Presentation on theme: "Basic Space Maintainers lecture one"— Presentation transcript:
1 Basic Space Maintainers lecture one Prepared by:Dr Seyed Ebrahim Jabbarifar Associate professorUniversity of Isfahan Department of Pediatric Dentistry2009
2 Basic Space Maintainers Are PASSIVE.036 wire is very heavy and should not be used to actively move teeth
3 Before Placing a Space Maintainer Evaluate Arch LengthHas the space already been lost?Is there excess space?Appropriate RadiographsSuccedaneous tooth?Time to Eruption?Patient/Family Compliance
4 Space Maintainers are Simple! Name the 4 most basic pediatric space maintainers
5 Basic Space Maintainers NANCE (Transpalatal Arch with AcrylicButton Stop on Palate)LOWER LINGUAL HOLDING ARCH (LLHA)BAND/CROWN and LOOPDISTAL SHOE
6 Distal Shoe MAXILLARY or MANDIBULAR Used when second primary molar requires extraction and first permanent molar has not erupted
7 Distal Shoe Should be evaluated with radiograph prior to cementation LengthPositionWill be replaced with another space maintainer when permanent teeth erupt.
8 Distal ShoeExample of use in partial eruption case.
9 Nance ApplianceMAXILLARY ONLYBands on first permanent molars
10 Nance ApplianceCross Palatal Bracing prevents rotation #3 and #14 around palatal root- this starts mesial migration of #3 and #14Acrylic Button provides additional stop
11 Transpalatal Holding Arch (TPA) Can be used like a Nance.AdvantageLack of acrylic button so less tissue irritation and more cleansibleDisadvantageLack of anterior stop = possible tooth shift (?)
12 Lower Lingual Holding Arch MANDIBULAR ONLYBands on first permanent molarsAnterior Stop = Cinguli of #23-#26
13 Lower Lingual Holding Arch Mandibular incisors often erupt lingually and are pushed forward by the tongueLLHA should not be placed with primary incisors
14 #K and #T Extractions : LLHA Indicated? NO- note lingual eruption #23 and #26Option: 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.
15 LLHA Omega LoopsOmega Loops in area of premolars allow slight adjustment to fit applianceShould not be used to activate appliance
16 Appliance Activation Features Can be added by attaching light wire featuresThis is beyond routine space maintenance
17 Band/Crown and Loop MAXILLARY or MANDIBULAR Unilateral most typical Can be bilateral if permanent teeth are not presentSingle tooth span
18 Crown and Loop Stronger than band and loop Cementation failure or loss less likelyExcellent choice if tooth needs a restoration
19 What About Removable Appliances? Yes, they are possible, however………..High failure rate due to breakage and lossParent and patient compliance must be exceptional
20 Which Space Maintainer? Distal Shoe = 2nd Primary Molar Extraction with unerupted 1st Permanent MolarNance or Band/Crown Loop = Maxillary problem with 1st Permanent Molars presentLower Lingual Holding Arch = Mandibular Problem with 1st Permanent Molars and Permanent Incisors presentBand/Crown and Loop= Primary 1st Molar Extraction
21 Must I Plan to Replace a Band/Crown and Loop ? All depends on ERUPTION SEQUENCENo, in maxillary archYes, in mandibular arch- may need LLHA laterWhy? Canine should exfoliate prior to eruption of 1st premolar, making space maintainer defunct.
22 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.
23 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?
24 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?
25 Question 3 Which teeth were extracted? How old is the patient? What is the appropriate space maintainer?When can the space maintainer be removed?
26 Question 4 Which teeth were extracted/ What is the appropriate space maintainer?
27 Question 5 Which teeth have been extracted? How old is the child? What is the most appropriate space maintenance?
28 “Somieh” CaseSomieh presented for an initial visit at the COD. She has had dental treatment on and off throughout life. She is in no pain, but mom reports that “we know she has dental problems.”
29 How old is Ali assuming normal dental development?
36 AliAssuming normal dental development, at what age will the space maintainer you placed no longer be needed?
37 “Ali” CaseAli was referred by his general dentist for ‘ tooth decay and crowding.’The family does not believe they can afford comprehensive orthodontic care, but does have dental insurance for “routine dental care.”
38 Ali: Chart Maxillary Dentition Only on the Odontogram
39 Ali’s Bite WingsChart any pathology or abnormal findings (including caries) for the maxillary arch only on the odontogram.
60 Ali Tx Plan Extract #L,S and T and Place LLHA #L and S due to abscess#T due to ectopic #28Appt #1: Fit bands and Impress for LLHAExtract #LAppt. #2: Seat LLHAExtract #S, T
61 AliAssuming normal dental development, at what age will the space maintainer you placed no longer be needed?Answer: When #21,28 and 29 erupt.Around age 12 years
62 “Ali” CaseAli was referred by his general dentist for ‘ tooth decay and crowding.’The family does not believe they can afford comprehensive orthodontic care , but does have dental insurance for “routine dental care.”
67 Ali Tx Plan Extract all maxillary primary teeth #A,B,J- Multiple caries and near exfoliationTE #C and #H due to root formation #6 and #11Restore #3 with direct M compositeRestore #14-MOPlace Nance Space Maintainer- slight space deficiency, but this will be very beneficial.
68 Ali Tx Sequence Appt 1 Appt 2 Fit bands #3 and #14 and Impress for NanceRestore #14TE #H and #JAppt 2Restore #3Seat NanceTE # A,B,C