Management of Space in Pediatric Dentistry Dr Seyed Ebrahim Jabbarifar :Associate professor Isfahan Dental School Pedodontic department 2009.

Management of Space in Pediatric Dentistry

Dr Seyed Ebrahim Jabbarifar :Associate professor Isfahan Dental School

Pedodontic department 2009QuickTime™ and aTIFF (Uncompressed) decompressor

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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 syndromesHypophosphatasia Rickets AcrodyniaHistiocytosis X triad Leukemia CherubismJuvenile Periodontitis Dentinal dysplasiaCyclic neutropenia Papillon-Lefevre syndrome

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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

1. Maintain space2. Prevent mvmt adjacent teeth3. Provide masticatory fx4. Prevent overeruption of opposing teeth

5. Improve esthetics6. Assist in speech (anterior segments)7. Aid in control of deleterious oral habits

Note: appliance must neither inhibit nor deflect normal growth changes



Ideal Prerequisites of a Space Maintainer

1. Simple to construct and maintain

2. Durable, strong, stable

3. Passive

4. Easily cleanable and not enhance dental caries or soft tissue pathology

5. Readily adjustable for flexible application



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

maintainer:1. Dental and periodontal condition

2. Arch length

3. Presence/absence of permanent successor

4. Time elapsed since loss of primary tooth

5. Status of first permanent molar eruption

6. Status of permanent successor’s development and eruption potential

7. Cooperation level of child and parents

8. Which tooth is lost, in which arch, at what time?



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:

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

1. Dislodged, broken, and lost appliances

2. Plaque accumulation

3. Caries

4. Interference with successor eruption

5. Undesirable tooth mvmt

6. Inhibition of alveolar growth

7. Soft tissue impingement

8. Pain



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?

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

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










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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: 2nd 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/Nanceb) Band & loopc) Distal shoe appliance - prior to eruption of 1st PM





Premature loss of posterior teeth: Multiple Teeth

Following appliances are indicated:a) Transpalatal arch

b) Nance appliance

c) Lingual arch

d) Removable



SM: Band and LoopIndications

1. Loss of primary molarprior/during period of eruption of 1st perm M.

2. Anywhere in posteriorfollowing a time lapse b/w loss of tooth and eruption of its permanent successor.

3. Loss of 2 post teeth or bilateral situations

rarely used

SM: Band and LoopAdvantages

1. Easy to construct.

2. Inexpensive.

3. Easily adjusted.

4. Allows eruption of permanent tooth.

5. Non invasive.

6. Painless.

SM: Band and LoopDisadvantages

1. Masticatory function.Not restored

2. Extrusion of opposing dentition.Not prevented

3. 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 LoopConstruction

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: Lingual ArchIndications

1. Premature loss of primary posterior teeth.

2. Base for aesthetic restoration in loss of anterior teeth.

3. Used as a base for habit appliance.



SM: Lingual ArchAdvantages

Disadvantages1. 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: Fixed Lingual ArchConstruction

Band: Stainless steel material 0.005 inches in thickness (ortho bands)

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

SM: Nance Appliance Maxillary arch: multiple

tooth lossIndications:

The same as for fixed lingual archConstruction:

Bands: Stainless steel material 0.005 inches in thicknessPalatal wire: Stainless steel round wire 0.036 inches in thickness

What would you do?

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









What would you do?

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



What would you do?

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





What would you do?

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

Thank You

Management of Space in Pediatric Dentistry Dr Seyed Ebrahim Jabbarifar :Associate professor Isfahan Dental School Pedodontic department 2009.

Documents

loss of space

loss of primary tooth

loop slide

pm slide

succeeding tooth

present space

management of space

space maintenance