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Space management«
By space maintainer«.
a Device used to maintain or regain space following loss
of primary tooth. So as to guide the permanent to
erupt in the proper position in the arch

a Objective:
Preservation of space
Integrity of dental arch
Normal occlusal plane
esthetic
ajequirement:

do not interfere with the replacing permanent
tooth

maintain the entire mesio-distal space

simple construction

restore function

prevent over-eruption of opposing tooth

do not exert excessive stress on adjoining tooth

easily cleansable

does not restrict normal growth & dev of dental
arch
a=eneral consideration;

Time elapsed since loss

Before 6 months after tooth loss

Insert SM as soon as the tooth is removed

Dental age of the patient

Permanent will erupt when 3/4 of root is completed

Amount of bone covering unerupted tooth

Sequence of eruption

Delayed eruption of permanent tooth

Congenital absence of permanent tooth

Presentation of problems to the parents
Indication..
„ Closure of space following premature loss
„ If the space after premature loss of deciduous teeth
shows signs of closing.
„ If the need for treatment of malocclusion at a later
stage is not indicated.
„ When the space for a permanent tooth should be
maintained for two years or longer.
„ To avoid supra ² eruption of a tooth from the opposing
arch.
„ To improve the physiology of a child·s masticatory
system and restore dental health optimally.
Contraindication..
„ If the radiograph of extraction region shows that
the succedaneous tooth will erupt soon
„ If the radiograph of extraction region shows one
third of the root of succedaneous tooth is already
calcified
„ When the space left by prematurely lost primary
tooth is greater than the space needed for the
permanent successor as indicated radiographically
„ If the space shows no signs of closing
„ When succedaneous tooth is absent
Appliance..
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„ Band & loop „ Acrylic partial

„ Crown & loop denture
„ Lingual arch „ Full denture
„ Palatal arch „ jemovable distal shoe
„ Transpalatal
„ Distal shoe
„ Esthetic ant
„ Band & bar
Fixed space maintainer«
a Fixed or fitted unto the teeth

a Advantages:
 Band & crown require minimum or no tooth prep
 Do not interfere with passive eruption of abutment
teeth
 Jaw growth is no hampered
 Permanent teeth are free to erupt
 Can be used in un-cooperative patient
 Masticatory functions is restored
aDisadvantages;
 Elaborates instrumentation with expert skill is
needed.
 They may result in decalcification of tooth material
under the bands.
 If pontics are used it can interfere with vertical
eruption of the abutment tooth.
jemovable appliance..
„ Used when more than 1 tooth has been lost in a quadrant

„ The only alternative when there are no suitable abutment teeth

„ Can replace occlusal function

„ Advantages:
„ Easy to clean
„ jestore vertical dimension
„ Can be worn part time allowing circulation of the blood to the ST
„ joom can be made for permanent teeth to erupt without changing
app
„ Stimulate eruption
„ Help in preventing dev of tongue thrust habit into the extraction
space
„ Disadvantages;
„ Lost or broken
„ Uncooperative patient may not wear the app
„ Lat jaw growth may be restricted, if clasps are
incorporated
„ May cause irritation of the underlying ST
„ Indication;
„ Esthetic
„ Abutment cannot support fixed app
„ Cleft palate require obturation of the palatal
defect
„ Unerupted permanent is not going to erupt in less
than 5 month time
„ Difficult to adapt bands
„ Multiple loss of primary which require functional
replacement
„ Contraindication;
„ Lack of patient cooperation
„ Allergic to acrylic
„ Epileptic patient
Acrylic Partial Dentures:
„ Bilateral removable functional passive space
maintainer
„ Bilateral removable non-functional Space
maintainer
„ Used successfully in patients who have undergone
multiple extractions.
„ The inclusion of artificial teeth in the denture
restores masticatory function.
„ Clasp can be fabricated on deciduous canines &
molars for retention.
Full or complete dentures:
„ In primary teeth of a pre school child where
extraction is indicated for rampant Caries.
„ These denture restore masticatory function and
esthetics.
„ =uide the first permanent molars into their
correct position.
„ Denture will have to be adjusted and a portion of
it cut away as the permanent incisor erupt.
jemovable Distal shoe space maintainer:
„ An ¶immediate· acrylic partial denture with an
acrylic distal shoe extension
„ guide the 1st permanent molar into position when
the deciduous second molar is lost shortly before
the eruption of the first permanent molar
„ The tooth to be extracted is cut away from the
stone model and a depression is cut into the stone
model to allow the fabrication of the acrylic
extension.
m

„ Used to maintain space of a single tooth
„ Cheap
„ Easy to fabricate
„ Do not restore the occlusal function of the
missing tooth
„ Indication;
„ Unilateral loss of the primary first molar before or
after the eruption of permanent 1st molar
„ Bilateral loss of a primary molar before the
eruption of the permanent incisors
m 


„ Bonding the first primary molar for guidance.
„ used in cases where the second primary molar is
lost before the eruption of the first permanent
molar.
£



„ Indication
„ Bilateral loss of primary teeth on the mandibular
arch during transitional dentition
„ Maintenance of arch perimeter and incisor
positions

contraindicated in primary dentition

„ Modification of LLA with omega loops
„ Activation of loop helps flare anteriors with some
distalising of permanent molars
„ Modifies LLA with claps to prevent distal tipping
of lateral incisors
O

 


„ Nance(1947) described the ¶preventive lingual
wire·
„ Consist of bands on the upper molars, with the
arch wire extending forward into the vault.
„ Indicated for loss of multiple primary teeth in
the maxillary arch
„ Acrylic button increased stability
„ Prevent tipping and rotation movements of molars
„ Acrylic button may cause difficulty in maintaining
hygiene in the rugae area
ï





„ Prevent rotation around the lingual root, prevent
loss of space.
„ Indicated for bilateral loss of primary maxillary
molars
„ Hygienic
„ May not prevent the mesial tipping of teeth
 


„ Indication;
Loss of primary 2nd molar before the eruption of the
1st permanent molar

„ Contraindication;
„ Poor oral hygiene
„ Medically compromised patient
„ Disadvantages
Over extension causes injury to the permanent
tooth bud i.e. second premolar.
if under extended it may allow the molar to tip into
the space or over the band.
Prevents complete epithelization of the extraction
socket.
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