This document discusses space maintainers, which are appliances used to maintain space lost prematurely due to tooth extraction. It defines space maintainers and classifies them as fixed or removable, functional or non-functional, unilateral or bilateral, active or passive, with or without bands, and combinations. Requirements for space maintainers are outlined, and removable, fixed, and specific types of space maintainers like distal shoe and crown and loop are described, including their advantages, disadvantages, and indications for use. Planning factors for space maintainers like time since tooth loss and dental age are also covered.

1. PROF (Dr.) SAIBEL FARISHTA
SPACE MAINTAINERS

2. DEFINATION
IT IS AN APPLIANCE GIVEN TO
MAINTAIN THE SPACE WHICH IS
LOST PREMATURELY.

3. CLASSIFICATION
1. Fixed / Removable.
2. Functional / Non - functional.
3. Unilateral / Bilateral.
4. Active / Passive.
5. With bands / without bands.
6. Combination of above.

4. • According to Hitchcock:
– Removable/fixed/semi-fixed
– With bands / without bands
– Functional / Non - functional
– Active / Passive
– Combinations
According to Raymond C Thurow
Removable
Complete arch
Individual tooth
Lingual arch
Extra-oral anchorage

5. According to Hinrichsen
Fixed Removable
Acrylic partial denturesClass I Class II
Non-Functional Functional
Bar Loop Pontic Lingual arch
Cantilever type
Distal shoe Band & loop

6. Requirements of Space maintainer
• To maintain M-D dimension created by lost tooth
• Must restore function as far as possible
• Prevent over eruption of opposing teeth
• Simple in construction
• Strong to withstand functional forces
• Should not exert excessive stress on adjoining
teeth
• Must permit oral hygiene maintenance
• Should not restrict normal growth &
development & natural adjustments which take
place during the transition from deciduous to
permanent dentition

7. Removable Space Maintainers
Helps in-
• Mastication
• Speech
• Esthetics
• To prevent space closure

8. Advantages
• Easy to clean
• Permits oral hygiene maintenance
• Can be worn part time allowing circulation of blood to
soft tissue
• Serve other function like mastication, phonetics &
esthetics
• Dental check-up for caries detection- possible
• Room for permanent teeth to erupt without changing the
appliance
• Stimulate eruption of permanent teeth
• Band construction is necessary
• Help prevent development of tongue thrust habit into
extraction space

9. Disadvantage:
• May be lost or broken
• Not effective in un-cooperative patients
• Lateral jaw growth may be restricted if clasps
are incorporated
• May cause irritation of underlying soft tissue
Contraindications
• Cannot be used in case of acrylic allergy
• Cannot be used in case of epileptic patients who
have uncontrolled seizures

10. If anteriors are missing ?????
Actually there is no needof treatment,
But…… considering Esthetics, speech, and psychological aspects………..
•Fixed,
•Bilateral,
•Functional,
•Passive,
•Withbands.

11. Anterior Space maintainer

14. Fixed Space maintainers
Advantages:
• Bands & crown are used which require minimum
or no tooth preparation
• Do not interfere with passive eruption of
abutment tooth
• Jaw growth is not hampered
• Succedaneous permanent tooth is free to erupt
• Can be used in uncooperative patients
• Masticatory functions is restored if pontics is
placed

15. Disadvantages:
• Elaborate instrumentation with expert
skills needed
• May result in decalcification of tooth
material under the bands
• Supra eruption of opposing teeth can take
place if pontics are not used
• If pontics are used it can interfere with
vertical eruption of abutment tooth & may
prevent eruption o for placing permanent
teeth if the patient fails to report

16. • E.g. of fixed space maintainers
– Band & loop
– Crown & loop
– Lingual arch
– Palatal arch appliance
– Trans palatal arch
– Distal shoe space maintainer
– Esthetic anterior space maintainer
– Band & bar type

17. DISTAL SHOE APPLIANCE
INDICATION
GIVENWHEN‘E’ IS EXTRACTED BEFORE THE
ERUPTIONOF ‘ 6 ‘
ALSO CALLED AS
- ERUPTION GUDING APPLIANCE
- WILLETTE‘S APPLIANCE
- INTRAGINGIVAL APPLIANCE
- ROCHE’S APPLIANCE
- MODIFIED ROCHE’S APPLIANCE
- STARKEYS APPLIANCE [ REMOVABLE DS]

18. E is to be extracted, according to
radiographic diagnosis

19. Tooth preparation of D for a
stainless steel crown

20. After the Stainless steel crown is
relocated in the impression, a plaster
study model is made.

21. Portion of the plaster model is
trimmed off to obtain necessary space
on the model.

22. Material to be used :
A ready made palatal bar of chrome
cobalt alloy, size 3.8mm in width and
1.3mm in height.

23. Fabrication of the distal shoe is
complete,and is ready to be soldered
to the stainless steel crown with silver
solder.

24. Completed
crown-distal -
shoe space
maintainer.

25. CROWN AND LOOP
Indications
•Premature loss of a first primary
molar.
•Premature loss of a second P molar
after the first permanent molar has
erupted or even after the distal-shoe
has been removed.

28. Passive lingual
arch

33. Nance appliance

37. Band and loop
Space
maintainer

38. If one side D is missing before the
eruption of 6 in mandibular arch
BAND AND LOOP
•Unilateral,
•Fixed,
•Non-functional,
•Passive,
•With bands.

39. IDEAL REQUIREMENTS :
--- Should maintain the mesiodistal
dimension of the tooth
--- Should not interfere with eruption of
adjacent teeth or permanent teeth
--- Should prevent supraeruption of
opposing tooth.
--- Should provide mesiodistal space
opening, if required
--- Maintain functional movements of teeth

43. Planning for Space maintainer
Following factors should be considered
• Time elapsed since the lost of tooth:
– Advised to place as soon as the primary tooth is removed
– Studies indicate maximum space lost with in 6 months.
• Dental Age of the patient:
– Should always be considered rather than chronological age
because of the variation in eruption of teeth observed
• Thickness of bone covering the un-erupted tooth
– The more the bone covering the un-erupted tooth the
more the time it would take to erupt
– Normally premolars take 4-5 months to erupt through a
bone of 1mm

44. • Sequence of eruption of teeth
– Space maintainer is planned in adequate
consideration is given to adjacent developing
& erupting teeth
– Neighboring dentition greatly influence the
closure of space. ( Mesial migration)
• Congenital absence of permanent tooth
– If congenital missing-should decide retain the
space for replacement

45. Thank You