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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Dr Seyed Ebrahim Jabbarifar :Associate professor Isfahan Dental School
Pedodontic department 2009
Hypophosphatasia Rickets Acrodynia
Histiocytosis X triad Leukemia Cherubism
Juvenile Periodontitis Dentinal dysplasia
Cyclic neutropenia Papillon-Lefevre syndrome
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 ageFunctions of a Space Maintainer
Note: appliance must neither inhibit nor deflect normal growth changes
“When should a space maintainer be placed?”
“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”.
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
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.
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.
a) Band and loop
b) SSC and loop
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 PMPremature loss of posterior teeth:2nd Primary Molar
Crib: portion of the wire spanning the edentulous space
Loop: portion of the wire contacting the abutting tooth 0.032 inches in diameterSM: Band and LoopConstruction
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:
Highly prone to caries.
3. Can promote decay in non-compliant patients.SM: Lingual ArchAdvantages Disadvantages
Lingual arch wire: Stainless steel round wire 0.036 inches in thicknessSM: Fixed Lingual ArchConstruction
The same as for fixed lingual arch
Bands: Stainless steel material 0.005 inches in thickness
Palatal wire: Stainless steel round wire 0.036 inches in thickness
G.T. age 5 after the removal of a necrotic #85
N.S. age 7 requires extraction of tooth #75.
P.G. age 8 requires pulp treatment and stainless steel crown restorations for teeth #54 and #55
M.M. age 8 is scheduled for a recall visit.