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Basic Space Maintainers Teaching Module and Competency. Prepared by: Cynthia K Christensen; DDS, MS Sean Whalen, DDS University of Iowa Department of Pediatric Dentistry 2008-2009. Basic Space Maintainers. Are PASSIVE .036 wire is very heavy and should not be used to actively move teeth.

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Basic space maintainers teaching module and competency

Basic Space MaintainersTeaching Module and Competency

Prepared by:

Cynthia K Christensen; DDS, MS

Sean Whalen, DDS

University of Iowa Department of Pediatric Dentistry

2008-2009


Basic space maintainers
Basic Space Maintainers

  • Are PASSIVE

    • .036 wire is very heavy and should not be used to actively move teeth


Before placing a space maintainer
Before Placing a Space Maintainer

  • Evaluate Arch Length

    • Has the space already been lost?

    • Is there excess space?

  • Appropriate Radiographs

    • Succedaneous tooth?

    • Time to Eruption?

  • Patient/Family Compliance


Space maintainers are simple

Space Maintainers are Simple!

Name the 4 most basic pediatric space maintainers


Basic space maintainers1
Basic Space Maintainers

  • NANCE (Transpalatal Arch with Acrylic

    Button Stop on Palate)

  • LOWER LINGUAL HOLDING ARCH(LLHA)

  • BAND/CROWN and LOOP

  • DISTAL SHOE


Distal shoe
Distal Shoe

  • MAXILLARY or MANDIBULAR

  • Used when second primary molar requires extraction and first permanent molar has not erupted


Distal shoe1
Distal Shoe

  • Should be evaluated with radiograph prior to cementation

    • Length

    • Position

  • Will be replaced with another space maintainer when permanent teeth erupt.


Distal shoe2
Distal Shoe

  • Example of use in partial eruption case.


Nance appliance
Nance Appliance

  • MAXILLARY ONLY

  • Bands on first permanent molars


Nance appliance1
Nance Appliance

  • Cross Palatal Bracing prevents rotation #3 and #14 around palatal root- this starts mesial migration of #3 and #14

  • Acrylic Button provides additional stop


Transpalatal holding arch tpa
Transpalatal Holding Arch (TPA)

  • Can be used like a Nance.

  • Advantage

    • Lack of acrylic button so less tissue irritation and more cleansible

  • Disadvantage

    • Lack of anterior stop = possible tooth shift (?)


Lower lingual holding arch
Lower Lingual Holding Arch

  • MANDIBULAR ONLY

  • Bands on first permanent molars

  • Anterior Stop = Cinguli of #23-#26


Lower lingual holding arch1
Lower Lingual Holding Arch

  • Mandibular incisors often erupt lingually and are pushed forward by the tongue

  • LLHA should not be placed with primary incisors


K and t extractions llha indicated
#K and #T Extractions : LLHA Indicated?

  • NO- note lingual eruption #23 and #26

  • Option: Reverse Crown and Loops

    #L-19 and #S-30.

    **LLHA will be placed 2-3 years later, prior to loss of #L and #S. Simply cut off loop and leave SSCs.


Llha omega loops
LLHA Omega Loops

  • Omega Loops in area of premolars allow slight adjustment to fit appliance

  • Should not be used to activate appliance


Appliance activation features
Appliance Activation Features

  • Can be added by attaching light wire features

  • This is beyond routine space maintenance


Band crown and loop
Band/Crown and Loop

  • MAXILLARY or MANDIBULAR

  • Unilateral most typical

  • Can be bilateral if permanent teeth are not present

  • Single tooth span


Crown and loop
Crown and Loop

  • Stronger than band and loop

  • Cementation failure or loss less likely

  • Excellent choice if tooth needs a restoration


What about removable appliances
What About Removable Appliances?

  • Yes, they are possible, however………..

  • High failure rate due to breakage and loss

  • Parent and patient compliance must be exceptional


Which space maintainer
Which Space Maintainer?

  • Distal Shoe = 2nd Primary Molar Extraction with unerupted 1st Permanent Molar

  • Nance or Band/Crown Loop = Maxillary problem with 1st Permanent Molars present

  • Lower Lingual Holding Arch = Mandibular Problem with 1st Permanent Molars and Permanent Incisors present

  • Band/Crown and Loop= Primary 1st Molar Extraction


Must i plan to replace a band crown and loop
Must I Plan to Replace a Band/Crown and Loop ?

  • All depends on ERUPTION SEQUENCE

    • No, in maxillary arch

    • Yes, in mandibular arch- may need LLHA later

      • Why? Canine should exfoliate prior to eruption of 1st premolar, making space maintainer defunct.


Space maintainer competency
Space Maintainer Competency

The following cases require space maintainer consideration. Assume that radiographs have been taken, there is no abnormal pathology (other than dental caries), and a successor is developing.

Please answer the questions on your worksheets.


Question 1
Question 1

  • What tooth was extracted? How old is this child?

  • What is the appropriate space maintainer?

  • Will it have to be replaced with a different space maintainer in the future? If so, with what?


Question 2
Question 2

  • What tooth was extracted? How old is the child?

  • What is the appropriate space maintainer?

  • Will it have to be replaced with a different space maintainer in the future? If so, with what?


Question 3
Question 3

  • Which teeth were extracted? How old is the patient?

  • What is the appropriate space maintainer?

  • When can the space maintainer be removed?


Question 4
Question 4

  • Which teeth were extracted/

  • What is the appropriate space maintainer?


Question 5
Question 5

  • Which teeth have been extracted? How old is the child?

  • What is the most appropriate space maintenance?


Cheyenne case
“Cheyenne” Case

Cheyenne presented for an initial visit at the COD. She has had dental treatment on and off throughout life. She is in no pain, but mom reports that “we know she has dental problems.”




Mandibular arch only chart dentition on the odontogram
Mandibular Arch Only:Chart Dentition on the Odontogram


Cheyenne
Cheyenne

Mandibular Arch Only : Chart abnormalities and pathology (including caries ) from the Panorex and Bite Wing Radiographs


Cheyenne1
Cheyenne

A Moyer’s space analysis predicted there to be 2.3 mm of excess space in the mandible.

Make a treatment plan and appointment sequence for the mandibular arch only.


Cheyenne2
Cheyenne

Assuming normal dental development, at what age will the space maintainer you placed no longer be needed?


Justin case
“Justin” Case

Justin was referred by his general dentist for ‘ tooth decay and crowding.’

The family does not believe they can afford comprehensive orthodontic care, but does have dental insurance for “routine dental care.”


Justin chart maxillary dentition only on the odontogram
Justin: Chart Maxillary DentitionOnly on the Odontogram


Justin s bite wings
Justin’s Bite Wings

  • Chart any pathology or abnormal findings (including caries) for the maxillary arch only on the odontogram.



Justin1
Justin

A Moyer’s space analysis predicts 1.2 mm of space shortage in the maxilla

Treatment plan and sequence appointments for the Maxillary Arch Only




Question 11
Question 1

  • 5 or 6 y.o. child. Tooth #I extracted.


Question 12
Question 1

  • Band/Crown and Loop #J-H

  • Will not need replacement. #12 should erupt before #H or J exfoliate


Question 21
Question 2

  • Tooth #L extracted. 3-5 y.o. child.

  • What is the appropriate space maintainer?

  • Will it have to be replaced with a different space maintainer in the future? If so, with what?


Question 22
Question 2

  • Band/Crown Loop #K-M

  • May need to be replaced by LLHA later. Tooth #M should exfoliate prior to eruption #21.


Question 31
Question 3

  • Teeth #A and #J extracted. Patient 8-9 y.o.


Question 32
Question 3

  • Nance #3-#14

  • Can be removed when #4 and #13 erupt-around age 12


Question 41
Question 4

  • Teeth #K and L extracted


Question 42
Question 4

  • Lower Lingual Holding Arch (LLHA) #19-#30


Question 51
Question 5

  • Teeth #K and #S extracted. 5-6 y.o. child.

  • Because permanent incisors are not erupted, LLHA not recommended. Options: Reverse band and loop #L-#19 and band and loop #T-#R.


Cheyenne3
“Cheyenne”

Cheyenne presented for an initial visit at the COD. She has had dental treatment on and off throughout life. She is in no pain, but mom reports that “we know she has dental problems.”



Cheyenne4
Cheyenne

Mandibular Arch Only : Chart abnormalities and pathology (including caries ) from the Panorex and Bite Wing Radiographs


Cheyenne5
Cheyenne

  • Teeth Present:

    19, K,L,M,23,24,25,26,R,S,T,30

    Restorations: SSC #L

    Pathology/Caries: #L and #S abscessed,

    #28 severely ectopic.


Cheyenne6
Cheyenne

A Moyer’s space analysis predicted there to be 2.3 mm of excess space in the mandible.

Make a treatment plan and appointment sequence for the mandibular arch only.


Cheyenne tx plan
Cheyenne Tx Plan

  • Extract #L,S and T and Place LLHA

    • #L and S due to abscess

    • #T due to ectopic #28

  • Appt #1: Fit bands and Impress for LLHA

    Extract #L

  • Appt. #2: Seat LLHA

    Extract #S, T


Cheyenne7
Cheyenne

Assuming normal dental development, at what age will the space maintainer you placed no longer be needed?

Answer: When #21,28 and 29 erupt.

Around age 12 years


Justin case1
“Justin” Case

Justin was referred by his general dentist for ‘ tooth decay and crowding.’

The family does not believe they can afford comprehensive orthodontic care , but does have dental insurance for “routine dental care.”



Justin4
Justin

A Moyer’s space analysis predicts 1.2 mm of space shortage in the maxilla

Treatment plan and sequence appointments for the Maxillary Arch Only


Justin5
Justin

  • Teeth Present: #3,A,B,C,7,8,9,10,H,12,J,14

  • Restorations: #A-MO, #B-DO.

  • Pathology/Caries: #3-M; #A-D; #B-M;

    #H-D;#J-abscess, #14-MO

    Note: #6 and #11 very advanced root development.



Justin tx plan
Justin Tx Plan

  • Extract all maxillary primary teeth

    • #A,B,J- Multiple caries and near exfoliation

    • TE #C and #H due to root formation #6 and #11

  • Restore #3 with direct M composite

  • Restore #14-MO

  • Place Nance Space Maintainer- slight space deficiency, but this will be very beneficial.


Justin tx sequence
Justin Tx Sequence

  • Appt 1

    • Fit bands #3 and #14 and Impress for Nance

    • Restore #14

    • TE #H and #J

  • Appt 2

    • Restore #3

    • Seat Nance

    • TE # A,B,C



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