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PASSIVE SPACE CONTROL Dr S.E. Jabbarifar;Isfahan Dental School,Pediatric Dentistry Departement 2009.

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Presentation on theme: "PASSIVE SPACE CONTROL Dr S.E. Jabbarifar;Isfahan Dental School,Pediatric Dentistry Departement 2009."— Presentation transcript:

1 PASSIVE SPACE CONTROL Dr S.E. Jabbarifar;Isfahan Dental School,Pediatric Dentistry Departement 2009

2 Prerequisite knowledge Understand that arch length is greatest at age four years Tooth position is maintained by balance of forces – shift vs. drift Greatest amount of space closure – within first 6 months of premature tooth loss Sequence & timing of exfoliation/eruption

3 Space control vs. space maintenance Space control Dynamic Careful ongoing supervision Space maintenance Utilization of appliance to preserve existing space Not always the rule!

4 Variables influencing space control Oral musculature & habits Time elapsed since extraction Dental age, eruption sequence & bony covering Available space Interdigitation Absence of anomalies

5 Considerations in premature 1 o tooth loss Preserve the arch length! Causes: Anterior – primarily trauma, caries Posterior – primarily caries If space lost: Space maintenance Space regaining No treatment

6 Space loss in primary and mixed dentitions Unrestored interproximal caries reduce arch circumference! first line of defense = Class II & SSC restorations Natural tooth is the best space maintainer

7 Planning for space maintenance No medical contraindications Patient must be dentally fit Patient must be able to demonstrate good OH

8 Planning for space maintenance Parents must all understand costs involved Parents must understand importance of & be willing to attend regularly for appliance supervision/maintenance – teeth lost in primary dentition stage may cause delayed eruption of succedaneous teeth Periodic recementation may be required

9 Primary Incisors

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11 Why replace primary incisors? Primarily for esthetic reasons Rarely see long-term effects on speech development and function Once 1 o cuspids have erupted in occlusion the anterior arch length is established

12 Primary Incisors Problems with replacement: Appliances are weak High maintenance – close monitoring reqd Frequent alterations as dentition changes Appliance may enhance caries risk

13 Primary Incisors

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17 Primary Canine Loss due to trauma or caries – rare Space maintainer: B&L vs. RPD Must be removed to accommodate lateral No space maintainer: Midline shift Lingual collapse in mandible

18 Premature loss of primary molars

19 Band-loop space maintainer Indications: Unilateral loss of the 1 st primary molar before eruption of the 1 st permanent molar Unilateral loss of the 1 st or 2 nd primary molar after eruption of the 1 st permanent molar Bilateral loss of the 1 st primary molars before eruption of the permanent incisors and 1 st permanent molars Bilateral loss of the 2 nd primary molars after eruption of the 1 st permanent molar

20 Early loss of the 1 st primary molar

21 Early loss of the 2 nd primary molar

22 Other indications Deflection of succedaneous tooth

23 Band-loop space maintainer FABRICATION & DESIGN

24 Band-loop fabrication Technique: Properly fitting band on abutment tooth (pg. 389 – Pinkham) Segmental impression (compound/alginate) Remove band from tooth & secure in impression Create working model

25 Band-loop fabrication Sectional impression tray Green or red compound

26 Band-loop fabrication

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29 Band-loop design Loop should be wide enough bu-li to allow eruption of bicuspid (8 mm) Loop should not restrict physiologic movement of adjacent teeth (eg. lateral movement of primary canine)

30 Band-loop design Loop should not impinge on soft tissue Loop should be in close approximation to ridge

31 Band-loop cementation Apply floss ligature Try-in / seat band completely Loop should contact abutment below contact point No soft tissue impingement Cementation in properly isolated, dry field Check/adjust occlusion

32 Try it in first!

33 Loop impingement

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36 Lingual arch

37 Indications: Bilateral single or multiple tooth loss in mandible Not recommended when primary incisors still present

38 Lingual arch

39 Lingual arch design Archwire should rest on cingulae of incisors mm above gingival margin Removable vs. soldered

40 Lingual arch design Solder joint should be in mid-third and parallel to band Wilson loops Archwire should be below plane of occlusion posteriorly

41 Lingual arch fabrication Fit molar bands Compound/alginate impression – accurate especially in lingual sulcus & lower incisor area

42 Lingual arch fabrication Secure bands in impression … …create working model

43 Lingual arch cementation Check for passivity on the model and in the mouth before cementation Archwire should be in contact with lower incisor cingulae

44 Lingual arch cementation Dry field GI or polycarboxylate cement No soft tissue impingement

45 Transpalatal arch

46 Rarely recommended for bilateral tooth loss in maxilla Can prevent mesio-palatal rotation of palatal root of Mx 1 st permanent molar but allows mesial tipping of molars & space loss

47 Transpalatal arch May have an indication for use when one side of the arch is intact but several primary teeth are missing contralaterally Some designs incorporate omega loop: when active can prevent bodily movement of molars

48 Nance arch

49 Used commonly in maxilla for bilateral tooth loss Incorporates acrylic button in contact with palate to prevent molars from tipping Can be very unhygenic

50 Nance arch

51 Nance arch fabrication Bands fitted on molars Mx impression in compound/alginate Working model

52 Nance arch fabrication Archwire will traverse the palatal vault

53 Nance arch fabrication Adapted archwire is soldered to bands Acrylic button is added to embed the wire

54 Nance arch fabrication Completed arch ready for try-in and cementation Ensure acrylic button in firm contact with palate

55 Crown-loop space maintainer

56 Indications: As for band-loop Abutment tooth requires full coverage SSC due to multi-surface caries or pulp treatment

57 Crown-loop fabrication Abutment tooth prepared for SSC Properly contoured SSC seated, but not cemented Compound impression SSC placed into impression Working model Another SSC fitted and cemented with temporary cement

58 Crown-loop space maintainer

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61 Crown-loop cementation Temporary SSC removed, under LA if necessary Try-in crown-loop to verify loop contours Cementation in dry field

62 Crown-loop space maintainer Disadvantages: If solder joint fails, there is no way to repair the appliance without entire re-make Cost is higher (extra SSC)

63 Band-loop over SSC Band can be fitted over SSC as alternative to crown- loop

64 Bonded space maintainer Difficult to retain due to shearing forces of occlusion Flexure in function will de-bond Difficult to adjust

65 Removable appliances Indicated for mulitple primary tooth loss when no suitable abutment teeth exist Need to restore occlusal function over longer span Clasping difficult for primary teeth therefore retention a problem Compliance issues

66 Removable appliances

67 INTRA-ALVEOLAR SPACE MAINTENANCE D362/QP362 Division of Orthodontics and Paediatric Dentistry Karen M. Campbell, DDS

68 Premature loss of the 2 nd primary molar If the 1 st permanent molar is erupted, can use conventional B & L from 6 to D

69 Premature loss of the 2 nd primary molar Band & loop from D to 6 Difficult to band Ds

70 Indications for intra-alveolar space maintenance Premature loss of the 2 nd primary molar prior to the eruption of the 1 st permanent molar

71 Contraindications Medically compromised: Cardiac patients requiring SBE prophylaxis Immunosuppression Chemotherapy/radiation therapy, pre-BMT Demonstrated lack of commitment to follow-up

72 Distal Shoe Provides a guiding plane for the eruption of the 1 st permanent molar

73 Dentists responsibility Mark on the working model the distal terminus of the appliance

74 Dentists responsibility Provide measurement from radiograph Mark depth of shoe with cut on model Shoe should be 1 mm below mes marginal ridge of the 1 st permanent molar

75 Completed appliance

76 Immediate insertion Follows extraction – can better visualize placement of shoe Area already anesthetized eliminates potential for 1 st permanent molar drift

77 Cemented appliance

78 Crown with distal shoe D prepared for SSC; E to be extracted at later appt

79 Crown with distal shoe Segmental impression with crown inserted

80 Crown with distal shoe Tooth temporized with SSC

81 Crown with distal shoe

82 Extraction of the E and preparation for cementation

83 Crown with distal shoe CementationConfirmation by radiograph

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85 Following eruption of the 1 st permanent molar Distal shoe no longer appropriate – 1 st permanent molar may tip mesially above shoe Parents must be aware of need for second appliance from the beginning Conventional B & L or lingual arch may be required

86 Drawbacks of the appliance Can only replace a single tooth due to its cantilever design Inherent lack of strength Cannot restore occlusal function Ds are very difficult to fit bands Epithelium perforated in area of distal shoe


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