the future? If so, with what? www.indiandentalacademy.com
  25. 25. Question 3 • Which teeth were extracted? How old is the patient? • What is the appropriate space maintainer? • When can the space maintainer be removed? www.indiandentalacademy.com
  26. 26. Question 4 • Which teeth were extracted/ • What is the appropriate space maintainer? www.indiandentalacademy.com
  27. 27. Question 5 • Which teeth have been extracted? How old is the child? • What is the most appropriate space maintenance? www.indiandentalacademy.com
  28. 28. “Cheyenne” Case • Cheyenne presented for an initial visit at the COD. She has had dental treatment on and off throughout life. She is in no pain, but mom reports that “we know she has dental problems.” www.indiandentalacademy.com
  29. 29. How old is Cheyenne assuming normal dental development? www.indiandentalacademy.com
  30. 30. Cheyenne‟s Bite Wings www.indiandentalacademy.com
  31. 31. Mandibular Arch Only: Chart Dentition on the Odontogram www.indiandentalacademy.com
  32. 32. Cheyenne • Mandibular Arch Only : Chart abnormalities and pathology (including caries ) from the Panorex and Bite Wing Radiographs www.indiandentalacademy.com
  33. 33. www.indiandentalacademy.com
  34. 34. Cheyenne A Moyer‟s space analysis predicted there to be 2.3 mm of excess space in the mandible. Make a treatment plan and appointment sequence for the mandibular arch only. www.indiandentalacademy.com
  35. 35. www.indiandentalacademy.com
  36. 36. Cheyenne • Assuming normal dental development, at what age will the space maintainer you placed no longer be needed? www.indiandentalacademy.com
  37. 37. “Justin” Case • Justin was referred by his general dentist for „ tooth decay and crowding.‟ • The family does not believe they can afford comprehensive orthodontic care, but does have dental insurance for “routine dental care.” www.indiandentalacademy.com
  38. 38. Justin: Chart Maxillary Dentition Only on the Odontogram www.indiandentalacademy.com
  39. 39. Justin‟s Bite Wings • Chart any pathology or abnormal findings (including caries) for the maxillary arch only on the odontogram. www.indiandentalacademy.com
  40. 40. Justin www.indiandentalacademy.com
  41. 41. Justin A Moyer‟s space analysis predicts 1.2 mm of space shortage in the maxilla Treatment plan and sequence appointments for the Maxillary Arch Only www.indiandentalacademy.com
  42. 42. Justin www.indiandentalacademy.com
  43. 43. Discussion www.indiandentalacademy.com
  44. 44. Question 1 • 5 or 6 y.o. child. Tooth #I extracted. www.indiandentalacademy.com
  45. 45. Question 1 • Band/Crown and Loop #J-H • Will not need replacement. #12 should erupt before #H or J exfoliate www.indiandentalacademy.com
  46. 46. Question 2 • Tooth #L extracted. 3-5 y.o. child. • What is the appropriate space maintainer? • Will it have to be replaced with a different space maintainer in the future? If so, with what? www.indiandentalacademy.com
  47. 47. Question 2 • Band/Crown Loop #K-M • May need to be replaced by LLHA later. Tooth #M should exfoliate prior to eruption #21. www.indiandentalacademy.com
  48. 48. Question 3 • Teeth #A and #J extracted. Patient 8-9 y.o. www.indiandentalacademy.com
  49. 49. Question 3 • Nance #3-#14 • Can be removed when #4 and #13 erupt-around age 12 www.indiandentalacademy.com
  50. 50. Question 4 • Teeth #K and L extracted www.indiandentalacademy.com
  51. 51. Question 4 • Lower Lingual Holding Arch (LLHA) #19-#30 www.indiandentalacademy.com
  52. 52. Question 5 • Teeth #K and #S extracted. 5-6 y.o. child. • Because permanent incisors are not erupted, LLHA not recommended. Options: Reverse band and loop #L-#19 and band and loop #T-#R. www.indiandentalacademy.com
  53. 53. “Cheyenne” • Cheyenne presented for an initial visit at the COD. She has had dental treatment on and off throughout life. She is in no pain, but mom reports that “we know she has dental problems.” www.indiandentalacademy.com
  54. 54. Assuming normal dental development, Cheyenne is 8 years old. www.indiandentalacademy.com
  55. 55. Cheyenne • Mandibular Arch Only : Chart abnormalities and pathology (including caries ) from the Panorex and Bite Wing Radiographs www.indiandentalacademy.com
  56. 56. www.indiandentalacademy.com
  57. 57. Cheyenne • Teeth Present: 19, K,L,M,23,24,25,26,R,S,T,30 Restorations: SSC #L Pathology/Caries: #L and #S abscessed, #28 severely ectopic. www.indiandentalacademy.com
  58. 58. Cheyenne A Moyer‟s space analysis predicted there to be 2.3 mm of excess space in the mandible. Make a treatment plan and appointment sequence for the mandibular arch only. www.indiandentalacademy.com
  59. 59. www.indiandentalacademy.com
  60. 60. Cheyenne Tx Plan • Extract #L,S and T and Place LLHA • #L and S due to abscess • #T due to ectopic #28 – Appt #1: Fit bands and Impress for LLHA Extract #L – Appt. #2: Seat LLHA Extract #S, T www.indiandentalacademy.com
  61. 61. Cheyenne • Assuming normal dental development, at what age will the space maintainer you placed no longer be needed? • Answer: When #21,28 and 29 erupt. • Around age 12 years www.indiandentalacademy.com
  62. 62. “Justin” Case • Justin was referred by his general dentist for „ tooth decay and crowding.‟ • The family does not believe they can afford comprehensive orthodontic care , but does have dental insurance for “routine dental care.” www.indiandentalacademy.com
  63. 63. Justin www.indiandentalacademy.com
  64. 64. Justin A Moyer‟s space analysis predicts 1.2 mm of space shortage in the maxilla Treatment plan and sequence appointments for the Maxillary Arch Only www.indiandentalacademy.com
  65. 65. Justin • Teeth Present: #3,A,B,C,7,8,9,10,H,12,J,14 • Restorations: #A-MO, #B-DO. • Pathology/Caries: #3-M; #A-D; #B-M; #H-D;#J-abscess, #14-MO Note: #6 and #11 very advanced root development. www.indiandentalacademy.com
  66. 66. Justin www.indiandentalacademy.com
  67. 67. Justin Tx Plan • Extract all maxillary primary teeth – #A,B,J- Multiple caries and near exfoliation – TE #C and #H due to root formation #6 and #11 • Restore #3 with direct M composite • Restore #14-MO • Place Nance Space Maintainer- slight space deficiency, but this will be very beneficial. www.indiandentalacademy.com
  68. 68. Justin Tx Sequence • Appt 1 – Fit bands #3 and #14 and Impress for Nance – Restore #14 – TE #H and #J • Appt 2 – Restore #3 – Seat Nance – TE # A,B,C www.indiandentalacademy.com
  69. 69. Please Evaluate This Teaching Module Thank You! www.indiandentalacademy.com

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