Pedodontics III Al Azhar University Palestine Gaza Upload By: Lama El Banna Faculty of oral and dental medicine

1. ‫الرحيم‬ ‫الرحمن‬ ‫هللا‬ ‫بسم‬
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2. College of Dentistry
Pedodontic II
Management of Space Maintenance
Problem in Children -3-
Dr. Hazem El Ajrami
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3. B. Space maintenance for the second primary
molar area:
The loss of second primary molar usually
has little effect on teeth in the anterior
segment. However, the irregularity will
develop in the permanent molar relationship.
The end result of premature loss of the
second molar is the mesial drifting of the first
permanent molar with an impaction of the
second premolar.
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4. 1. Space maintenance for the second primary
molar area after the eruption of the first
permanent molar:
The same as that recommended when the
first primary molar is lost, i.e. band and loop
or stainless steel crown and loop.
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5. 2. Space maintenance for the second primary
molar area before eruption of the first
permanent molar:
Mesial movement and migration of the
first permanent molar will often occur prior
to eruption in case of premature loss of the
second primary molar. So a space maintainer
that will guide the first permanent molar into
its normal position is indicated such as crown
or band maintainer with distal shoe
extension. The first primary molar is used as
the abutment tooth.
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6. C. Space maintenance for the primary canine
area:
If loss of primary canine occurs before the
eruption of the permanent lateral incisor there
is always shift of the midline and space
closure. If it is lost and there has been no shift
in the midline or space closure a band or
crown and loop maintainer can be used. The
first primary molar is used as the abutment
tooth.
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7. D. Space maintenance for the first primary
incisors area:
If spacing between the anterior teeth is
present, there is little possibility that drifting of
the adjacent teeth will occur with resultant loss
of space needed for eruption of the permanent
teeth. However, if the anterior primary teeth
were in contact before the loss or if there is
evidence of an arch length inadequacy in the
anterior region, a collapse of the arch
following loss of the primary incisors is almost
certain. In some patients, even the primary
canines drifted mesially out of their normal
relationship.7

8. 1. Removable partial denture: It produces the
desirable esthetic appearance, reestablish
function and prevent the possibility of
abnormal speech and tongue habits. Acrylic
partial dentures can be constructed for very
young children, if there is a degree of co-
operation and interest. A removable partial
denture should not be used if there is severe
dental caries problem, if the child will not
keep the mouth clean to reduce the possibility
of dental caries activities, or if the child is
uncooperative, i.e. he will not wear the partial
denture or there is possibility of loosing or
breaking it.8

9. Advantages:
1) Maintain vertical dimension and prevents
over eruption of opposing teeth.
2) Restore masticatory function .
3) Restore esthetic in case of anterior tooth loss.
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10. Disadvantages:
1) Often lost or broken.
2) Patient compliance and cooperation essential.
3) Require supervision to assure compliance as
well as adjust to changing conditions.
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11. 2. Modified fixed partial denture:
Bands will be adapted on the last molars
in the arch, a wire arch will be adapted on the
bands touching the lingual surfaces of
posterior teeth passively and passing over the
crest of the ridge of the edentulous area and
acrylic base will be applied engulfing the
wire.
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12. E. Space Maintenance for the permanent
incisors area:
The loss of anterior permanent teeth requires
immediate treatment by the dentist. Within few
days following the loss of a tooth as a result of
trauma or extraction, the teeth adjacent to the
space will begin to drift and even within few
weeks, several millimeters of the space will be
lost. An impression should be taken at the time
of the initial appointment or within few days.
The temporary appliance can then be
constructed and inserted within a matter of
hours after the loss and thus prevent space
closure.12

13. • If any degree of space closure has occurred
after the loss of an anterior tooth, the space
should be regained before the construction of a
space maintainer. If the child has no other
irregularities in the occlusion that require the
attention of an orthodontist, the general
practitioner can complete the treatment. A
partial denture working appliance can be used
successfully in this procedure, if there is no
necessity for bodily movement of teeth.
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14. • Cervical clasps should be adapted to the first
permanent molars to aid in retention of the
appliance. Finger springs should be contoured
to the teeth to be repositioned. The wire should
be placed as far cervically as possible. Finger
springs should be adjusted each 2-3 weeks.
• A temporary tooth replacement may be made
to improve the child's appearance. After the
space has been regained, a new partial denture
can be constructed to serve until the time a
fixed replacement can be considered.
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15. • The loss of an anterior tooth occasionally
occurs before the eruption of an adjacent tooth
for example, if a maxillary permanent central
incisor is lost prior to the eruption of the lateral
incisors, the lateral will drift mesially during
its eruption. The addition of an acrylic
extension into the alveolus will normally be
successful in guiding the unerupted tooth into
position.
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16. F. Space maintenance for the area of
multiple loss of the teeth:
1. Acrylic partial denture:
Indicated when there has been
bilateral loss of more than a single tooth it
can be easily adjusted to allow for the
eruption of teeth. As artificial teeth are
included in the denture, it restores normal
masticatory function. However, from its
disadvantages, that it is easily broken from
a child.
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17. • If the appliance is removed from the mouth
even for few days, changes in the denture base
will occur and drifting of teeth may make it
impossible for the child to replace the
appliance unless extensive adjustment has to
be done by the dentist. There is a possibility of
the development of new carious lesions unless
proper cleaning of the teeth and denture is
performed.
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18. • From the retention point of view, stainless
steel wire clasps are contoured for the canines
if they are present and stainless steel wire rests
for die molars. If the permanent incisors are in
an active state of eruption, it is advisable to
remove the clasps after the child has become
accustomed to wear the appliance to allow the
distal drifting and lateral movement of the
canines and alignment of the permanent
incisors.
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19. • If the loss of one or both of the second primary
molar occurs a short time before the eruption
of the first permanent molars, the acrylic
partial denture may be preferable than the
distal shoe type maintainer. The distal border
of the acrylic should approximate the mesial
surface of the unerupted first permanent
molars. Scraping the model in this area to
produce an accentuated post dam may
influence the first permanent molar favorably
in its eruption.
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20. 2. Passive lingual arch:
It is sometimes the space maintainer of
choice following the multiple loss of teeth in
the maxillary or mandibular arch. Although it
does not satisfy the requirements of restoring
function, the appliance has many advantages. It
eliminates the problem of patient cooperation,
there is no breakage problem, no concern
whether the child is actually wearing the
appliance and the problem of increase in dental
caries activity is considerably lessened.
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21. Passive lingual arch
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22. • Orthodontic bands are adapted on the first
permanent molars or the most posterior teeth
in the arch. An alginate impression of the
entire arch is taken, the bands are removed
from the teeth placed in the impression and a
stone model is prepared. 0.8 mm. stainless
steel wire should be contoured to the arch
extending forward and making contact with the
cingulum portion of the incisors at the gingival
margin order that the arch wire will not
interfere with them.
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23. • The arch wire should be extended posteriorly
along the middle third of the lingual surfaces
of the molar bands and soldered in this
position in an inactive state. After polishing, it
can be cemented in the mouth, after polishing
the abutment teeth and drying them. The
appliance should be entirely passive to prevent
undesirable movement of the teeth.
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24. 3. Active lingual arch:
In case of multiple loss of teeth and loss
of space in older children where the first
permanent molars and mandibular and
maxillary incisors are fully erupted. This
active lingual arch (with U loops) will be
constructed and the bands will be cemented
to the first permanent molars. Before
insertion of the arch the U loops will be
activated thus, it will act on the molars to
distalize them.
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25. 4. Transpalatal bar:
Bands will be adapted to the maxillary first
permanent molar and a bar adapted to the
palate will be soldered to the bands, thus
preventing the maxillary molars from mesial
movement as it rotates around its palatal root.
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26. Transpalatal bar
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27. 5. Active transpalatal bar:
When there is mesial movement of the
maxillary first permanent molar with rotation
a U loop will be constructed to distalize and
regain the original position of the maxillary
molars.
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28. 6. Full dentures for children:
Some children may have all of their teeth
removed because of the wide spread of oral
infection or because the teeth are extensively
decayed and or in cases of complete
anodontia. Young children can put complete
dentures successfully before the eruption of
the permanent teeth.
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29. G. Space maintenance for the first permanent
molar area:
1. Loss of first permanent molar after
eruption of the second permanent molars:
When the first permanent molar is lost
after the eruption of the second permanent
molar, consultation with the orthodontist is
desirable, and the following points should be
considered.
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30. • Is the child in need of corrective treatment
other than in the first permanent molar area?
Should the space be maintained for fixed
bridge work? Or should the second molar be
moved forward bodily into the area formerly
occupied by the first molar? The latter choice
is almost satisfactory even though there will
be a difference in the number of molars in the
opposing arch. A third molar can often be
removed to compensate for the difference.
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31. • If it is decided that the space should be
maintained by band or stainless steel crown and
loop space maintainer can be constructed. A
modified fixed bridge can also be used although
gingival recession will continue and margin of
restoration may be exposed. It can be replaced
with another bridge after completion of growth
and ceasing of all active and passive eruption.
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32. 2. Loss of the first permanent molar before
the eruption of the second permanent
molar:
If no treatment is performed, the second
permanent molar will drift mesially prior to
eruption. Repositioning of this tooth by the
orthodontist is possible after its eruption.
However, the child must then be considered
for prolonged space maintenance until the
time when a fixed bridge can be constructed.
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33. • If the first permanent molars are removed
several years prior to the eruption of the second
permanent molar, there is an excellent chance
that second molars will erupt in an acceptable
position. However, the axial inclination of the
second molars, particularly in the lower arch,
may be slightly greater than normal.
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34. • The decision to allow the second molar to drift
mesially or to be guided forward in an upright
position may be influenced by the presence of a
third molar of normal size. If there is a question
regarding the favorable development of a third
molar on the affected side, then the decision to
reposition the drifted second molar and hold it
for fixed bridge work is the treatment of choice.
If it is decided that the space should be
maintained, band and loop or stainless steel
crown and loop with distal shoe extension is the
space maintainer of choice.
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35. The above mentioned classification of space
maintainers can be summarized in the
following:
Classification according to function
restoration:
Functional.
Non-functional.
Classification according to activity:
Active.
Passive.
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36. Classification according to retention means:
Fixed.
Semifixed.
Removable.
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37. Thank You
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