Space Maintainers PDF

Space Maintainers  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! Name t...

Space Maintainers  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! Name the 4 most basic pediatric space maintainers  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 MAXILLARY or MANDIBULAR Used when second primary molar requires extraction and first permanent molar has not erupted  Distal Shoe Should be evaluated with radiograph prior to cementation – Length – Position Will be replaced with another space maintainer when permanent teeth erupt.  Distal Shoe Example of use in partial eruption case.  Nance Appliance MAXILLARY ONLY Bands on first permanent molars  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) 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 MANDIBULAR ONLY Bands on first permanent molars Anterior Stop = Cinguli of #23-#26  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? 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 Omega Loops in area of premolars allow slight adjustment to fit appliance Should not be used to activate appliance  Appliance Activation Features Can be added by attaching light wire features This is beyond routine space maintenance  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 Stronger than band and loop Cementation failure or loss less likely Excellent choice if tooth needs a restoration  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? 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 ? 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 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 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 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 Which teeth were extracted? How old is the patient? What is the appropriate space maintainer? When can the space maintainer be removed?  Question 4 Which teeth were extracted/ What is the appropriate space maintainer?  Question 5 Which teeth have been extracted? How old is the child? What is the most appropriate space maintenance?