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Management of Space in Pediatric Dentistry. Dr Seyed Ebrahim Jabbarifar :Associate professor Isfahan Dental School Pedodontic department 2009. Etiology of Early Primary Tooth Loss. Extraction or destruction: extensive caries or traumatic injury Premature exfoliation:

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management of space in pediatric dentistry

Management of Space in Pediatric Dentistry

Dr Seyed Ebrahim Jabbarifar :Associate professor Isfahan Dental School

Pedodontic department 2009

etiology of early primary tooth loss
Etiology of Early Primary Tooth Loss
  • Extraction or destruction:
    • extensive caries or traumatic injury
  • Premature exfoliation:
    • abnormal root resorption (e.g. ectopic eruption)
    • systemic disorders or hereditary syndromes

Hypophosphatasia Rickets Acrodynia

Histiocytosis X triad Leukemia Cherubism

Juvenile Periodontitis Dentinal dysplasia

Cyclic neutropenia Papillon-Lefevre syndrome

functions of a space maintainer
Function:

prevent undesirable tooth mvmt following the premature loss of a primary tooth

i.e. Mesial migration of posterior segments and lingual collapse of anterior segments

Negative Tooth Mvmt:

Reduction or loss of space required by succeeding tooth

Considerable influence on dental dvlpt well into adolescence and adult age

Functions of a Space Maintainer
functions of a space maintainer1
Functions of a Space Maintainer
  • Maintain space
  • Prevent mvmt adjacent teeth
  • Provide masticatory fx
  • Prevent overeruption of opposing teeth
  • Improve esthetics
  • Assist in speech (anterior segments)
  • Aid in control of deleterious oral habits

Note: appliance must neither inhibit nor deflect normal growth changes

ideal prerequisites of a space maintainer
Ideal Prerequisites of a Space Maintainer
  • Simple to construct and maintain
  • Durable, strong, stable
  • Passive
  • Easily cleanable and not enhance dental caries or soft tissue pathology
  • Readily adjustable for flexible application
factors to consider when planning a space maintainer
Factors to consider when planning a space maintainer:
  • Question:

“When should a space maintainer be placed?”

  • General Rule:

“Whenever the clinical situation will allow space loss to encroach on the arch length needed for the unerupted permanent teeth, giving due consideration to the patients dental health, motivation, and occlusion status”.

factors to consider when planning a space maintainer1
Factors to consider when planning a space maintainer:
  • Dental and periodontal condition
  • Arch length
  • Presence/absence of permanent successor
  • Time elapsed since loss of primary tooth
  • Status of first permanent molar eruption
  • Status of permanent successor’s development and eruption potential
  • Cooperation level of child and parents
  • Which tooth is lost, in which arch, at what time?
a space maintainer may not be required if there is
A space maintainer may not be required if there is:

1. Existence of cuspal interference.

2. Widely spaced primary dentition.

3. If succeeding tooth is expected to erupt within 6 months.

4. If present space is not adequate for the succeeding tooth.

5. The possibility of future orthodontic work.

6. Where the opposing 6's are locked into a desirable and stable relationship

suggested that succeeding tooth will most likely erupt within 6 months if
Suggested that succeeding tooth will most likely erupt within 6 months if:

1. 75% of the root is present on the succeeding tooth.

2. Less than 1 mm of alveolar bone is covering succeeding tooth.

3. Destruction of the alveolar bone occurred when the primary tooth was lost.

4. Mixed-dentition is in its later stages.

adverse effects
Adverse Effects
  • Dislodged, broken, and lost appliances
  • Plaque accumulation
  • Caries
  • Interference with successor eruption
  • Undesirable tooth mvmt
  • Inhibition of alveolar growth
  • Soft tissue impingement
  • Pain
prior to obtaining the consent parents should be informed that
Prior to obtaining the consent, parents should be informed that:

1. Space maintainer requires monitoring.

2. Patient must maintain adequate OH.

3. Appliance may break, requiring repair or replacement.

4. Broken appliances are hazardous to the child and will be ineffective.

5. Even properly maintained appliances may fail to preserve the space.

It is necessary to obtain parental awareness and understanding related to space maintenance.

premature loss of anterior teeth
Premature loss of anterior teeth?
  • 1 Incisors:
    • no decrease in intracanine dimensions if loss after eruption of canines
    • Need SM?: Not necessary
  • 1 Canines:
    • common loss due to ectopic eruption of permanent lateral incisors
    • Need SM?: consider LLHA with spur or elective extraction of canine
premature loss of posterior teeth
Comprehensive evaluation:

determine if space maint. is indicated for:

a) First primary molar

b) Second primary molar

c) Multiple tooth loss

Priority:2nd M > 1st M > Canine > Incisor

Premature loss of posterior teeth?
classification and types of space maintainer appliances
Classification and Types of Space Maintainer Appliances
  • Unilateral fixed:
    • Band & loop / Crown & loop
    • Distal shoe
  • Bilateral fixed
    • Lower lingual holding arch
    • Transpalatal arch
    • Nance appliance
  • Removable
    • Modifications of Hawley retainer design
premature loss of posterior teeth 1 st primary molar
Premature loss of posterior teeth:1st Primary Molar
  • Little/no space loss prior to eruption of 1st PM
  • Need SM if: in full primary dentition or approximating eruption of 1st PM
  • No SM if: after 1st PM have erupted
  • Following appliances are indicated:

a) Band and loop

b) SSC and loop

premature loss of posterior teeth 2 nd primary molar
Max molar: M tipping, bodily mvmt, MB

rotation around palatal root

Mand molar: M and lingual tipping,

slight bodliy mvmt; also retroclination

of anterior teeth

Following appliances are indicated:

a) Lingual arch/TPA/Nance

b) Band & loop

c) Distal shoe appliance - prior to eruption of 1st PM

Premature loss of posterior teeth:2nd Primary Molar
premature loss of posterior teeth multiple teeth
Following appliances are indicated:

a) Transpalatal arch

b) Nance appliance

c) Lingual arch

d) Removable

Premature loss of posterior teeth:Multiple Teeth
sm band and loop indications
Loss of primary molar

prior/during period of eruption of 1st perm M.

Anywhere in posterior

following a time lapse b/w loss of tooth and eruption of its permanent successor.

Loss of 2 post teeth or bilateral situations

rarely used

SM: Band and LoopIndications
sm band and loop advantages
1. Easy to construct.

2. Inexpensive.

Easily adjusted.

4. Allows eruption of permanent tooth.

5. Non invasive.

6. Painless.

SM: Band and LoopAdvantages
sm band and loop disadvantages
Masticatory function.

Not restored

Extrusion of opposing dentition.

Not prevented

Normal distal mvmt of primary cuspids during eruption of perm lateral incisor

Not allowed if placed for the early loss of mand 1st primary molar

SM: Band and LoopDisadvantages
sm band and loop construction
Band: stainless steel material 0.005 inches in thickness

Crib: portion of the wire spanning the edentulous space

Loop: portion of the wire contacting the abutting tooth 0.032 inches in diameter

SM: Band and LoopConstruction
sm lingual arch indications
Premature loss of primary posterior teeth.

Base for aesthetic restoration in loss of anterior teeth.

3. Used as a base for habit appliance.

SM: Lingual ArchIndications
sm lingual arch advantages disadvantages
1. Maintains est. arch form.

2. Allows eruption of perm teeth w/o interference.

3. Not easily displaced.

4. Ease of cleaning for proper OH.

5. Can be modified easily to serve in many situations.

6. Patient comfort.

1. Does not prevent extrusion of opposing teeth.

2. Not advisable to band teeth which are:

Hypoplastic

Hypocalcified

Highly prone to caries.

3. Can promote decay in non-compliant patients.

SM: Lingual ArchAdvantages Disadvantages
sm fixed lingual arch construction
Band: Stainless steel material 0.005 inches in thickness (ortho bands)

Lingual arch wire: Stainless steel round wire 0.036 inches in thickness

SM: Fixed Lingual ArchConstruction
sm nance appliance maxillary arch multiple tooth loss
SM: Nance ApplianceMaxillary arch: multiple tooth loss

Indications:

The same as for fixed lingual arch

Construction:

Bands: Stainless steel material 0.005 inches in thickness

Palatal wire: Stainless steel round wire 0.036 inches in thickness

what would you do
What would you do?

G.T. age 5 after the removal of a necrotic #85

what would you do1
What would you do?

N.S. age 7 requires extraction of tooth #75.

what would you do2
What would you do?

P.G. age 8 requires pulp treatment and stainless steel crown restorations for teeth #54 and #55

what would you do3
What would you do?

M.M. age 8 is scheduled for a recall visit.