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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
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 1o 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

10 Primary Incisors

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

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

13 Primary Incisors

14 Primary Incisors

15 Primary Incisors

16 Primary Incisors

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 1st primary molar before eruption of the 1st permanent molar Unilateral loss of the 1st or 2nd primary molar after eruption of the 1st permanent molar Bilateral loss of the 1st primary molars before eruption of the permanent incisors and 1st permanent molars Bilateral loss of the 2nd primary molars after eruption of the 1st permanent molar

20 Early loss of the 1st primary molar

21 Early loss of the 2nd primary molar

22 Other indications Deflection of succedaneous tooth

23 Band-loop space maintainer

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

27 Band-loop fabrication

28 Band-loop fabrication

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

34 Loop impingement

35 Loop impingement

36 Lingual arch

37 Lingual arch 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 Transpalatal arch Rarely recommended for bilateral tooth loss in maxilla Can prevent mesio-palatal rotation of palatal root of Mx 1st 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 Nance arch 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 Crown-loop space maintainer
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

59 Crown-loop space maintainer

60 Crown-loop space maintainer

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

D362/QP362 Division of Orthodontics and Paediatric Dentistry Karen M. Campbell, DDS

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

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

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

73 Dentist’s responsibility
Mark on the working model the distal terminus of the appliance

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

75 Completed appliance

76 Immediate insertion Follows extraction – can better visualize placement of shoe Area already anesthetized eliminates potential for 1st 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 Crown with distal shoe Extraction of the E and preparation for cementation

83 Crown with distal shoe Cementation Confirmation by radiograph


85 Following eruption of the 1st permanent molar
Distal shoe no longer appropriate – 1st 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 D’s are very difficult to fit bands Epithelium perforated in area of distal shoe

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