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DEPARTMENT OF PEDODONTICS
SEMINAR ON SPACE MAINTAINER AND REGAINER
SUBMITTED TO:Dr. JASHEENA SINGH Prof. and H.O.D Department of pedodontics GUIDED BY:Dr. SUBHASH SINGH (MDS,Sr. Lecturer) Dr. GARIMA SINGH (MDS,Sr. Lecturer) Dr. SHIVIKA MEHTA (MDS,Sr. Lecturer) SUBMITTED BY:ANKUR SAHU Final year Roll no.- 10 Batch- B
• SPACE MAINTAINER
• INTRODUCTION • CLASSIFICATION • FIXED SPACE MAINTAINER
» » » » » BAND AND LOOP LINGUAL ARCH TRANSPALATAL ARCH NANCE PALATAL ARCH DISTAL SHOE
• REMOVABLE SPACE MAINTAINER
• SPACE REGAINER
• INTRODUCTION • CLASSIFICATION • REMOVABLE SPACE REGAINER • FIXED SPACE REGAINER
INTRODUCTION Space Maintainers: “Space maintainers can be defined as appliances used to maintain space or regain minor amount of space lost.” . so as to guide the unerupted tooth into a proper position in the arch.
mastication.IDEAL REQUIRMENTS 1. It should provide mesiodistal space opening when it is required. It should not interfere with speech. 5. It should not interfere with the eruption of the replacing permanent teeth. 3. It should not interfere with eruption of occluding teeth. It should maintain the desired mesiodistal dimension of the space created by loss of tooth 2. 4. .
. • When succeeding tooth is congenitally absent and space closure is required. therefore it is best time to insert an appliance. • Congenital absence of permanent teeth. • When gross space discrepancy present requiring future extractions and orthodontic treatment. • Maximum closure occurs within 6 months after extraction.INDICATIONS • When malocclusion exists or abnormal oral habits are present. CONTRAINDICATIONS • When there is no alveolar bone overlying the crown of erupting teeth and there is sufficient space for its eruption. • Delayed eruption of permanent teeth.
ACCORDING TO HITCHCOCK: a) b) c) d) Removable.CLASSIFICATION 1. fixed or semifixed With bands or without bands Functional or non functional Active or passive e) Certain combinations of above.Extraoral anchorage c) Individual tooth space maintainer . ACCORDING TO RAYMOND C THROW: a) Removable b) Complete arch .Lingual arch . 2.
ACCORDING TO HEINRICHSEN: a) Fixed space maintainer Class 1Non functional .Loop type Functional -Pontic type -Lingual arch type Class 2Cantilever type (distal shoe.3.Bar type . band and loop) b) Removable space maintainer .
Palatal arch appliance. Crown & loop space maintainer. Full or complete dentures. Distal shoe.APPLIANCE THERAPY Fixed space maintainersBand & loop space maintainer. . Transpalatal arch. Bonded space maintainer Removable space maintainersAcrylic partial dentures. Lingual arch. Band & Bar type space maintainer. Removable distal shoe space maintainer.
FIXED SPACE MAINTAINER “Space maintainers which are fixed or fitted onto the teeth are called fixed space maintainers. • Jaw growth is not hampered. .” ADVANTAGES:- • Patient cooperation is not required. • Cement loss and solder failure occur • It results in decalcification of tooth material under the bands. DISADVANTAGES • Instrumentation with skill is required. • Masticatory function is restored if pontics are placed.
3. 2. High caries activity. non functional and passive space maintainer. 3.BAND AND LOOP Unilateral. •CONTRAINDICATION:1. • INDICATIONS:1. More than one adjoining teeth is missing. Bilateral loss of primary molar before eruption of permanent incisors. 2. Loss of 2nd primary molar. Unilateral loss of primary 1st molar. Marked space loss. . fixed.
METHODS: 1. BRASS WIRE 2. OTHERS . ELASTIC THREADS 3.CONSTRUCTION SEPERATION OF TEETH Orthodontic separators can placed if tight inter proximal contacts are present for creating space for band material.
DIRECT BAND FORMATION 1. .BAND PINCHING • Band strips are contoured in an occluso gingival direction using the Johnson’s contouring pliers. • The end of strips are welded and a loop is made for reception of Howlett band forming pliers.
FESTOONING • The process of contouring the band in order to follow the gingival margin proximally.2. . • The level of band at marginal ridge is also adjusted such that it is approximately 1mm below mesial and distal marginal ridges.
. • Lingually it should placed just below deepest portion of deep developmental groove. 4. • The folded over remnant is then spot welded.3. FOLDED FLAP METHOD • Band is folded neatly against the lingual surface of the tooth. TRIMMING • Adjusts the occluso-cervical length of the band by reducing buccal and lingual side if required. • Buccally it should placed just below the level where the opposing cusps touch the grooves.
WELDING • • It is the process during which a portion of the metal being joined is melted & flowed together. . Bands are generally joined by welding.
IMPRESSION MAKING • Make an impression of arch with alginate impression material. • Band is removed after impression and stabilize in impression CAST PREPRATION • Cast is prepared by pouring impression in dental stone. • The loop should be parallel to edentulous ridge and should contact the abutment tooth below the contact point.035 inch and is soldered to the band. LOOP CONSTRUCTION • The loop is constructed of 0.030 inch to 0. • The faciolingual dimension of the loop should be approximately 8mm .
CEMENTATION Band is cemented with glass ionomer cement. polycarboxylate or zinc phosphate cement with tooth.SOLDERING It is the process by which the two metals are joined together by an intermediary metal of a lower fusion temperature. .
.both the abutment teeth are banded. Band and bar space maintainer .To overcome the disadvantage of appliance slipping gingivally.if abutment tooth is grossly carious. .if distal abutment tooth cannot be banded. .MODIFICATIONS Crown and loop space maintainer .no band is placed.bar is placed in between them insteadof loop. . Reverse band and loop .loop is bonded with resin on teeth. Bonded space maintainer. . Occlusal rest is given on the tooth.
fixed or semifixed. passive space maintainer. • INDICATIONS Bilateral loss of posterior teeth after the eruption of permanent incisors in lower arch. • CONTRAINDICATIONS It should not given before the eruption of permanent incisors because it may interfere with eruption of permanent incisors. . nonfucnctional .LINGUAL ARCH • It is bilateral.
MODIFICATIONS Semi fixed or removable lingual arch . Canine spurs .Time saving .Preformed arch wires. Looped lingual arch . .1 or 2 ‘U’ loops incorporated in arch wire to make it active. Ellis loop lingual arch wires .Spur added to the arch wire at distal end of canine and prevent distal collapse of the canine.Band is fixed and arch wire is removable.
TRANSPALATAL ARCH It is used in maxillary arch. CONTRAINDICATION • It is not given in bilateral missing case because both permanent molars can move mesially simultaneously. INDICATION • It is indicated when there is unilateral loss of deciduous molar. without button and without touching the palate. straight. The arch wire is soldered to both sides. .
.Palatal lesions . CONTRAINDICATION .If either of the molars has not erupted. .Combined with a habit breaking appliance. INDICATION . .Bilateral loss of the deciduous molar.Patients allergic to acrylic.NANCE PALATAL ARCH • It extends up to the rugae area and is embedded in an acrylic button.
DISTAL SHOE (Intralveolar Appliance/Eruption guidance appliance) • It is unilateral. MEDICAL CONDITIONS • CONTRAINDICATIONS . .Early loss of second deciduous molar before the eruption of first permanent molar.Congenitally missing first molar.poor oral hygiene . fixed.Poor patient cooperation. . in which portion of the appliance is extending into alveolus. • INDICATIONS . non functional and passive space maintainer. .Inadequate abutments due to multiple loss of teeth. Blood dyscrasias Immunosuppression Chronic inflammatory disease Congenital cardiac defect Sub acute bacterial endocarditis Rheumatic fever diabetes . • It is intra-alveolar appliance.Medically compromised patient.
• Present design which is commonly used is Roche’s modified distal shoe and had a ‘ V ‘ shaped gingival extension.• Early version was called as Willet’s distal shoe and was made of cast gold and had bar type gingival extension. .
Types: It can be functional or non functional. FUNCTIONAL NON FUNCTIONAL .REMOVABLE SPACE MAINTAINER Definition: They are the space maintainer that can be removed and reinserted by the patient into the oral cavity.
• INDICATIONS . . • CONTRAINDICATIONS . . .Uncooperative patients. . .When space maintainer is required for short period.Premature loss of anterior teeth having effect on speech and esthetics.Patient allergic to acrylic.Multiple teeth loss is seen.Masticatory function is important.Epileptic patient. .
INDICATION • When there is need to re-establish about 3 mm or less of space. removable space regainer .SPACE REGAINERS • It is removable or fixed. active space maintainers. TYPES 1. fixed space regainer 2. • The main goal of space regainer is the recovery of lost arch width or improved eruptive position of succedaneous teeth.
• It takes about 3-4 months to regain 3mm of space. • TYPES REMOVABLE SPACE REGAINER Free end loop Split saddle Sling shot Jack screw . an active component such as springs and screw and acrylic base plat.REMOVABLE SPACE REGAINERS • It consists of retentive components like Adams and clasp.
Sling shot space regaine • It consist of wire elastic holder with hooks instead of a wire string. Jack screw • • Expansion screws are used in the edentulous space. Base of appliance is made of acrylic resin.Free end loop space regainer • • Labial arch wire with back action loop spring is constructed. Space is opened by expanding the plates anteroposteriorly. . Split saddle/ split block • It differ from free end spring type in that the functional part consists of an acrylic block that split bucco lingually.
FIXED SPACE REGAINER FIXED SPACE REGAINER OPEN COIL GERBER SPACE REGAINER HOTZ LINGUAL ARCH LIP BUMPER .
GERBER SPACE REGAINER • • It consists of an open coil inserted into a ‚U‛ shaped wire.OPEN COIL SPACE REGAINER • A reciprocal active fixed regainer used to in the mandibular arch when the first premolar has erupted into the oral cavity. The wire is inserted into the molar tube on the band. HOTZ LINGUAL ARCH • It is used where the lower first permanent molar has drifted mesially .but the premolar or cuspid has not drifted distally. .
• It consists of .LIP BUMPER • Indicated when bilateral movement is desired.heavy labial arch wire . • It align lower incisors under tongue pressure. pre-treatment post-treatment . • It is used to relieve the lip pressure.acrylic flange is prepared over it in the anterior region such that it does not contact the lower anteriors. • It is used to distalize molars and to align lower incisors.
. But if space maintainer is not used. then it may result in the removal of some teeth along with costly orthodontic treatment in future. But when these are lost.CONCLUSION • The best space maintainer is a well maintained primary tooth. it is essential to have space management strategy that is giving the space maintainer.
8th edition 2. Pediatric dentistry. 3rd edition 5.html . McDonaldAveryDean . Internet dentalbooks-drbassam.REFERENCES 1. 4th edition 4. Arathi Rao. Pinkham Casamassimo Fields McTigue Nowak.washington. Textbook of Pedodontics . 2nd edition 3.edu/peddent/AtlasDemo/space024.blogspot.com depts. Dentistry for the child and adolescent . Principle and practice of pedodontics. Shobha Tandon.
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