Space management involves maintaining space for developing or unerupted teeth after premature loss of primary teeth. Removable space maintainers are easy to clean but may be lost or broken. Fixed space maintainers like band and loop or lingual arch are more durable but require more expertise. The rate and direction of space closure varies, with maxillary spaces closing faster mesially and mandibular spaces closing distally. Space maintainers must fulfill criteria like maintaining space, not interfering with eruption, and being durable, affordable and easy to construct.
AGE FACTORS IN ORTHODONTICS
An important consideration in orthodontic diagnosis and treatment planning is the age of the patient. In addition age factors influence the treatment mechanics and prognosis.
There are certain features which are normal to a child, however if present in an adult would constitute malocclusion. These malocclusions need no treatment at that age as they get corrected automatically as the age advances.
The chronological age may sometimes be misleading and may not reflect the exact growth status. Thus skeletal and dental ages of the patient should be ascertained for a more accurate diagnosis.
This presentation is intended to give the GP dentists as well as specialists some essential information regarding " white spot lesions" ,which can be considered as one of the most common side effect of orthodontic treatment with fixed appliances.
Dental management of children with special health care needsaravindhanarumugam1
hope this will throw a light in understanding special children and dental management of the same particularly for pediatric dentistry PGs .children with genetic diseases and emotionally handicapped ( child abuse and neglect ) are not discussed here as they are separate topics.
dr. aravindhan
preventive and interceptive for general practitioners.docxDr.Mohammed Alruby
Scope of orthodontics
for general practitioner
Prepared by
Dr. M Alruby
Orthodontics: is a branch of science and art of dentistry dealing with prevention, interception, and correction of positional and dimensional dentofacial abnormalities.
Orthodontic treatment could be divided as follow:
1- Preventive orthodontic treatment.
2- Interceptive orthodontic treatment.
3- Corrective orthodontic treatment. a) Early corrective. b) late corrective.
4- Post. Treatment maintenance or retentive and follow up.
Preventive orthodontics:
It is defined as that phase of orthodontics employed to recognize and eliminate potential irregularities and malposition in the developing dentofacial complex. It is directed toward improving environmental conditions to permit future normal development
N: B: the child as a patient: children will accept orthodontic treatment if the purpose for treatment is explained in a simple terms that they can understand. Information concerning treatment aims and procedures should be given to the child without hesitation and under authority; neither gives him a great attention nor neglect him. Be familiar with the child and give him some sympathy.
Most children at preadolescent age are ready to accept orthodontic treatment if the orthodontist was able to establish a sympathetic relationship with the child. The child must not force to treatment but it is better to postpone treatment until the child feels the needs for treatment.
The adolescent patients: the 15 years old patient frequently consider himself as a man and must has a special management. Adolescent patient may deny that his teeth need correction and warning of the appliances. It is very important to know whether the patient came to the office alone, with friends or forced by his parents.
Preventive orthodontics is a long range approach and it is largely a responsibility of the general dentist. Many of the procedures are common in preventive and interceptive orthodontics but the timing are different.
Preventive procedures are undertaken in anticipation of development of a problem. Interception procedures are undertaken when the problem has already manifested. For extraction of supernumerary teeth before they cause displacement of other teeth is a preventive procedure, while their extraction after the signs of malocclusion have appeared is an interceptive procedure.
Preventive procedures:
A- Pre-dental preventive procedure ( parents education):
Instruct the mother to feed her baby from breast and if the baby to be feed by a bottle, the nipple should be long enough to rest on the anterior third of the tongue. It also should contain a small side opening instead of single large end hole, this allows the milk to flow on the dorsum of the tongue and prevent it from being squeezed directly into the pharynx, by this method the tongue is allowed to function properly during swallowing which is very important in general growth of the jaws, al
AGE FACTORS IN ORTHODONTICS
An important consideration in orthodontic diagnosis and treatment planning is the age of the patient. In addition age factors influence the treatment mechanics and prognosis.
There are certain features which are normal to a child, however if present in an adult would constitute malocclusion. These malocclusions need no treatment at that age as they get corrected automatically as the age advances.
The chronological age may sometimes be misleading and may not reflect the exact growth status. Thus skeletal and dental ages of the patient should be ascertained for a more accurate diagnosis.
This presentation is intended to give the GP dentists as well as specialists some essential information regarding " white spot lesions" ,which can be considered as one of the most common side effect of orthodontic treatment with fixed appliances.
Dental management of children with special health care needsaravindhanarumugam1
hope this will throw a light in understanding special children and dental management of the same particularly for pediatric dentistry PGs .children with genetic diseases and emotionally handicapped ( child abuse and neglect ) are not discussed here as they are separate topics.
dr. aravindhan
preventive and interceptive for general practitioners.docxDr.Mohammed Alruby
Scope of orthodontics
for general practitioner
Prepared by
Dr. M Alruby
Orthodontics: is a branch of science and art of dentistry dealing with prevention, interception, and correction of positional and dimensional dentofacial abnormalities.
Orthodontic treatment could be divided as follow:
1- Preventive orthodontic treatment.
2- Interceptive orthodontic treatment.
3- Corrective orthodontic treatment. a) Early corrective. b) late corrective.
4- Post. Treatment maintenance or retentive and follow up.
Preventive orthodontics:
It is defined as that phase of orthodontics employed to recognize and eliminate potential irregularities and malposition in the developing dentofacial complex. It is directed toward improving environmental conditions to permit future normal development
N: B: the child as a patient: children will accept orthodontic treatment if the purpose for treatment is explained in a simple terms that they can understand. Information concerning treatment aims and procedures should be given to the child without hesitation and under authority; neither gives him a great attention nor neglect him. Be familiar with the child and give him some sympathy.
Most children at preadolescent age are ready to accept orthodontic treatment if the orthodontist was able to establish a sympathetic relationship with the child. The child must not force to treatment but it is better to postpone treatment until the child feels the needs for treatment.
The adolescent patients: the 15 years old patient frequently consider himself as a man and must has a special management. Adolescent patient may deny that his teeth need correction and warning of the appliances. It is very important to know whether the patient came to the office alone, with friends or forced by his parents.
Preventive orthodontics is a long range approach and it is largely a responsibility of the general dentist. Many of the procedures are common in preventive and interceptive orthodontics but the timing are different.
Preventive procedures are undertaken in anticipation of development of a problem. Interception procedures are undertaken when the problem has already manifested. For extraction of supernumerary teeth before they cause displacement of other teeth is a preventive procedure, while their extraction after the signs of malocclusion have appeared is an interceptive procedure.
Preventive procedures:
A- Pre-dental preventive procedure ( parents education):
Instruct the mother to feed her baby from breast and if the baby to be feed by a bottle, the nipple should be long enough to rest on the anterior third of the tongue. It also should contain a small side opening instead of single large end hole, this allows the milk to flow on the dorsum of the tongue and prevent it from being squeezed directly into the pharynx, by this method the tongue is allowed to function properly during swallowing which is very important in general growth of the jaws, al
Visit Dentistry and Medicine for more PPT's,EBooks and Lecture notes on Dentistry and Medicine here : http://dentistryandmedicine.blogspot.com/
Space maintainers are appliances used to maintain space or regain minor amounts of space lost,so as to guide the unerupted tooth into a proper position in the arch.
Retention & relapse in orthodonticsChetan Basnet
Retention:
Maintaining newly moved teeth in a position long enough to aid in stabilizing correction.
-Moyer
Relapse:
It has been defined as the loss of any correction achieved by orthodontic treatment.
-Moyer
A BRIEF INTRODUCTION REGARDING THE SELECTION OF ABUTMENT TOOTH/TEETH IN FIXED PROSTHODONTICS.ALL THE CONTENTS ARE TAKEN FROM THE BIBLE OF FIXED PROSTHODONTICS,SHILLINGBERG
A concise review on some conditions that cause epithelial erosion in the oral cavity.
This presentation covers some important lesions with clear diagrams for better comprehension.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
2. ❖ Space control refers to a careful supervision of
the developing dentition, it reflects an
understanding of the dynamic nature of occlusal
development.
❖ Space maintaining is utilizing an appliance to
preserve space without necessarily an
awareness of dynamics of the situation.
3. ❖ Space Maintenance is the process of maintaining a space in
a given arch previously occupied by a tooth or group of teeth.
❖ Space maintainer refers to an appliance designed to retain a
given area or space, generally in the primary and mixed
dentitions.
❖ Space Regainer- is a fixed or removable appliance capable
of moving a displaced permanent tooth into its proper
position in the dental arch.
4. Objective of space maintenance:-
o preservation of primate spaces
o integrity of dental arches
o normal occlusal planes
o esthetics
o phonetics.
“ Tooth itself is the best space
maintainer.”
6. Dentition is designed to function as a single unit,
retained spatially by the sum of forces exerted
upon each individual member :
Occlusal forces.
Muscular forces.
Eruptive forces.
7. Nature & prevalence of space loss
• Incidence of premature loss of deciduous molars
Premature loss of teeth- crowding due to rotation,
tipping or bodily movement
• Rate & time of space closure-
➢ earlier the tooth loss- greater the space loss
➢ greatest space loss occurs in the first 6 months
after extraction
• Amount of space closure- maximum in the
maxillary region due to premature loss of the 2nd
deciduous molars
8. • Direction of space closure
Maxillary extraction sites close by- mesial movement
of posterior teeth
Mandibular- distal migration of anterior teeth
• Effect of caries
severe interproximal caries- at least 1mm of space
loss
9. Variables Influencing Space
Maintainer Programme
1. Oral musculature and habits.
maxillary arch- proclination
mandibular arch- cuspid extraction- shift of midline
2. Time elapsed since extraction.
maximum loss in the first six months
3. Dental age, eruption pattern, bony covering.
• 4-5 months for an erupting tooth to pass through
1 mm of bone
• tooth lost due to infection- bone not a reliable
predictor
• Ectopic eruption & root resorption- delays / hastens
exfoliation time
10. 4. Available space.
Amount of space available and required should be measured
5. Interdigitation.
Occlusion stabilized by increased cuspal height & proper
interdigitation
6. Anomalies of teeth.
Hamper eruption- complete radiographic assessment
7. Sequence of eruption.
2nd deciduous molar lost prematurely- 2nd molar is erupting –
space maintenance needed
11. Indications of Space Maintainers.
If the space after premature loss of primary teeth
show signs of closing.
If the use of space maintainer will aid in or make
the future orthodontic treatment less involved.
If the need for treatment of malocclusion at a later
date is not indicated.
12. Contraindications
If the radiograph of extraction region shows one
third of the root of succudaneous tooth already
calcified.
When space left by prematurely lost primary tooth
is greater than the space needed for permanent
successor as indicated radiographically.
If the space shows no signs of closing.
13. Contraindications
When there is general lack of sufficient arch length
and where space maintainer would further
complicate existing malocclusion.
When succidaneous tooth is absent.
When there is no bone observed radiographically
overlying the erupting permanent tooth, which
suggests that the tooth will erupt within a few
months.
15. ➢ Complete & accurate medical history and examination to evaluate
general & dental health of patient.
➢ Full – mouth radiographic survey or panoramic radiograph –
cephalogram.
➢ Diagnostic models for analysis.
➢ Variables affecting space maintenance programme are considered.
➢ Appliance selection.
16. Appliance selection depends on:-
❖ Patient cooperation.
Removable appliances- greater cooperation
❖ Integrity of the appliance.
Mandibular removable appliance most susceptible
to breakage
❖ Maintenance- length of time the appliance has to
be worn
❖ Modifiability - future modifications
❖ Limitation
❖ Cost- direct bonded are the best- less time- but
high charges
18. They should maintain the mesiodistal
dimension of space created by lost tooth.
They should be functional if possible, to the
extent of preventing over eruption of opposing
tooth.
Should be as simple and strong as possible.
Should not interfere with normal occlusal
adjustments.
Should not interfere with erupting teeth.
19. Should maintain individual functional
movement of teeth.
Should not interfere with normal vertical
eruption of adjacent teeth.
Simple design, easy construction and
placement.
Should be easily adjustable.
Should not restrict normal growth and
developmental process.
20. Must not endanger remaining teeth by imposing
excessive stresses on them.
Should not interfere with mastication, speech or
deglutition.
Must be easily cleansed.
Should be durable and corrosion resistant.
Should have reasonable cost.
22. First primary molar
Loss may be maxillary, mandibular or both, unilateral or
bilateral.
Potential for space loss when first deciduous molar is lost
depends on the different stages of eruption of first
permanent molar.
➢ When first deciduous molar is extracted before active
eruption of first permanent molars, there is no influence on
the arch to cause space loss.
➢ Potential for space loss is great during eruption of first
permanent molars since it exerts a strong eruptive force
against the distal crown surface of second deciduous molar
23.
24. Lower first permanent molar erupts directly against
the deciduous distal crown surface.
Maxillary first permanent molar erupts distal ward &
rotates & swings forward once cusp tips are through
the tissue.
25. Second primary molarSecond primary molars
serve as a buttress for
permanent molar eruption.
Maxillary permanent
molar erupts distally &
swings forward to contact
distal of second primary
molar.
If it is missing during
this time, permanent
molar continues to swing
mesially until it contacts
distal of first primary
molar.
26. If mandibular primary second molar is lost early,
permanent molar will continue its mesial eruption
pathway & become mesially tipped.
27. Primary canines
Most probable cause is erupting laterals resorbing the roots
of primary canines.
If the loss is unilateral, - midline shift to the side of space
loss due to migration of larger permanent incisor segment
into the space.
Decrease in arch circumference - due to lingual tipping of
permanent incisors - from the force of orbicularis and its
associated muscles.
28. Primary incisors
➢ Primary incisors become spaced with growth to
accommodate larger permanent incisors- space
maintainers are not necessary to maintain space
which is getting increased with growth of jaw.
➢ As far as speech development, esthetics, social
trauma for child are concerned, space maintainers
should be given.
30. 1. Eruption of premolars will be delayed in children who lose
primary molars at 4 or 5 Yrs of age and before.
❖ If primary molars are lost after 5 Yrs, there will be a
decrease in delay of premolar eruption.
❖ At 8-10 Yrs, premolar eruption resulting from premature
loss of primary molars is greatly accelerated.
2. Premolar eruption accelerated in presence of long –
standing necrosis.
31. 3. Mesial drift of permanent first molar will lead to:-
❖ Second premolar impaction
❖ Deflected and impacted second premolar.
❖ Deflected and ectopically erupting second premolar
❖ Second premolar erupting into normal position.
33. Hitchcock
Removable or fixed or semi fixed
Banded/ bonded
Functional or non functional
Active or passive
Certain combinations of the above.
34. Advantages of removable type
space maintainers
❖ Easy to clean and permits teeth to be cleansed.
❖ Maintains or restores the vertical dimension.
❖ Can be used in combination with other preventive
procedures.
❖ Can be worn part time allowing circulation of blood to the
soft tissues.
.
35. ❖ Serves in functions like esthetics, phonetics and mastication
❖ Helps keeping the tongue in bounds.
❖ Stimulates eruption of permanent teeth.
❖ Caries detection can be made easily.
❖ Room can be made for permanent teeth to erupt without
changing the appliance.
36. Disadvantages of Removable
Space Maintainers.
May be lost or can be broken by the patient.
Patient may not wear it.
Lateral jaw growth can be restricted if clasps are
incorporated
May irritate underlying soft tissues.
37.
38. Advantages of Fixed Space Maintainers
Easy manipulation.
Does not interfere with passive eruption of abutment.
Jaw growth is not hampered.
Can be used for uncooperative patient.
Masticatiory function is restored if pontics are placed.
39.
40. Disadvantages of Fixed Space Maintainers.
❖ Elaborate instrumentation with expert skill is needed.
❖ May result in decalcification of tooth material under
bands.
❖ May be harmful to the abutment tooth due to
development of torque forces resulting in appliance
breakage.
❖ Supra eruption of opposing teeth if pontics are not used.
❖ If pontics are used, it interferes with vertical eruption of
abutment.
41. Fixed space maintainers are appliances utilizing
bands or crowns for their construction
Band and loop,
Crown and loop ,
Band and bar,
Lingual arch,
Palatal arches like transpalatal arch and nance palatal holding
arch,
Distal shoe.
42. Band and Loop Space Maintainer
Is a unilateral fixed appliance indicated for
space maintenance in the posterior segments
when single tooth is lost.
43.
44.
45.
46.
47. Indications.
a. In controlling space created by early loss of
first primary molar.
b. Bilateral loss of first primary molars.
c. When second primary molar is lost after the
eruption of first permanent molar.
d. Premature loss of primary canines.
48. Advantages
I. Effective space maintainer for unilateral loss of
single tooth.
II. Economical to make and construction is simple.
III. Less chair time if pre-formed bands are used.
49. Disadvantages.
i. Decalcification under the bands.
ii. Will not prevent continued eruption of
opposing teeth.
iii. Does not restore chewing function.
iv. Limited to maintenance of single tooth
space.
50. Construction of Appliance
S Stainless steel band is adapted to the tooth
posterior to the edentulous area. Pre – formed
bands may also be used.
S Full length alginate impression is taken with the
band in place.
S Band is removed from the tooth and positioned
in the impression.
51. S Impression is poured in stone and cast is
made.
S Mesial end of the loop should rest on the
area just below the greatest curvature on the
proximal of the tooth mesial to the space.
52. The distal ends of the loop should
overlap mesial one third of the buccal
and lingual surfaces of the band, just
above free gingival margin. The arms
should run on each side of alveolar
ridge close to the gingiva. Anterior part
of the loop is secured in position, distal
ends are soldered on to the band.
Finishing is done later on.
53. Lingual Arch
Use – indicated to preserve the spaces
created by multiple loss of primary
molars when there is no loss of space
in the arch.
Modifications are also in use.
54. Advantages
Excellent source of anchorage.
Causes little or no inconvenience to
patient.
Less bulky than removable space –
maintainers.
Less conspicuous.
56. FABRICATION
Stainless steel bands adapted around
the teeth distal to the space. Arch
design should be directed toward
minimizing maintenance problems.
Arch wire should contact the erupted
permanent incisors at the cingulum.
57. Should be located 1-2mm lingual to
posterior teeth to permit satisfactory
eruption of the premolars in a
buccolingual plane.
Arch wire is soldered on the mid third
of the band lingually.
58. Distal Shoe Space Maintainer
Early designs made of cast gold
WILLET DISTAL SHOE.
Roche’s distal shoe was used later.
60. CONTRAINDICATIONS.
1. Inadequate abutment due to multiple
loss of teeth.
2. Poor oral hygiene.
3. Medically compromised patients.
4. Congenitally missing first permanent
molar.
61.
62.
63.
64. Rate of Space Closure
Maxilla
D : 0.8mm/Yr.
E : 2.0mm/Yr.
65. Amount of Space Closure.
Maxilla Mandible
D E D E
1st year 1.3mm 2.8mm 1.8mm 2.4mm
2nd year 1.8mm 4.5mm 2.7mm 3.1mm
3rd year 3.2mm 8.0mm 3.3mm 4.5mm
66. Hinrichsen.
a. Fixed Appliances.
Class - I a ) Non functional types.
1. BAR TYPE.
2. LOOP TYPE.
Class – I b ) Functional types.
1. PONTIC TYPE.
2. LINGUAL ARCH TYPE.
Class – II a ) Cantilever type (distal shoe,
band & loop).
b) Removable acrylic partial dentures.