Pedodontic Fifth-year First semester By Lama El Banna Al Azhar University Gaza Palestine

1. ‫الرحيم‬ ‫الرحمن‬ ‫هللا‬ ‫بسم‬
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2. College of Dentistry
Pedodontic II
Management of Space Maintenance
Problem in Children -2-
Dr. Hazem El Ajrami
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3. • Space Maintainers:
There are numerous types of space
maintainers. They range from the very simple
to those with numerous bands and wires.
They can be constructed differently and used
in different parts of the mouth.
• Indications:
I. The premature loss of primary molars may
require the placement of a space maintainer
to prevent the migration of the adjacent
teeth, depending upon the teeth present and
the arch length.
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4. II. When loss of a primary canine occurs, the
dental arch midline may be compromised
and the arch length may be reduced. The
premature loss of primary canines may
therefore require the placement of a space
maintaining appliance to prevent midline
deviation and/or loss of arch length,
perimeter.
III. The premature loss of primary incisors does
not usually require the placement of a
dental appliance for the maintenance of
space because mesial movement of the
adjacent teeth is not generally expected.
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5. • Contraindications:
A space maintainer is usually not necessary if
there is a sufficient amount of space present to
allow for eruption of permanent tooth/teeth.
A space maintainer may not be recommended
if severe crowding exists, such that space
maintenance is of minimal effect and
subsequent orthodontic intervention is
indicated.
A space maintainer may not be necessary if
the succedaneous tooth will be erupting soon.
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6. • Requirements of an ideal space maintainer:
1) Maintain mesio-distal and vertical
dimensions of the space.
2) Not interfere with tooth eruption.
3) Allow individual functional movement of
teeth.
4) Not interfere with mesio-distal space
opening through natural growth.
5) Be esthetically pleasing in case of anterior
tooth loss.
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7. • Factors affecting constructions of space
maintainers:
1. The time factor.
2. Age.
3. Amount of bone covering the unerupted
tooth.
4. Degree of development of permanent
successor.
5. Sequence of the eruption of teeth.
6. Delayed eruption of the permanent tooth.
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8. 1. The time factor:
If space closure is to occur, it will usually
take place during the 6 months period following
extraction. After several years, following
premature extraction unfortunate changes may
occur in the occlusion. Even though space
closure has occurred, it may occasionally be
desirable to construct a space maintainer to aid in
the reestablishment of normal occlusal function
in the area, sometimes it is desirable to construct
an active space maintainer (space regainer) to
regain the lost space prior to holding it for the
eruption of the permanent successor.8

9. 2. Age:
The chronological age is not as important as
the developmental one. The average eruption
dates must not influence decisions regarding
the construction of a space maintainer. There is
too much variation in the eruption times of
teeth. It is not uncommon to observe premolars
erupting at age of 8 years, or retained primary
molars until age 15 years. The dentist must
depend upon x-ray to provide useful
information to when the tooth is going to erupt
instead of the eruption tables.
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10. 3. Amount of bone covering the unerupted
tooth:
This provides important information
regarding the eruption time. If there is an
amount of bone covering the crown of the
permanent successor, this indicates that still
many months before this tooth is going to
erupt but its bone is destroyed by, for
example, alveolar abscess related to the
primary predecessor, the tooth may erupt
before of its eruption date written in the
eruption table.
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11. 4. Degree of development of permanent
successor:
It has been proven that the developing tooth
does not move in its crypt until the complete
calcification of the crown and the beginning of
root formation. At the time of extraction of the
deciduous tooth, if the crown of the permanent
successor is not fully formed, there might be a
great chance of complete wound healing with
bone formation, and thus delay the eruption of
the permanent successor up to one year.
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12. • On the other hand if the extraction of the
deciduous tooth happened after the commence
of root formation of the permanent successor
the tooth might erupt earlier up to 6 months.
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13. 5. Sequence of the eruption of teeth:
The dentist should observe the relationship
of the developing and erupting teeth to teeth
adjacent to the space created by the premature
loss of primary tooth. For example, if a second
primary molar has been lost prematurely and
the second permanent molar is a head of the
second premolar in eruption, there is a
possibility that the second permanent molar
will exert a strong force on the first permanent
molar causing it to drift mesially and occupy
some of the space required by the second
premolar.
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14. 6. Delayed eruption of the permanent tooth:
Individual permanent teeth are often,
observed to be delayed in their development,
and consequently in their eruption. It is not
uncommon to observe partially impacted
permanent teeth or a deviation in the eruption
path that will result in abnormally delayed
eruption in case of this type it is usually
necessary to extract the primary tooth,
construct a space maintainer and allow the
permanent tooth to erupt and assume its
normal position.
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15. A. Space maintenance for the first primary
molar area:
The resulting effect of the premature loss of
the first primary molar on the occlusion
depends to some extent on the stage of
development of the occlusion at the time the
loss occurs. If the primary molar is lost during
the time of active eruption of the first
permanent molar a strong forward force will be
exerted on the second primary molar causing it
to tip into the space required for the eruption of
the first premolar.
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16. • Also, distal drifting of the primary canine is
likely to occur if the loss happened during the
active stage of eruption of the permanent lateral
incisors. There may be shifting in the midline
towards the space created by the premature loss
and a falling in of the anterior segment on the
affected side and increased overbite.
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17. 1. Band and loop maintainer:
A band and loop space maintainer is a
unilateral fixed space maintainer. It is likely
utilized in case of a single tooth loss; usually
the first primary molar or the second primary
molar if such occurs after the first permanent
molars have erupted.
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18. Advantages:
1) Ease of construction.
2) Low cost of the materials.
3) The appliance can give room for the erupting
permanent teeth.
4) Under the control of the dentist with no
necessity for patient compliance.
5) Can be used for very young patients.
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19. Disadvantages:
Will not restore masticatory function.
Will not prevent continuous eruption of the
opposing tooth.
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20. 2. Stainless steel crown and loop maintainer:
The stainless steel crown is indicated if the
posterior abutment tooth has extensive caries
and requires a crown restoration, or if the
abutment tooth has had vital pulp therapy, in
which case it is desirable to protect the crown
with full coverage. The loop may be cut off
and the crown is left to continue serve as a
restoration for the abutment tooth when there
is no longer need for the space maintainer.
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22. Thank You
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