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Transcript of space maintainers
How to decide if a space maintainer is needed?
Adverse Effects Associated with Space Maintainers:
Soft tissue irritation/impingement
interference with eruption
undesirable tooth movement
fractured, dislodged or lost appliances
Distal shoes may be associated with: difficulty in the accurate construction of the appliance,the presence of a constant foreign body in a sensitive area in the mouth, and a possible route of infection between intraoral and submucosal areas.
Recent research regarding the success and failure of space maintainers:
. Researches show that the Nance appliance had the highest survival rate, followed by the band and loop , and the lingual arch showed the lowest .
unilateral space maintainers survived more than twice as long as bilateral appliances
surveys showed that cement loss and breakage were the most common reasons of appliance failure
Recent advances of space maintainers:
Space maintenance involves using an appliance to passively hold teeth in position in order to allow for the eruption of permanent successors into occlusion.
what is a space maintainer?
I) Interproximal caries with cavitations
ii) Early loss of As prior to the eruption of the Cs
iii) Early loss of Cs
iv) Early loss Ds prior to the eruption of 6s.
v) Early loss of E
vi) Permanent tooth loss
vii) Preservation of arch length by maintenance of leeway space
It is the amount of time since premature loss of primary teeth to the eruption of their successor that determines whether space closure would occur and its intensity.
X-rays are the most reliable tool used by the dentist for time determination, as it shows the amount of bone covering the un-erupted tooth and its degree of development.
The dentist should predict the size of permanent teeth that will erupt using space analysis techniques.
Ballard and Wylie's analysis.
Types of space maintainers
Various appliance designs can be employed depending on which teeth are missing, which dental arch is involved, how many teeth are missing, and the stage of dental development. Spms can be unilateral or bilateral, fixed or removable.
Unilateral Fixed space maintainers:
• Band and loop maintainer:
• Stainless steel crown and loop maintainer
The chrome steel crown is indicated in cases of extensive caries or vital pulp therapy of the abutment.
• Band/ stainless steel crown with a distal shoe extension maintainer:
The distal shoe is used in cases of premature loss of E and before eruption of the 6.
loss of 6 before the eruption of 7
It guids the tooth to erupt normally in its place.
Removable bilateral space maintainers:
• Removable partial dentures
• Removable complete dentures
• Removable unilateral maintainers:
These are examples of dangerous space maintainers. They are too small and present swallowing and choking dangers for children. Thus are not used anymore.
• Lingual arch space maintainer:
lingual arch is a bilateral fixed space maintainer.
Used in the case of multiple loss of teeth.
Fixed appliances are easier to maintain and they are less likely to be removed, damaged, or lost by the child.
• Nance Appliance:
used in situations where premature bilateral loss of maxillary primary teeth
The palatal portion incorporates an acrylic button that contacts the palatal tissue, providing resistance to anterior movement of the posterior teeth, however causes tissue irritation.
• Transpalatal arch:
similar to the Nance's appliance; however, the issue of palatal soft tissue irritation and inflammation is avoided .
active type incorporating the omega loop helps regain lost space.
passive type without omega loop functions only to maintain space.
bilateral fixed space maintainers
favorite among many clinicians because of its low cost, ease of construction and efficiency
mainly used in cases of premature loss of Ds
loss of Es after eruption of the 6
loss of C before eruption of 2
loss of 6 after eruption of 7
These appliances are typically used when more than one tooth has been lost in a quadrant.
it may not be worn by the patient and it is more susceptible to breakage or loss by the patient
will restore esthetics, function and guide first permanent molars to erupt in their natural position.
The denture is adjusted as permanent teeth erupt as shown.
Fixed space maintainers combined with open-face stainless steel crowns:
Studies showed promising results with the use of open faced space maintainers in cases of extensive caries or loss of occlusogingival dimension. However more research and studies are still needed to prove definite success of such modified appliances.
Fiber reinforced composite loop space maintainer:
Research has proved that "fiber reinforced composite loop space maintainers" are comparable to the conventional band and loop maintainer in terms of physical strength.
it eliminates the need of cast or working models,
breakage or dissolution of luting cement leading to abutment caries
, soft tissue irritation,
possible metal allergy
annual maintainace all needed with the conventional band and loop maintainer
Fathian, M., Kennedy, D. B., & Nouri, M. R. (2007). Laboratory-made space maintainers: A 7- year retrospective study from private pediatric dental practice. Pediatric Dentistr.
Dhindsa, A., & Pandit, I. K. (2008). Modified Willet's appliance for bilateral loss of multiple deciduous molars: A case report. Journal of the Indian Society of Pedodontics & PreventiveDentistry
Brothwell, D. J. (1997). Guidelines on the use of space maintainers following premature loss ofprimary teeth. Journal (Canadian Dental Association),
Bijoor, R. R., & Kohli, K. (2005). Contemporary space maintenance for the pediatric patient.
New York State Dental JournalBrill, W. A. (2002). The distal shoe space maintainer chairside fabrication and clinical performance.
Pediatric Dentistry Padma Kumari, B., & Retnakumari, N. (2006). Loss of space and changes in the dental arch after premature loss of the lower primary molar: A longitudinal study. Journal of the Indian Society of Pedodontics & Preventive Dentistry