This document provides information on band and loop space maintainers. It begins by introducing space maintainers and their objectives in maintaining arch integrity and guiding eruption of permanent teeth. It then discusses different types of space maintainers, including removable, fixed, functional and non-functional varieties. Specific appliances like band and loop, lingual arch, and distal shoe are explained. The document outlines the indications, contraindications, advantages and disadvantages of band and loop space maintainers. It provides details on the materials and instrumentation used in fabricating band and loop space maintainers. Overall, the document serves as an overview of band and loop space maintainers, their classification, objectives, considerations and fabrication.

1. BAND AND LOOP SPACE
MANTAINER
PRESENTED BY : DR KRITIKA SINGH
JR:3
DEPARTMENT OF PEDIATRIC & PREVENTIVE
DENTISTRY KGMU LKO
1

2. Introduction
 A healthy primary dentition preserves space for
permanent teeth and maintains arch integrity.
 Diverse dietary patterns make children more
susceptible to dental caries.
 Space maintainers guide the eruption of the
permanent teeth and obviate the need for
complex orthodontic treatment later.
2

3. Boucher’s :
 Space maintainer is a fixed or
removable appliance designed to
preserve the space created by the
premature loss of a tooth/teeth.
WHAT IS A SPACE
MAINTAINER
3

4. WHAT ARE ITS
OBJECTIVES?
 Preservation of primate spaces
 Preservation of the integrity of the dental
arches
 Preservation of normal occlusal planes
 Anterior space maintenance should aid in
Esthetics and phonetics.
4

5. Tulley and Camp bell indicated the
situations in which space may be
maintained with some advantage which are
as follows:
 Acceptable dentition where early loss
occurs in one or both quadrants of the
lower arch.
 Class II malocclusions with early loss in the
lower arch
 class III malocclusions with early loss in the
upper arch
5

6. PRE
REQUISITES
maintain the functional
movements of the
teeth.
S/N impose
excessive
stresses on
remaining
teeth
mesiodistal
dimension
S/B
functional if
possible
S/B simple
and strong.
S/N interfere with
the normal
vertical eruption
of the adjacent
teeth
S/N interfere
with normal
occlusion
6

7. PRE
REQUISITES
have
universal
application
reasonabl
e in cost.
durable
and
corrosion
resistant
Provide
mesiodistal
space
opening
easily
adjustable
S/N interfere
with functions
as
mastication,
speech or
deglutition
S/N restrict
normal growth
and
developmental
processes.
easily
cleansed
7

8. CLASSIFICATION
Raymond C Thurow :
 Removable
 Complete arch
 Lingual arch
 Extra oral anchorage
 Individual tooth space maintainer
Hitchcock :
 Removable or Fixed or Semifixed
 With bands or without bands
 Functional or Nonfunctional
 Active or Passive
 Combinations of above
Sidney B. Finn. Textbook of Clinical Pedodontics. 4th ed. Philadelphia: WB Saunders 1973.
8

9. Hinrichsen
1962
Fixed space
maintainer
Class I
Functional
Pontic type
Lingual arch
Non-Functional
Bar type
Loop type
Class II Cantilever type Distal shoe type
Removable
Acrylic partial
dentures
Sidney B. Finn. Textbook of Clinical Pedodontics. 4th ed. Philadelphia: WB Saunders 1973.
9

10. 10

11. 11

12. TREATMENT CONSIDERATIONS-
These following considerations are important to the dentist
when space maintenance is considered after loss of primary
tooth:
1.Time elapsed since loss
2.Amount of Space loss
3. Dental age of the patient/ Eruption pattern
4. Amount of bone covering the unerupted tooth
5.Congenital absence of the permanent tooth
6.Congenital absence of the permanent tooth
7.Oral musculature and habits
12
(McDonald & Avery’s Dentistry for the child and adolescent)

13. APPLIANCE THERAPY
 Fixed space maintainers-
 Band & loop space maintainer
 Trans palatal arch
 Distal shoe.
 Lingual arch.
 Band &.Bar type space maintainer
 Crown & loop
 Esthetic anterior space maintainer
Removable space maintainers-
• Removable distal shoe
• Full or complete dentures
• Acrylic partial dentures.
13

14. Four appliances that are most commonly used to
maintain space in the mandibular primary dentition-
 The Band & Loop
 The Lingual Arch
 The Distal Shoe
 The Removable Appliance
14

15. 15

16. Fixed space maintainers
ADVANTAGES:
1. Bands and crowns are used which require minimum or no
tooth preparation.
2. They do not interfere with passive eruption of abutment teeth.
3. Jaw growth is not hampered.
4. The Succedaneous permanent teeth are free to erupt in to the
oral cavity.
5. They can be used in un-co-operative patients.
6. Masticatory functions is restored if pontics are placed.
16

17. DISADVANTAGES:
1. They may result in decalcification oft tooth material
under the bands.
2. Supra eruption of opposing teeth.
3. If pontics are used it can interfere with vertical eruption
of the abutment tooth & may prevent eruption of
replacing permanent teeth if patient fails to report.
17

18. Band and loop is which type
of space maintainer?
 Fixed
 Unilateral
 Non functional
 Passive
18

19.  Premature loss of any primary
molar
 Premature loss of a primary 2nd
molar as the PFM is erupted
 Bilateral loss of primary molar
before eruption of permanent
incisors.
INDICATIONS
BY
MATHEWSON
19

20.  Extremely crowded dentition
 High caries activity
 Replacement of primary anterior teeth.
 Replacement of primary 2nd molar
without eruption of PFM
 Cases that need guidance of eruption
 Not indicated to manage leeway space
(McDonald’s)
CONTRAINDICATION
20
BY
MATHEWSON

21. FABRICATION OF FIXED SPACE
MAINTAINER
Text bookof pediatric dentistry : nikhil marwa , 2nd
21
BAND CONSTRUCTION
IMPRESSION MAKING AND CAST
PREPARATION
LOOP FABRICATION
SOLDERING
POLISHING
CEMENTATION
FABRICATIO
N

22. ARMAMENTARIUM
 Stainless steel band material or
Preformed bands
 Pliers
• Contouring pliers
• Band forming plier
• Band seater or pusher
• Band adapter
• Howe pliers (straight &
curved)
• Band cutting scissors
• Bird beak plier
Text bookof pediatric dentistry : nikhil marwa , 2nd
edition,
22

23. - Crimping plier
- Three pronged plier
- Universal plier
Stainless steel wires
 Spot welding unit, soldering unit, silver
solder, flux,alcohol water mixture
 Wire cutter
 Finishing burs, polishing stones.
Text bookof pediatric dentistry : nikhil marwa , 2nd
23

24. Meherson band pusher
Nylon band seater
Oliver jones band removinmg plier
24

25. Johnson contouring plier(no 114)
Howe plier
25

26. Band forming plier/ peak plier
Bird beak plier (no. 139)
26

27. BAND CONSTRUCTION
ACCORDING TO FABRICATION
LOOP BANDS
a) Precious metal
(first introduced by Johnson)
b) Chrome alloy bands
TAILORED BANDS
a) Precious metal
b) Chrome alloy
Text bookof pediatric dentistry : nikhil marwa , 2nd
27

28. PREFORMED SEAMLESS BANDS
1-32 range
ACCORDING TO BAND MATERIAL
Anterior teeth - 0.003 X 0.125 X 2 inches
Bicuspids - 0.004 X 0.150 X 2 inches
Primary molars - 0.005 X 0.180 X 2 inches
Permanent molars - 0.006 X 0.180 X 2 inches
Text bookof pediatric dentistry : nikhil marwa , 2nd
28

29. BAND CONSTRUCTION PROCEDURE
Text bookof pediatric dentistry : nikhil marwa , 2nd
29
SEPARATIO
BAND
FORMATIO
WELDING SOLDERING

30. ELASTIC THREADBRASS WIRE
Elastic threads0.015-0.020 INCH
soft brass wire
Gentle force over
prolong time
period
Young patient with
thick periodontal
membrane
Painless at
insertion
Painful at insertion
SEPARATION
depts.washington.edu/peddent/AtlasD
30

31. Text bookof pediatric dentistry : nikhil marwa , 2nd
BAND CONSTRUCTION
DIRECT BAND FORMATION
(PINCHING)
Weld the ends of the band material and make
a loop.
• Inciso-cervical or occluso
cervical contouring using -Johnsons
contouring pliers
31

32. Upper molar band: pulled from
palatal side (seam at mesio-
lingual line angle)
Pinch on the cuspal areas & not on groove
areas
Lower molar
band: pulled
from buccal
side (seam at
mesio-buccal
line angle)
Text bookof pediatric dentistry : nikhil marwa , 2nd
32

33. Festooning is done with curved scissors.
Crescent shaped pieces of band are
removed from cervical area mesially & distally
in order to follow the gingival margin
proximally.
FESTOONING
The distal surface may require more trimming
because of the lower position of the
marginal ridge as well as due to the raised
position of the gingiva.
Text bookof pediatric dentistry : nikhil marwa , 2nd
33

34. Mark the excess ; buccal & lingual
Mesially & distally, occlusal surface
of band should be just below the
crest of the mesial marginal ridge &
just above the contact area
Text bookof pediatric dentistry : nikhil marwa , 2nd
TRIMMING
34

35. Hold the band firmly with the
help of finger pressure from
buccal aspect & pinch the band
with beak pliers.
After placing, pull it from lingual
aspect squeezing the excess out.
Text bookof pediatric dentistry : nikhil marwa , 2nd
35

36. Trim any sharp points & polish
the band before refitting
Text bookof pediatric dentistry : nikhil marwa , 2nd
36

37. Properly adapted molar band
Occlusal margin of band is apical to the
Proximal ridges
gingival margin of the band is in the gingival
sulcus
Band snugly adapted top the tooth surface
Band is out of occlusion
37

38. BAND AND LOOP
• Band: stainless steel material
0.005 inches in thickness
• Crib: portion of the wire
spanning the edentulous space
• Loop: portion of the wire
contacting the abutting tooth
0.032 inches in diameter
38

39. Design of Band Loop Space Maintainer
The mesial end of the loop contacts the
distal surface of the first primary molar
at a point just below the height of
contour.
The wire should be above the gingiva at
the point of contact with the abutment
tooth
39

40. Design of Band Loop Space Maintainer
The central portion of the loop is shaped wide
enough to allow the full eruption of the permanent
tooth.
 The facio-lingual dimension should be approximately
8mm.
 The loop should be contoured to follow the
edentulous ridge, but 1mm off the tissue
The anterior curve of the loop is shaped to
approximate the shape of the distal surface of the
abutment tooth and to match its width.
40

41. S- Bend
Mark wire far enough mesially to allow the finished s-bend to be
completed before reaching the band.
Purpose of S-bend
 Allows transition of wire from the ridge to band
without impinging on the gingival tissues
41

42. Distal Ends
- Use simple bends to contour the
wire so it contacts the band near the
mesial line angle and remains in
contact for the full length of the
band
- Cut away any excess wire or plaster
that interferes with fitting
42

43. Band and Loop SM Disadvantages
1. Masticatory function not restored.
2. Extrusion of opposing dentition not prevented
3. Normal distal movement of primary cuspids during
eruption of permanent lateral incisor Not allowed if
placed for the early loss of mandibular 1st primary
molar.
4.tendency for disintegration of cement and increased
chairside and laboratory time.
43

44. Modifications and
advancement in band
and loop space
maintainer
1. 3D-printed band and loop space
2. Functional Band and Loop Space
Maintainers in Children
3. Band and loop with STOPPERS
4. BAND & BAR SPACE MAINTAINER
5. CROWN AND LOOP
6. REVERSE BAND & LOOP
7. MAYNE SPACE MAINTAINER
8. Ribbond
9. EXTENDED BAND & LOOP
10.Direct technique or Single sitting
technique
44

45. Maintenance of space by innovative
three-dimensional-printed band and loop space
maintainer
• A new technology of
three-dimensional (3D) printing also
known as additive manufacturing or
desktop fabrication has been recently
introduced.
• It is a process of making 3D solid
objects from a digital file
Pawar BA. Maintenance of space by innovative three-dimensional-printed band and loop space maintainer. J Indian Soc
Pedod Prev Dent 2019;37:205-8.
45

46.  Single-step impression - addition silicon and make
a cast.
 The cast -3D printing laboratory for scanning and
printing a metal-based SM .
 cementation by using glass ionomer cement (Type
2; GC Fuji; Tokyo, Japan)
The patient was instructed not to eat or drink for 30
min and not to bite on any hard food. The patient was
recalled after 3 months
Advantages :
• 3D-printed SM is precise, quick, and easy.
• Development and perfection of 3D printing
technology allow production of information in
3Ds with accuracy.
46

47. Text bookof pediatric dentistry : nikhil marwa , 2nd
47STOPPERS can be used to prevent gingival as well as
buccal movements of loop.

48. • BAND & BAR
48
Abutment teeth on
either side of the
extraction space are
banded and
connected to each
other by bar

49. pinkham
49
In extraction sites woven polyethylene
fibres (RIBBOND) were placed as a space
maintainer.
• Ribbond provides an excellent esthetic
choice as a space maintainer.
• It is well tolerated by the patient,
less time consuming.
Journal of Clinical and Diagnostic Research. 2013 Oct, Vol-7(10): 2402-2405 2403
Woven polyethylene fibres (Ribbond)

50. CROWN AND LOOP
- band is adapted over the crown & soldered to
it
Indications:
• Highly carious
• Exhibits marked hypoplasia
50

51. • There is the premature loss of the
primary 2nd molar & the permanent
molar are not fully erupted.
• Primary 1st molar is banded & a loop
is made that touches just below the
marginal ridge of permanent molar.
Text bookof pediatric dentistry : nikhil marwa , 2nd
51
REVERSE BAND & LOOP

52. MAYNE SPACE MAINTAINER (W.R Mayne)
Nonfunctional space maintainer that permits
minor adjustments for space control while
the tooth is erupting.
Indications :
• The abutmenttooth is rotated
• The permanent tooth is almost
erupting
• When theloop is going to be a
restrictionfor theeruption of the
permanent tooth
© 2018 International Journal of Pedodontic Rehabilitation | Published by Wolters Kluwer - Medkno
52

53. 8) EXTENDED BAND & LOOP 53

54. Functional Band and Loop Space
Maintainers in Children
 Fabrication - construct a conventional band and loop space maintainer in the region
of premature tooth loss and placement of an acrylic tooth in the edentulous area.
54
V. Vinothini ,1 V. Vinothini; drvinumds@gmail.com Published 24 April 2019

55. Advantages-
(1) Aids in mastication.
(2) Prevents supra eruption of the opposing tooth.
(3) Distribution of occlusal forces on the pontic and hence less chance of
loop distortion/slippage and impingement in gingiva.
4.Prevents the development of abnormal tongue habits.
55
V. Vinothini ,1 V. Vinothini; drvinumds@gmail.com Published 24 April 2019

56. Limitations
(1) Direct visualization of the eruption of the
successor is not possible.
(2) Cement loss and solder failure can be possible
reasons for failure of this appliance. Hence, quality
designing of the appliance, close supervision, and
frequent follow-ups at 2-4 month interval are
imperative.
56
V. Vinothini ,1 V. Vinothini; drvinumds@gmail.com Published 24 April 2019

57. J indian Soc Ped Prev Dent September (2004) 22 (3) 134-136
“Direct technique or Single sitting technique”
57
Prefabricated band and loop
ADVANTAGES
 Single sitting procedure
 No impression making
 Lesser chair side time
 Lesser laboratory time
 Better accuracy
 Easy fabrication

58. 58
The overall benefits of using space maintaining
appliances include reduced prevalence or severity
of:
• crowding, ectopic eruption, tooth impaction,
crossbite, excessive overbite and overjet, and
poor molar relationship.
• Potential for considerable cost savings by
reducing the need for future orthodontic
treatment.

59. 59
Conclusions –
The band and loop space maintainer is used in majority
of patients requiring single tooth space maintenance in
both primary and mixed dentitions.
It preserves the proximal dimensions, but
masticatory function and maintaining arch integrity in
early loss of the primary teeth are challenging tasks.
so in such types of case ,The functional band
and loop space maintainer will be a good choice for in
very young children.

60. 60