Presentation on theme: "Management of Space in Pediatric Dentistry"— Presentation transcript:
1Management of Space in Pediatric Dentistry Dr Seyed Ebrahim Jabbarifar :Associate professor Isfahan Dental SchoolPedodontic department 2009
2Etiology of Early Primary Tooth Loss Extraction or destruction:extensive caries or traumatic injuryPremature 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 syndromeEctopic Eruption of Primary Canine: first clinical sign of a significant arch length-tooth size discrepancy
3Functions of a Space Maintainer prevent undesirable tooth mvmt following the premature loss of a primary toothi.e. Mesial migration of posterior segments and lingual collapse of anterior segmentsNegative Tooth Mvmt:Reduction or loss of space required by succeeding toothConsiderable influence on dental dvlpt well into adolescence and adult ageSpace Maintainers are recommended to reduce the prevalence and severity of malocclusion following premature loss of primary teeth.
4Functions of a Space Maintainer Maintain spacePrevent mvmt adjacent teethProvide masticatory fxPrevent overeruption of opposing teethImprove estheticsAssist in speech (anterior segments)Aid in control of deleterious oral habitsNote: appliance must neither inhibit nor deflect normal growth changes
5Ideal Prerequisites of a Space Maintainer Simple to construct and maintainDurable, strong, stablePassiveEasily cleanable and not enhance dental caries or soft tissue pathologyReadily adjustable for flexible applicationPassive--must not impose excessive stress of pressures on remaining teeth which might effect orthodontic movements.
6Factors 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”.
7Factors to consider when planning a space maintainer: Dental and periodontal conditionArch lengthPresence/absence of permanent successorTime elapsed since loss of primary toothStatus of first permanent molar eruptionStatus of permanent successor’s development and eruption potentialCooperation level of child and parentsWhich tooth is lost, in which arch, at what time?
8A 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
9Suggested 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.Roots:if 1/3 to 1/2 root dvlpt: then eruption delayedIf 1/2 to 3/4 root dvlpt: then eruption accelerated
10Adverse Effects Dislodged, broken, and lost appliances Plaque accumulationCariesInterference with successor eruptionUndesirable tooth mvmtInhibition of alveolar growthSoft tissue impingementPain
11Prior 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.Monitor: assess integrity of cement, evaluate + clean abutment teeth
12Premature loss of anterior teeth? 1 Incisors:no decrease in intracanine dimensions if loss after eruption of caninesNeed SM?: Not necessary1 Canines:common loss due to ectopic eruption of permanent lateral incisorsNeed SM?: consider LLHA with spur or elective extraction of canineCanine loss: compromises arch length, possibly deepens bite, shift of dental midline toward side of loss
13Premature loss of posterior teeth? Comprehensive evaluation:determine if space maint. is indicated for:a) First primary molarb) Second primary molarc) Multiple tooth lossPriority: 2nd M > 1st M > Canine > Incisor
14Classification and Types of Space Maintainer Appliances Unilateral fixed:Band & loop / Crown & loopDistal shoeBilateral fixedLower lingual holding archTranspalatal archNance applianceRemovableModifications of Hawley retainer design
15Premature loss of posterior teeth: 1st Primary Molar Little/no space loss prior to eruption of 1st PMNeed SM if: in full primary dentition or approximating eruption of 1st PMNo SM if: after 1st PM have eruptedFollowing appliances are indicated:a) Band and loopb) SSC and loopIf there is a loss of the 1st primary molar and space maintenance is required…
16Premature loss of posterior teeth: 2nd Primary Molar Max molar: M tipping, bodily mvmt, MBrotation around palatal rootMand molar: M and lingual tipping,slight bodliy mvmt; also retroclinationof anterior teethFollowing appliances are indicated:a) Lingual arch/TPA/Nanceb) Band & loopc) Distal shoe appliance - prior to eruption of 1st PMIf there is a loss of the 1st primary molar and space maintenance is required, then the…Note: B+L and LLHA--used after the 6 is in placeDistal Shoe--used before the 6 is in place
17Premature loss of posterior teeth: Multiple Teeth Following appliances are indicated:a) Transpalatal archb) Nance appliancec) Lingual archd) Removable
18SM: Band and Loop Indications Loss of primary molarprior/during period of eruption of 1st perm M.Anywhere in posteriorfollowing a time lapse b/w loss of tooth and eruption of its permanent successor.Loss of 2 post teeth or bilateral situationsrarely used
19SM: Band and Loop Advantages 1. Easy to construct.2. Inexpensive.Easily adjusted.4. Allows eruption of permanent tooth.5. Non invasive.6. Painless.
20SM: Band and Loop Disadvantages Masticatory function.Not restoredExtrusion of opposing dentition.Not preventedNormal distal mvmt of primary cuspids during eruption of perm lateral incisorNot allowed if placed for the early loss of mand 1st primary molar
21SM: Band and Loop Construction Band: stainless steel material inches in thicknessCrib: portion of the wire spanning the edentulous spaceLoop: portion of the wire contacting the abutting tooth inches in diameter
22SM: 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.
23SM: 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:HypoplasticHypocalcifiedHighly prone to caries.3. Can promote decay in non-compliant patients.
24SM: Fixed Lingual Arch Construction Band: Stainless steel material inches in thickness (ortho bands)Lingual arch wire: Stainless steel round wire inches in thickness
25SM: Nance Appliance Maxillary arch: multiple tooth loss Indications:The same as for fixed lingual archConstruction:Bands: Stainless steel material inches in thicknessPalatal wire: Stainless steel round wire inches in thickness
26G.T. age 5 after the removal of a necrotic #85 What would you do?G.T. age 5 after the removal of a necrotic #85Q: Tooth missing: #85--singleQ: Choices: Distal shoeUse: Distal shoe
27N.S. age 7 requires extraction of tooth #75. What would you do?Q: Tooth missing: #74, soon to be 75--multipleQ: Choices: LLHA, ?B+L, (?partial)Use: LLHA--loss of multiple teethAt age 7, need to assess if all perm incisors are in--make modification if necessary.N.S. age 7 requires extraction of tooth #75.
28What would you do?Q: Tooth missing: #64 and 65--multiple, high caries risk--potentially #54 and/or 55 in futureQ: Choices: Nance, ?B+LUse: NanceP.G. age 8 requires pulp treatment and stainless steel crown restorations for teeth #54 and #55
29M.M. age 8 is scheduled for a recall visit. What would you do?Recall: assess integrity of cementevaluate and clean abutment teethNote: Space loss in UR Quadrant--may require space regaining appliance/ortho consultM.M. age 8 is scheduled for a recall visit.