The document discusses preventive orthodontics and space maintenance. It defines preventive orthodontics as actions taken to preserve normal occlusion. Space maintenance involves maintaining space left by premature loss of primary teeth using appliances like bands, lingual arches or removable partial dentures. Factors like dental development stage, eruption timing and bone levels determine need for and type of space maintainer used.
The term Deep Bite and ways to manage it simplified.
TYPES, MANAGEMENT,
*The illustrative videos used in the presentation may not play.
(refer to YouTube)
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Removable partial denture design clasp selection according to the position ...Mohammad Ayham Hakkoum
This presentation is about important topic in dentistry/removable prosthodontics.
It talk about removable partial denture design related to clasp selection in distal extension cases according to the position of retentive undercut.
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The term Deep Bite and ways to manage it simplified.
TYPES, MANAGEMENT,
*The illustrative videos used in the presentation may not play.
(refer to YouTube)
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
Removable partial denture design clasp selection according to the position ...Mohammad Ayham Hakkoum
This presentation is about important topic in dentistry/removable prosthodontics.
It talk about removable partial denture design related to clasp selection in distal extension cases according to the position of retentive undercut.
Indian Dental Academy: will be one of the most relevant and exciting
training center with best faculty and flexible training programs
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Dentistry, Periodontics and General Dentistry.
THE ART AND SCIENCE OF TREATMENT PLANNING ON ORTHODONTIC EXTRUSIONAbu-Hussein Muhamad
Traumatized anterior teeth with subgingival fractures of crown are a challenge to treat. This paper reports the man¬agement of subgingival fractures of crown of the maxillary central incisor in an 29 year old female. The technique described here involves the use of fixed appliance, post and core with a loop fabricated on it for retention of fixed appliance.
Keywords: Fracture, Tooth, Root Extrusion, Crown Fracture.
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Orthodontic Treatment Modalities Done by: Dr. Mohamad Ghazi Kassem
2. Orthodontic Treatment Modalities Preventive orthodontics: Interceptive orthodontics Corrective orthodontics • Removable appliances • Fixed appliances Orthognathic Surgery “Jaw Surgery”
3. Preventive orthodontics Preventive Orthodontics is the action taken to preserve the integrity of what appears to be normal at a specific time. Any procedure that attempt to ward off untoward environmental attacks or anything that would change the normal course of events, e.g. 1. Early connection of proximal caries that might change the arch length 2. Early recognition and elimination of oral habits that might interfere with the normal development of the teeth and jaws 3. Placing of a space maintainer to maintain proper position of contiguous teeth It is defined as the action taken to preserve the integrity of what appears to be a normal occlusion at a specific time.
4. 1960 : Kesling stated that “some case should be referred as early as 3 or 4 years of age and all cases by the age of 8 or 9 years” there by lying the foundation of preventive and interceptive orthodontics. 1977: Begg stated that “proper time to begin the treatment is as the beginning of the variation from the normal, in the process of development of dental apparatus, as possible” 1980: Profit and Ackermann has defined it as a prevention of potential interference with occlusal development.
5. Various Preventive procedures are : 1. Pre-dental procedures 2. Care of deciduous dentition 3. Patient and parents education programs 4. Supernumerary teeth 5. Early loss of deciduous teeth 6. Proximal caries 7. Oral habits 8. Space maintainers
6. 1. Pre-dental procedures: • Proper nutrition of the child. • Proper nursing care of the infant. • Bottle feeding should be discouraged.
7. 2. Care of deciduous dentition: 3. Patient and parent’s education programs: Need of maintaining good oral hygiene should be explained to the patient and the parents. Demonstration of brushing methods and diet counseling etc are also important.
8. 4. Supernumerary teeth: Supernumerary teeth and supplemental teeth can interfere with the eruption of nearby teeth. Presence of mesiodens prevents the two maxillary central incisors from approximating each other. They should be removed at appropriate time.
9. 5.Oral habits: Abnormal oral habits should be recognized and patient should be helped by motivation or by fitting a suitable habit breaking appliance.
10. digit sucking Methods to prevent tongue thrusting Mouth breathing
11. 6.Space maintainers: Premature loss of deciduous teeth can cause drifting of the adjacent teeth into the space. Space maintainers must be inserted in appropriate cases after the loss of teeth, particularly after the loss of deciduous molars in inadequate arches. Fixed Space Maintainers Removable space maintainers
12. Interceptive orthodontics Richardson (1982)
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Eruption problems /certified fixed orthodontic courses by Indian dental academy Indian dental academy
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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
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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
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
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ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
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
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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.
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
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2. Introduction
Definition
Rationale
Benefits of early treatment
Goals
loss of individual tooth
Treatment for loss
Space supervision
Space maintenance
Criteria for space maintenance
2
3. An old saying prevention is better than cure holds
true for preventive orthodontics. For the preventive
approach to be truly effective it needs to apply at
its earliest, i.e at the primary prevention level.
3
4. Graber in the year 1966 defines preventive
orthodontics as the action taken to preserve the
integrity of what appears to be normal occlusion at
a specific time.
Interceptive orthodontics is defined as phase of
science and art of orthodontics employed to
recognize and eliminate the potential irregularities
and malpositions in the developing dentofacial
complex (AAO-1969)
4
5. JC BRAUER IN 1941 defined space maintenance
as the process of maintaining a space in a given
arch previously occupied by a tooth or a group of
teeth.
Space control- careful supervision of the
developing dentition; it reflects an understanding
of the dynamic nature of occlusal development-
GAINSFORTH 1955
5
6. Some malocclusions can be prevented or
intercepted.
It is the dentist’s responsibility to obviate, when
possible, lengthy or complicated treatment.
Treatment is easier in some cases.
More alternative methods are available.
6
7. Possibility of achieving a better result.
Some forms of treatment can only be done at an
early age.
Early treatment of serious deleterious habits is
easier than treatment after years of ingrained habit
reinforcement.
There are psychological advantages to early
treatment in some children.
Younger patients are often more cooperative and
attentive.
7
8. Dentition and occlusion
Musculature: cheek, lip and tongue muscles may tend
to limit buccal, labial, and lingual movement of the teeth.
These forces contribute to dental arch form by
maintaining tooth contact and eastabilising a relatively
stable intermolar and intercanine width.
Craniofacial skeleton
Treatment planning
8
10. PROBLEM ARCH
IMMEDIATE
TREATMENT
FUTURE
TREATMENT
Loss of 1
primary lateral
Upper/lower
Extract antimere
Stripping or
extraction of
primary canine
within 6-12
months
Both primary
laterals
Upper/lower No treatment
necessary
Maxilla only-
reduce midline
diastema
Incisor
crowding<4
Strip primary
canines
Preserve lee
way space
Incisor
crowding>4
Extract primary
canine
Preserve lee
way space or
possible
extraction 10
11. PREMATURE
LOSS OF PRI
CANINE
Without midline
shift
Upper
Lower
Extract antimere
Stop lingual
arch
Preserve lee
way space or
possible
extraction
therapy
Orthodontic
consultation
With midline
shift
Upper/lower Extract antimere Orthodontic
consultation
Lower Lingual arch
11
13. Maxillary 1st molar-
primary cuspid shifts distally
1st permanent molar and primary 2nd molar shifts
mesially
An erupting 1st bicuspid is guided along the mesial
surface of the mesially migrating 2nd primary
molar, eventually lying close to the lateral inscisors
13
14. Loss of maxillary 2nd molar
The second bicuspid is generally impacted
Permanent molar shifts mesially
The cuspid and 1st decideous molar shifts distally
The resultant lack of space between 1st
permanent molar and 1st bicuspid causes
impaction of 2nd bicuspid
14
15. Loss of mandibular molar
in case of loss of mandibular 1st molar, the
permanent molar and second primary molar both
tip forward.
In case of loss of second primary mandibular
molar, the permanent molar tips forward.
15
17. Maxillary central incisors: An acrylic plate with a
pontic of a snug fit should be placed at once and
worn until an age when a permanent restoration
can be inserted. A pontic supported by a wire
frame work held in place by acid etch composite
on lingual side of adjacent teeth.
Maxillary lateral incisor:
Cuspid: Seen rarely. Hold space untill bridge can
be placed
First bicuspid: multibanded mechanotherapy is
required.
17
18. Premolar may drift into space left by first molar.
A dipping in the line of occlusion occurs owing to the
change in the axial inclination of the remaining posterior
teeth.
Closure of bite
18
19. Clinical condition Treatment
suggestion
reason
Intrusion Wait 6-10 weeks for
tooth to reerupt.
Favourable prognosis
for reerution without
incidence
Extract No evidence of
reeruption- 10 weeks
suggests ankylosis
Extrusion Extract Ectopic eruption
Avulsion Do not implant
Coronal fracture Restore fracture Protect pulp
Radicular Extract Ectopic eruption
19
20. Pulp pathology
Concussion observe Possible
reversible reaction
Internal resorption Extraction/pulpect
omy
Reperative
response of pulp
Necrosis Extraction of
pulpectomy
Periapical
infection
20
21. It is a term applied when it is doubtful, according
to the mixed dentition analysis, whether there will
be room for all the teeth.
Prognosis for supervision is always questionable,
where as prognosis is always good for regaining
space and for space maintenance.
Space supervision cases are those that will have a
better chance of getting through the mixed
dentition with clinical guidance than they will
without.
21
22. Misdiagnosed supervision cases that require
extractions of permanent teeth are more
difficult to treat than gross discrepancy cases-
a. More space closure is needed
b. The patient’s cooperation often lags after the
planned interceptive procedure has failed.
Because of the critical effect of the skeletal
pattern on molar relationship and utilization of
available space three space supervision
protocols are needed:
22
23. Space supervision is not begun until the
mandibular cuspid and first premolar show
approximately one-quarter to one-third of the root
formed.
Primary teeth are extracted serially to provide an
eruption sequence of cuspid, first premolar and
second premolar in the maxilla.
An effort is made to keep the mandibular teeth
erupting well ahead of the maxillary.
One takes care that a late mesial shift of the
mandibular first molar does not occur.
23
24. Normal skeletal profile
Permanent molars are in class 1 molar relation at
the time of instituting space supervision.
Extraction of mandibular primary cuspid is done
when manibular bicuspid has clearly begun root
formation.
Removale of primary first molar and slicing of
mesial primary second molar.
Puropse of second step is to allow allow cuspid to
erup distally and hasten the eruption of first
bicuspid.
24
25. A holding arch wire is inserted and primary second
molar is extracted.
25
27. The protocol is quite similar to that for a mesial
step- with one expection-
Since the molars are not in class 1 relationship
and a late mesial shift cannot be allowed to occur,
it is necessary to achieve a class 1 molar
relationship by guidance of the eruption of the
maxillary 1st permanent molar or its movement
distally.
A sved plate with helical springs may be used.
The sved plate frees the occlusion, which aids in
the distal tipping of the maxillary 1st permanent
molar, helps flatten the mandibular occlusal plane, 27
28. Maxillary molar is
restrained during
the downward and
forward growth of
maxilla
The maxillary 1st
molar is tipped
distally a slight
amount, thus
changing the axial
inclination of tooth
during subsequent
vertical development
28
29. Space supervision combined with distal step is a
much more serious matter and the space problem
is quite secondary to the skeletol contributions to
the distal step
29
30. It is a fixed or removable appliance designed to
preserve the space created by the premature loss
of a primary tooth or a group of teeth- BOUCHER
30
31. If arch integrity is disrupted by early loss of
primary teeth, problems may arise that affect the
alingnment of permanent teeth.
Miyamoto and colleagues observed the effects of
early loss of primary teeth by measuring crowding
and malalingnment in permanent dentition of 255
school children aged 11years or older.
Children who had premature loss of one or more
primary canines or molars were more likely to
receive orthodontic treatment in permanent
dentition with the need more than 3 times greater
in children who had lost one or more primary teeth
31
32. Incidence of space loss
Time elapsed since loss
Stage of developmental/dental age of patient
Amount of space closure
Direction of closure
Eruption timing of permanent succesors
Amount of bone covering the non erupted tooth
Abnormal oral musculature
Congenital absence of the permanent teeth
32
33. Almost all cases of early primary molar loss show
some decrease in arch length.
The amount of closure is affected by numerous
variables
(tooth involved, time of loss)
33
34. Space loss usually takes place during the first 6
months after the primary tooth is lost-Mc Donald
Space closure occurs more rapidly in the maxillary
arch than in the mandible.
This indicates that when a primary tooth is
removed and factors indicate need for space
maintenance , it is best to insert an appliance as
soon as possible after extraction.
34
35. More space loss is likely to occur if teeth are
actively erupting adjacent to the area left by
premature loss of the primary tooth.
Significant space loss is most influenced by the
stage of eruption of the first permanent molar with
the potential particularly high if a primary molar is
lost just before or during eruption of the first
permanent molars.
If the first primary molar has been lost prematurely
and permanent lateral incisor is in an active state
of eruption , it may result in distal movement of the
primary canine and encroachment on space
35
36. This condition is frequently accompanied by a shift
in the midline toward the area of the loss.
In mandibular arch, a lingual collapse of the
anterior segment may occur with a resulting
increased overbite.
36
37. Helm reported that space closure is more common
in the mandibular segment were as Ronnerman,s
study showed reverse.
Maxillary second primary molar- 8mm- Mc donald
Mandibular second primary molar- 4mm
Ronnerman and Thilander
Mandibular arch
Primary 1st molar 0.8-1.7mm
Primary 2nd molar 2.1-3.1mm
Maxillary arch
Primary 1st molar 0.5-1.4mm
Primary 2nd molar 3.7-4.5mm
37
38. Olsen, 1959 stated that greater loss occurs in
mandible owing to a mesial axial orientation of 1st
molar.
Richardson 1965, Cohen 1941, Seipel 1949 sated
that loss of 2nd primary molar will cause greater
space loss.
MAXILL
A
MANDIBL
E
D E D E
1ST
YEAR
1.3 MM 2.8 1.8 2.4
2ND
YEAR
1.8 MM 4.5 2.7 3.1
3RD
YEAR
3.3 MM 8.0 3.3 4.5
38
39. Preeruption position of the permanent first molar
and the location of yet unformed root apices.
mesial position of
upper 1st molar roots
distal position
39
40. As each permanent molar erupts against the distal
crown surface of primary 2nd molar, there is a
normal vertical alingnment of permanent crown
and root to eastablish a slight mesial inclination of
the molar.
40
41. Maxillary posterior spaces close predominantly by
mesial bodily movement and mesiolingual rotation
around the palatal root of the first permanent
molars- Stewart 1965
Minimal mesial tipping of first molar is noted.
Mandibular spaces close primarily by mesial
tipping along with distal movement and
retroinclination of teeth anterior to the space.
Bodily movement of first molar is not seen in lower
arch.
Rose JS 1966 stated that, space closure can
occur in two ways: either through forward 41
42. Teeth normally erupt when three fourths of the root
is developed- Gron
Studies have indicated that loss of a primary molar
before 7 years of age leads to delayed emergence
of the succedaneous tooth, whereas loss after 7
years of age leads to early emergence.
42
43. Strong mentalis muscle paterns may have a
pronounced negative effect after loss of
mandibular primary molars or canine with collapse
of the arch and distal drifting of the anterior
segment that is often exhibited.
43
44. 1mm of bone resorbs in 4 to 5 months
So if bone is present over succedaneous tooth it is
an indication for space maintainer.
44
47. Removable or fixed or semi-fixed.
With bands or without bands.
Functional or non-functional.
Active or passive.
Certain combinations of the above
47
49. Fixed space maintainers-
CLASS I (a) Non-functional types-
i. Bar type.
ii. Loop type.
(b) Functional types-
i. Pontic type.
ii. Lingual arch type.
CLASS II Cantilever type (distal
shoe,band & loop.)
Removable space maintainers-
Acrylic partial dentures
49
51. Unilateral
Non functional
Passive
Fixed appliance
INDICATION
Premature loss of single primary molar
Bilateral loss of single primary molar before eruption of
permanent incisors
Second primary molar is lost after eruption of 1st permanent
molar
51
52. ADVANTAGES DISADVANTAGES
EASY TO CONSTRUCT CANNOT STABILIZE THE ARCH
LESS APPOINTMENT NON FUNCTIONAL
MODIFICATIONS ARE POSSIBLE SLIPAGE OF LOOP BY
MASTICATORY FORCES
MOST OF THE TIME PRIMARY 2ND
MOLAR IS LOST BEFORE
ERUPTION OF PREMOLAR
52
53. Stoppers can be usd to prevent gingival as well as
buccal movements of loop.
Crown and loop.
Crown-band and loop.
Meyne’s space maintainer.
Reverse band and loop
Band and bar
53
54. INDICATION
Multiple loss of primary molars when there is no loss of space in arch
Bilateral loss of primary molars after eruption of lower central incisors
Unilateral loss of primary molars after eruption of lower lateral incisors
54
56. Hotz lingual arch- with u loop used for space
regaining.
Removable lingual arch
Omega bands- in canine region to prevent
interference.
56
57. Maxillary 1st permanent molar positioning when
there is bilateral premature loss of primary teeth
with no loss of space in arch and a favourable
mixed dentition analysis.
Advantage- arch stabilizing
Disadvantage-
a. Tissue hyperplasia
b. Irritation to palatal tissues
c. Pressure effect
d. Cannot be used in patients allergic to acrylic.
57
58. One side of arch is intact and several primary
teeth on the other side are misssing.
Primary molars are lost bilaterally.
Its is designed to prevent the molars from rotation.
In arch expansion
58
60. Intra alveolar appliance.
Used when second primary molar requires extraction
and first permanent molar has not erupted.
An unerupted permanent first molar drifts mesially within
the alveolar bone if the primary second molar is lost
prematurely .The result of the mesial drifts is loss of arch
length & possible impaction of the second premolar.
60
61. Mcdonald – 9th edition
PAEDITRIC DENTISTRY-Ray E Stewart
Hand book of orthodontics-Moyer’s
Text book of paediatrictric dentistry- Raymond
Brahman
Nikhil Marwah
Sobha Tondon
61