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The early loss of primary teeth can disrupt the integrity of the arch and can lead to problems that affect the alignment of the permanent dentition. Miyamoto and colleagues observed the effects of the early loss of the primary teeth by measuring the crowding and malalignment in the permanent dentition and found that the children who had premature loss of one or more primary canines or molars were more likely to receive orthodontic treatment in the permanent dentition. So space management is an important responsibility of the clinicians who are involved in monitoring the developing dentition , as the loss of arch length may lead to problems such as crowding , ectopic eruption , dental impaction , cross bite formation and dental midline discrepancies. Dental arch length is the most important of dental arch dimensions in the developing individual. The maintenance of the dental arch length during primary , mixed and early permanent dentition is of great significance for the normal development of a functional , well- aligned and balanced adult occlusion. The concept of space loss resulting from early exfoliation of teeth was described as early as 1880 by Davenport and Hutchinson. Loss of arch length occurs as a result of tooth migration , following premature loss of primary teeth , loss of interproximal contact as a result of decay , extraction or ankylosis of an adjacent tooth result in space loss because of mesial and to a lesser extent distal occlusal drift of the adjacent teeth. An important part of preventing iatrogenic malocclusion is the correct handling of the spaces created by the untimely loss of deciduous teeth. So a clinician should meticulously manage the space. Space management is a general term that includes four subdivisions : – Space maintenance – Space regaining
– Space supervision – Management of gross discrepancies The goal is to prevent loss of arch length , width and perimeter by maintaining the relative position of the existing dentition. DEVELOPMENT OF OCCLUSION : The supervision of the developing dentition and the initiation of preventive procedures , including space maintenance , require an understanding of the biogenetic course of the primary and permanent dentition. A review of the clinical studies by Baume informs about two consistent morphological arch forms of the primary dentition i,e spaced dentition and those without space. CHANGES IN ARCH DIMENSION: From 4 years of the age until the eruption of the permanent molars the sagittal dimension of dental arch remains unchanged. A slight decrease in the dimension can occur either as a result of the mesial migration of the primary 2nd molar just after eruption or after development of proximal dental caries . Only minor changes in the transverse dimension of the maxillary and mandibular primary arches during period of 3-6 years. Baume evaluated cast at time of eruption of permanent incisors. A transverse widening of mandibular arches occurred representing a physiological process to provide space for the erupting permanent incisors. This widening was brought about by lateral and frontal alveolar growth during the time of eruption of permanent incisors. Mean increase in maxillary arch width is greater than mandibular arch.(because of bigger teeth meee) INTERCANINE WIDTH INCREASE: It increases at the time of eruption of maxillary central incisor and mandibular lateral incisor. By the time lateral incisors have completed their eruption , inter canine width has increased by about 3 mm in each of the maxilla and mandible. In maxilla , the intercanine width increases by another 1.5mm when the canine erupts.
RADIOGRAPHIC METHOD : width of erupted tooth on cast = width of unerupted tooth on a radiograph Width of unerupted tooth Width of erupted tooth on radiograph . guidance of eruption . By dividing the dental arch into segments that can be measured as straight line approximations of the arch or by contouring a piece of wire to the line of occlusion and then straightening it out for the measurement. over the contact point of the posterior teeth and the incisal edge of the anterior. space regaining or just periodic observation of the patients ( smith et al. cunat 1982. PRINCIPLES OF SPACE ANALYSIS: An accurate mixed dentition space analysis is one of the important criteria in determining whether the treatment plan may involve serial extraction. lee-chan et al 1998. bishara and jakobsen 1998) MIXED DENTITION ANALYSIS: CONVENTIONAL SPACE ANALYSIS : The conventional or canine space analysis was first proposed by Nance in 1947. Therefore. space maintenance . The size of the unerupted permanent teeth can be estimated using radiographic method or using the prediction table or the combination of the both. 1979. There are two basic ways to accomplish it. conventional orthodontic diagonosis is frequently based upon assessment of mandibular arch space requirement using arch-length analysis.In mandibular arch there is limited potential for arch expansion and also the distalization is considered difficult. The space required is the summation of the mesiodistal widths of the erupted mandibular permanent incisors and the estimated mesiodistal widths of the unerupted permanent canines and premolars. This is accomplished by measuring arch perimeter from mesial of one first molar to the other. This analysis consists of comparing the amount of space available for the the alignment of the teeth to the amount of space required for proper alignment .
dental analysis have been used but Tweed mentioned that if teeth are not in a stable relationship with basal bone. HIXON.OLDFATHER’S METHOD : The major problem with using radiographic method is evaluating the size of canine teeth. TWEED’S ANALYSIS : For any discrepancy in the occlusion. it is desirable to know the area affected . TANAKA AND JOHNSTON METHOD : Add the width of mandibular incisors and divide by two.4 . The predicted value of 3.MOYERS MIXED DENTITION ANALYSIS : The purpose of this is to analyse the amount of space available in the arch for erupting permanent canines and premolars. the problem is confined to a particular area and since it is possible to direct treatment specifically to one area . This method uses the size of permanent central incisors measured from the dental cast and size of the unerupted premolars measured from the radiographs to predict the size of the unerupted canines. In many instances. 5 is seen through moyers prediction table. The mesiodistal width of four lower incisors is added and the amount of space available for 3. relapse is liable to occur. So tweed introduced a face oriented analysis which took into account. not just the dental correction but cephalometric correction as well.4. A graph developed by Stanley-kerber allows canine width to be read directly from sum of incisor and premolar widths.5 to predict the combined widths of the mandibular cuspid and bicuspid and 11mm to predict the combined widths of the maxillary cuspids and bicuspids. To the value add 10. This method incorporates the relationship of teeth to the basal bone. Also various mixed dentition analysis demonstrate the discrepancy only and do not indicate the exact area where the discrepancy occurs.5 after incisor alignment is determined by measuring the distance between the distal surface of lateral incisor and mesial surface of first permanent molar.
maintain arch length with an appliance and periodically examine the patient. then FMIA should be 68. This gives cephalometric discrepancy. INTERPRETATION OF A MIXED DENTITION ARCH LENGTH ANALYSIS: If an analysis predicts that a child will have no crowding problem.TWEED’S METHOD : Total discrepancy = dental discrepancy + cephalometric discrepancy Dental arch discrepancy is calculated by the conventional method. When FMPA is 30. TOTAL SPACE ANALYSIS : It was developed by Merrifield and took into account the tooth measurement. Tweed established the following relationships: When FMPA is 21-29. When FMPA is 20 or less. then IMPA should not exceed 92. posterior or middle ) where the space discrepancy occurred. Prepare patients with borderline crowding for possible orthodontic treatment. Cephalometric discrepancy is assessed by Three planes are used for assessing jaw discrepancy. This is multiplied by 2 to include both right and left sides. If a permanent first molar moved mesially because of premature loss of primary molar. cephalometric correction and soft tissue modification. the patient will likely develop crowding of the permanent teeth that will require orthodontic treatment following a comprehensive evaluation of the malocclusion. . If an analysis predicts crowding in excess of 4mm. When an analysis predicts borderline crowding (1mm . continue routine care and periodic observation of the patient.4mm). then FMIA should be 65. mandibular plane and the lower incisal plane. This method also indicated the exact area ( anterior. So according to the guidelines. if FMPA is 30 and FMIA is 50 (which otherwise should be 65). These are the Frankfort’s horizontal plane. an objective line making an FMIA of 65 is also drawn on cephalogram and distance between objective line and actual line is measured by callipers in mm. use an appliance to regain the lost arch length before making a space maintainer.
Permanent teeth. Distobuccal orientation of the erupting molar does not permit adjacent tooth contact until active eruption is nearly complete. atleast in part. . however if the arch continuity has been interrupted due to loss of either primary or permanent tooth. the patient may benefit from the serial extraction treatment. thereby establishing continuous arch. Eruptive forces:: As the arches continue to develop & permanent molars erupt. These forces contribute to dental arch form by maintaining tooth contact & establishing relatively stable intermolar & intercanine width. Maxillary mesial force may not be as significant. GENERAL FACTORS AFFECTING SPACE MANAGEMENT BIOLOGICAL FACTORS Occlusal forces:: Primary teeth assume a 90 degree orientation of the occlusal plane. as well as continuous pressure against the last tooth in the arch.The resulting anterior component of force causes a physiologic mesial drift which may contribute to space closure. however. Eruptive force may be greater in the mandibular arch as the mesiolingual orientation of the erupting mandibular molar provides early contact.If crowding in excess of 6mm is predicted in the lower arch. An intact dentition anterior to this force offers sufficient resistance. for physiologic spacing commonly seen in the primary dentition exhibiting adequate arch dimension. The result is decrease in arch length. an upright arrangement probably responsible. space supervision and gross discrepancy management. Muscular Forces:: Cheek. a powerful mesial force is exerted. maintain a mesial inclination during passive eruption . space regaining . buccal & lingual movement of the teeth. lip & tongue muscles may tend to limit labial. space closure is inevitable. After space analysis it is necessary to identify the cases pertaining to space maintenance.
Class1: movement around a center of resistance located in a vertical direction (rotation) Class2: movement around a center of resistance located in a horizontal plane either in a mesiodistal or buccolingual direction (deflection) Class3: 180 degree movement around a center of resistance located in a horizontal plane. PERIAPICAL INFLAMMATION: .It extends over a considerable time period beginning as early as 4 ½ years of age in some instances & extending until the molars are in full occlusal contact at 6½ 7 years of age. ACTIVE ERUPTION OF 1st PERMANENT MOLAR: .Developmental problems associated with ankylosis include loss in arch dimension. Type of displacement is dependant on the direction. The maxillary permanent molar erupts distally & then swings forward to contact the 2nd deciduous molar.It may exert pressure on follicle contents & cause tooth displacement in various directions. STAGE OF OCCLUSAL DEVELOPMENT: . If 2nd deciduous molar is missing early in the process & no space appliance is placed. duration & amount of pressure exerted & can be classified into 3 categories. Prevention of normal exfoliation. it is common for the maxillary 1st permanent molar . possible results in ectopic or delayed eruption of permanent successor.More space loss is likely to occur if the tooth is actively erupting adjacent to the space left by premature loss of a primary tooth. ANKYLOSIS: . occurring as adjacent teeth tip toward the depressed area in an attempt to maintain tooth contact. (inversion) Treatment in class 1 & class 2 involves extraction of offending primary tooth & space maintenance Treatment in class 3 involves extraction of offending primary tooth & space maintenance & surgical intervention to reposition the tooth bud.
much of the permanent molar root formation is still unfinished with completion taking place in this false position. An abnormally high tongue position coupled with a strong mentalis and buccinator muscle may be damaging to the occlusion after the loss of a . Molars erupt mesially. A collapse of the lower dental arch and distal drifting of the anterior segment will result.A strong mentalis muscle may damage the occlusion after the loss of a mandibular primary molar. If 2nd deciduous molar is extracted late in the eruption sequence of 1st permanent molar.Dental caries continues as the single factor responsible for loss of arch circumference. with the result that the permanent molar develops in near normal upright position. As this occurs early in the eruptive process. There is complete loss of space & the 1st Permanent molar fully occupies the position of 2nd deciduous molar. direction of eruption of teeth is as follows. DIRECTION OF ERUPTION: . The result of treatment may well be crowding of lower incisor with possible midline deviation.Fusion and Supernumerary teeth ABNORMAL ORAL MUSCULATURE: . This space may have permitted proper positioning of the permanent lateral incisor as it erupted. Premolars & canines erupt distally. guided into position by a tooth distal to it. DENTAL ANOMALIES: .crown to continue to swing mesially until it comes in contact with the 1st deciduous molar. primate space between canine & molar is eliminated. Maxillary permanent incisor erupts distally. guided into position by a tooth mesial to it.If space exists. allowing distal & lateral repositioning of the primary canine. than upper permanent molar will assume a more tipped position into the space & space closure is not severe CARIES: . By placing a stainless steel crown with too great a mesiodistal diameter. Mandibular permanent incisor erupts mesially.
.Based on amount of root formation. the tooth remains stationery & erupted later than its antimere. The spurt is leveled off. [Gron] Based on amount of bone covering the unerupted tooth. Eruption of succedaneous tooth (THE Fanning study): . If primary molar is lost at 6 year.mandibular primary molar. if a tooth is missing for 6 months or more. (tooth will erupt when one half to three fourth of the root formation is complete but canine has slightly more root formation at the time of emergence). A collapse of the lower dental arch and distal drifting of anterior segment will be the result. IN CASE OF EARLY EXTRACTION: .If a tooth is scheduled for extraction. However. Several studies have indicated that the loss of primary molar before 7 years of age (chronological) will lead to delayed emergence of the succedaneous tooth. (A guideline for predicting emergence is that erupting premolars usually require 4-5 months to move through 1 mm of the bone as measured on a bite wing radiograph). where as the loss after 7 years of age leads to an early emergence. Local factors affecting space management TIME ELAPSED SINCE LOSS: . give a space maintainer.(4 yrs of age before completion of crown).An immediate spurt in the eruption of premolar has occurred regardless of the stage of development of premolar & timing of extraction of deciduous molar. emergence will be delayed of 6 months. EMERGENCE OF THE TOOTH: . If a primary molar is lost at 4 years of age. the emergence of the premolar is delayed by 1 year. emergence will occur at the stage of root completion. space loss needs to be evaluated for the decision. emergence will occur at a time when root development approaches completion.
always evaluate the arch length The position of the lower incisors over basal bone must be determined: .Before placing space maintainers or starting tooth movement.Partially impacted permanent teeth or deviation in the eruption path will result in abnormally delayed eruption. AMOUNT OF CROWDING ARCH LENGTH ADEQUACY: .(WHEN TOOTH IS ACTIVELY ERUPTING): to this spurt eruption is fast & results in fast eruption. one may obtain additional arch length by placing them in a more normal axial inclination. Due Other instances where fast eruption occurs is when necrosis of bone occurs due to abscess or infection SEQUENCE OF THE ERUPTION OF TEETH: . If first primary molar is lost during the time of eruption of the first permanent molar. If the lower incisors are . CONGENITAL ABSENCE OF THE PERMANENT TOOTH: .In case of LATE EXTRACTION: .If the teeth are retroclined. If the permanent teeth in the same area of the opposing dentition have erupted.it is necessary to extract the primary tooth. a strong forward force will be exerted on the second primary molar which eventually tips into the space required for the eruption of the first premolar.it is advisable to incorporate an occlusal stop in the appliance to prevent supraeruption in the opposing arch.If the primary 1st molar has been lost prematurely & the permanent lateral incisor is in the active state of eruption. DELAYED ERUPTION OF PERMANENT In case of impacted permanent tooth.construct a space maintainer & allow the permanent tooth to erupt at its normal position. the eruption will result in a distal movement of the teeth.
Generally. When levelled. 1 mm of linear space is required per side for every 11illimetre of the depth of the curve of Spee. every overlapped contact will require at least 1 mm or more of space for correction. Space maintenance or maintenance of arch perimeter is undertaken only when the following conditions are present: 1. Miscellaneous Factors These factors influence planning because they may be associated with either space gain or space loss. the ideal occlusion will have a nearly flat or very slight curve of Spee.wear and attrition.C Braurer in 1941. proximal caries. Loss of one or more primary teeth. . Some of these factors are growth of jaws. Abnormal Oral Habits They will exert abnormal pressure on dental arches and so may influence the type and planning of space maintainer. By J. Delayed or early eruption of succedaneous teeth. Creation of arch length inadequacy.near their upper limit when measured to the mandibular plane on a cephalogram. depending on the severity of crowding. SPACE MAINTENANCE: Space maintenance can be defined as “an appliance used for correct handling of space created by untimely loss of deciduous tooth. The degree of crowding and amount of space needed to correctly align the anterior segment must be determined. the teeth will require more linear space than they occupied before. further flaring or anterior advancement would jeopardize the periodontal support of these teeth. Tilting of tooth adjacent to extraction space. the absence of which lead to either malocclusion or encouragement of detrimental oral habits or to psychological trauma”. CURVE OF SPEE: .According to (Andrews 1972). Effect of premature loss of primary teeth Space closure by drifting of teeth.
The highest prevalence & amount of space closure occurs after the premature loss of primary 2nd molar. Psychological trauma. Extrusion and rotation of opposing teeth. Development and aggravation of malocclusion. Encouragement of deleterious habits. 2. space maintainer is indicated when 1. The mandibular space loss continued at a rather constant rate. The amount of space loss is associated with the length of time following premature extraction. the greater are the chances of drifting of the adjacent teeth. The first step in space maintenance is to preserve the size of the primary tooth crown by restoring the carious tooth as soon as possible. The rate of space loss is higher in maxillary than in mandibular premature extraction. Unilateral tooth loss can lead to arch asymmetry and shifting of midline. No loss of arch perimeter. . Favourable mixed dentition prediction. A carious lesion on the distal surface of the 2nd primary molar allows the 1st permanent molar to tip mesially. The loss in arch perimeter may occur due to caries or unwanted loss of teeth. 3. (B) Loss of primary teeth : When a primary tooth is lost . The permanent successor is present and developing normally. (A) Caries of primary teeth: This is one of the most frequent cause of arch perimeter loss in the mixed dentition. The earlier the primary molars are extracted especially before the eruption of1st permanent molar. The rate of space loss was age related mainly in the maxilla & not in the mandible. Succedaneous teeth may become impacted due to bony crypt or mucosal barrier.
The space from the lost tooth has not diminished. Space maintainer is not required if the primary tooth has been lost after the child is 4 years of age. region or not.2. Favourable mixed dentition analysis. it is desirable to replace missing incisor for acceptable esthetic. then little possibility of drifting of adjacent teeth will occur to cause the loss of space. PRIMARY CUSPIDS: Other than caries . Each case must be critically evaluated. 3. the eruption of large permanent incisor is the more frequent cause of the loss of primary cuspids. to prevent abnormal speech and tongue habits. -But if no spacing or prior contact is present in the anterior region than there may be a collapse of the arch after the loss of one of the primary incisors is almost certain. nor should one maintain 4mm of space for a tooth known to be 7mm in width. an acid etch composite pontic not only serves as a space maintainer but aids esthetics as well. If the permanent successors have not developed sufficiently to maintain the dimensions of the arch . -If spacing is present. . In children in whom space loss is likely to occur. PRIMARY INCISORS : There is controversy regarding whether space closure occurs in ant. the loss of a primary incisor can result in the rapid closure of space. Even if spacing is present. Some believe space closure rarely occurs in the anterior part of the mouth. But this is not always true. There is no reason to insert a space maintainer if the permanent successor is absent.
SECOND PRIMARY MOLAR : According to Northway. The maxillary first permanent molar usually erupts distally and begins a rotation to swing forward once the cusp tips appear through the tissue at the eruption site. More space was lost in the 1st year after premature tooth loss than in successive years. Space loss was age related in the upper but not in the lower arch. Wainright & Demirjian Study E loss had the most deleterious effect on dental arch length. at the time of contact.However.Unilateral loss of a mandibular primary cuspid poses a special problem since the dental midline can be misplaced. Arch perimeter loss is most likely to occur when the 1st primary molar is lost very early. The potential for space loss is greater during eruption of first permanent molars since this is the time when the permanent molar exerts a strong eruptive force against the distal crown surface of second deciduous molar. When this tooth is lost . Upper D lost typically resulted in blocked out cuspids. Space maintainers that can be used are removable plate or lingual arch or a band and loop. always maintain space until the arrival of the second bicuspid. Early posterior primary loss resulted in 2-4 mm space closure per quadrant in both arches. The greatest space loss was caused by mesial molar movement.The permanent molar then contacts the second deciduous molar in a less direct eruptive force. . – The most rapid losses in the perimeter of the arch usually are due to a mesial tipping and rotation of the 1st permanent molar after removal of the 2nd primary molar. An alternative to band and loop is to attach a similar loop to the buccal and lingual surfaces of the 2nd primary molar with composite. there should be a space maintainer in place to resist the potential for mesial displacement of second deciduous molar. FIRST PRIMARY MOLAR : In most cases the loss of 1st primary molar is not serious as the loss of the second primary molar. upper E Loss usually led to an impacted 2nd permanent premolar. The immediate extraction of the other primary cuspid should be considered and a lingual arch appliance should inserted to prevent the lingual tipping of the mandibular incisors and shortening of arch perimeter.
It is not necessary to cast an elaborate framework and meticulously carve occlusal patterns for primary partial dentures. Never place a space maintainer when space regaining is indicated. maintain the vertical height. CONTRAINDICATIONS OF SPACE MAINTAINER There is no reason to place space maintainer if the permanent successor is absent Do not place space maintainer to maintain 4 mm of space for a tooth known to be 7 mm in width. – Before inserting any appliance to maintain the 2nd primary molar space determine that no space has been lost. A lingual arch wire or a multiple acrylic space-maintainer will serve the purpose. And if the 1st permanent molar has not yet erupted . FACTORS CONTRIBUTING FOR SPACE CLOSURE: . The distal shoe space maintainer is not indicated because it is unhygienic and inflexible. If the latter is missing and no space appliance is placed. it is common for the maxillary first permanent molar crown to continue to swing mesially. A block of acrylic to provide a smooth occluding surface .– Maxillary permanent molar erupts distally and then swings forward to contact the second deciduous molar. In such cases it is best to insert the appliance the very day the teeth are removed. The mandibular first permanent molar strongly depends on the presence of second deciduous molar distal crown surface for eruptive guidance. If the 1st permanent molar has erupted then a reverse crown and loop or band and loop or a similar loop held in place by composite is used to maintain space. Thus if the deciduous tooth is lost during permanent molar eruption the latter will continue its mesial eruption pathway to produce a severe space loss and tipped position. then the free –end acrylic block type of maintainer may be used. and prevent extrusion of the opposite teeth will suffice. until it come in contact with first molar thus blocking out the second premolar. MULTIPLE LOSS OF PRIMARY TEETH : Sometimes it is necessary to extract more than one primary tooth at the same appointment.
4. It must permit maintenance of oral hygiene. Path of least resistance.this is created following loss of support because of extraction or missing tooth. It must restore the function as far as possible & prevent over-eruption of opposing teeth. Premature loss of deciduous teeth 3. It should not come in the way of other functions. Inclination of long axis of permanent molars –tendency of molar to shift mesially because their long axis is mesially inclined.” IDEAL REQUIREMENTS It should maintain the entire mesio-distal space created by a lost tooth. It must not restrict normal growth & development and natural adjustments which take place during the transition from deciduous to permanent dentition.”are appliances used to maintain space or regain minor amounts of space lost. It should be simple in construction.1. so as to guide the unerupted tooth into a proper position in the arch. It should not exert excessive stress on adjoining teeth. 2. 5. Space maintainers. . It should be strong enough to withstand the functional forces. less is the amount of horizontal thrust transmitted to teeth in occlusion. Influence of buccal musculature – buccinator exerts forces that can derange occlusion. Effect of position of center of rotation of mandible– Smyd pointed out that more the axis of mandibular rotation is lowered in respect to occlusal plane.
Ant. Removable distal shoe space maintainer-an immediate acrylic partial denture with an acrylic distal shoe extension has been used successfully to guide the first permanent molar into position when the deciduous second molar is lost shortly before the eruption of the first permanent molar. The . & post. Removable space maintainers: . band & loop. Acrylic partial dentures are given for multiple tooth loss. (b) Functional types Pontic type OR Lingual arch type CLASS II Cantilever type (distal shoe. posterior Class 5 – bilateral max. These are classified as functional and non functional. The clasps can be given on deciduous canines and molars for retention. posterior Class 3 – bilateral max.(a) Non-functional types Bar type OR Loop type.CLASSIFICATION OF SPACE MAINTAINER According to Hitchcock Removable or fixed With or without bands Functional or non functional Active or passive Certain combinations of the above According to Raymond C Thurow Removable Complete arch Lingual arch extra oral anchorage Individual tooth According To HinrichsenFixed space maintainersCLASS I: . Class 7 – primary/ permanent anterior Class 8 – complete primary teeth loss.) Removable space maintainersAcrylic partial dentures CLASSIFICATION OF RFEMOVEABLE APPLIANCES BY BRAUER Class1 – unilateral maxillary posterior Class 2 – unilateral mand. Class 6 – bilateral mand. ant.These are the space maintainers which can be removed and placed into the oral cavity by the patient. & post. posterior Class 4 – bilateral mand.
Passive Mandibular arch appliance) It was popularized by Burstone. Non functional. The extension can be removed after eruption of permanent molar. It does not restore the occlusal function of the missing tooth.Space maintainers which are fixed or fitted onto the teeth are called fixed space maintainers. 4. It is used to maintain the posterior space in the primary dentition. 3. They belong to that group of space control appliances which not only control anteroposterior movements but also are capable of controlling & preventing an arch perimeter distortion. 2. 5. The lingual arch is often suggested when teeth are lost in both quadrants of the same arch. Fixed Space Maintainers: . It is inexpensive & easy to fabricate. ADVANTAGES: 1. Non functional.40 inches in diameter closely adapted to the lingual . • BAND & LOOP APPLIANCE (Fixed. Masticatory function is restored if pontics are placed. The succedaneous permanent teeth are free to erupt into the oral cavity.32 to 0. Bands and crowns are used which require minimum or no tooth preparation.0. They do not interfere with passive eruption of abutment teeth. Passive space maintainer) It is used to maintain the space of a single tooth.tooth to be extracted is cut from the cast to allow fabrication of the acrylic extension. It consist of a round stainless steel or precious alloy wire. Jaw growth is not hampered. 6. by controlling the lingual collapse of single tooth or segments of the arch. • LINGUAL ARCH (Fixed. They can be used in un-co-operative patients.
Omega bends – in canine region to prevent interference. The acrylic button is present on the slope of the palate & provides an excellent resistance against forward movement(U loop).Nance(1947) described the “preventive lingual wire”.with the arch wire extending forward into the vault. NANCE ARCH or NANCE SPACE HOLDING APPLIANCE (Fixed.surfaces of the teeth & anchored to bands on the first permanent molars. The maxillary lingual arch is feasible in the primary dentition because it can be constructed to rest away from the incisors.) PASSIVATION. Passive. It consists of bands on the upper molars. These appliances use a large wire (36 mil) to connect the banded primary teeth on both sides of the arch that are distal to the extraction site.The lingual archwire should be completely passive. 1947) The Transpalatal arch (Robert Goshgarian.The Nance arch incorporates an acrylic button that rests directly on the palatal rugae. Because the permanent incisor tooth buds develop & erupt somewhat lingual to their primary precursors. Modifications 1.Nance arch (HN Nance. Removable lingual arch 3. The Transpalatal arch (TPA) is made from a wire that traverses the palate directly without touching it.a conventional mandibular lingual arch is not recommended in the primary dentition (bilateral band & loop appliances are recommended in this situation.The wire should extend from the lingual of bands to the deepest & most anterior point in the . The difference b/w the two appliances amounts to where the wire is placed in the palate. Nonfunctional. Hotz lingual arch – with U-loop used for space regaining 2. while keeping the wire gently in place on the cingula with an old instrument. This is done by heating the wire to a dull brownish appearance. 1972). Maxillary arch appliance): . Two types of lingual arch designs are used to maintain maxillary space. The means used to anchor the archwire to the bands will define whether the lingual arch is of a removable or fixed type.
for indirect fabrication of band and loop space maintainer. the appliance can replace only a single tooth & is somewhat fragile. Passive appliance): . Eruption guidance appliance): . straight without a button & without touching the palate.25mm which is attached to two abutment teeth. o A coil spring of 0. o Histologic examination shows that complete epithelialization does not occur after placement of the appliance. ‘U’ bend is given in the wire for the retention of the acrylic 1-2mm away from the soft tissue. . DISADVANTAGESo Because of its cantilever design & the fact it is anchored on the occlusally convergent crown of the primary first molar. o Other space maintainers o SANNERUD’S SM (1955) –indicated when single tooth loss and abutment are present on both side.it is used to maintain the space of a primary second molar that has been lost before the eruption of the permanent first molar.middle of hard palate. • TRANSPALATAL ARCH (Fixed. The basis of the appliance is that the migration & rotation is caused by rotation around the lingual root. Cross arch anchorage can be used if only one of the primary molars is lost & both the permanent molars are erupted. The result of the mesial drift is loss of arch length & possible impaction of the second premolar. o DISTAL SHOE (Intra-alveolar. o INDIRECT SM – IN 1964 Jenning and Aronsons described a tech.The arch is soldered to both sides. By preventing this. space loss is prevented by the appliance. Non-functional. o No occlusal function is restored because of this lack of strength.7mm is placed on a soft SS wire of 0. An unerupted permanent first molar drifts mesially within the alveolar bone if the primary second molar is lost prematurely.
there would be adequate room for all the teeth. number of roots and occlusal relationship. Mesial tipping causes the distobuccal cusp to become more prominent occlusally. Mayne is a non functional SM that permits minor adjustments for space control while the tooth in question is erupting. When 2nd primary molar . DIRECT BONDED SM –it can be anterior direct bonded functional SM posterior direct bonded either -functional when having pontic or -non functional when only a arch wire or Ni-Ti wire is bonded GLASS FIBER REINFORCED COMPOSITE RESIN SM. the distobuccal cusp becoming more prominent buccally.Either one or more primary teeth have been lost or some space in the arch has been lost to mesial drift of the 1st Permanent molar or if mixed dentition analysis shows that if one could recapture what was once there. MESIAL DRIFT OF PERMANENT MOLAR: .Rotation .Translation There are distinct differences in the mode of mesial movement between the upper & lower 1st molar due to variation in crown shape.by W. Because of large lingual root of maxillary 1st permanent molar. rotation of crown also is seen with mesial tipping.It involves 3 different kind of tooth movements: -Mesial Crown Tipping .it can as anterior esthetic functional SM or posterior functional SM SPACE REGAINING INDICATIONS: .o MAYNE SM.R. Maxillary 1st permanent molar quickly tips mesially with the loss of crown substance of primary 2nd molar.
there is a reciprocal force exerted to the teeth and supporting tissues anterior to the space.Construction Molar band fitted to first permanent molar Molar tubes spot welded in horizontal position both buccally and lingually Impressions taken . which must recapitulate in reverse the movements that occurred as the teeth drifted mesially. translation. FIXED SPACE REGAINERS Open coil space regainer: . The lingual tipping is caused by the absence of a lingual root & the fact that occlusal function occurs buccally to the centre of mass of lower molar aggravates the 1st molars to drifts mesially DISTAL MOVEMENT OF 1ST PERMANENT MOLAR: .is lost prior to eruption of 1st permanent molar. crown rotation and translation as well but more likely to show lingual tipping with mesial movement. Surprising amount of arch perimeter space often is created just by distal tipping & rotation of the 1st molar. The result may be an undesirable flaring of anterior teeth. ANCHORAGE CONSIDERATIONS: . or combination of these movements is required. Distalization potential for maxillary molars is 5-7 mm/side whereas the distalization potential for mandibular molars is 1-2 mm/side.The basic tooth movement necessary in space regaining is distal movement of 1st Permanent molar. Therefore tipping & rotation should be achieved prior to attempting translation. Mandibular 1st molars display mesial tipping. translation during eruption may be seen.When appliances are used to reposition the first permanent molars. Distal movement can be most satisfactorily achieved by headgear appliance. selection of space regaining appliance is dependant on whether tipping. Therefore.Can be used to good advantage in mandibular arch when the first premolar has erupted into the oral cavity.
Easily used for space regaining procedures in which bilateral movement is desired Construction. .When appliance has to fabricated directly in mouth during a relatively short appointment and requires no lab work. It is advantageous to use removable lingual arch space maintainer since it facilitates frequent removal of arch for the purpose of activation. Stainless steel wire bent into U shape The base of U has a reverse bend to contact the distal surface of first premolar A solder stop should be placed on both arms where the straight parts meet the bend in the wire.It consists of a heavy labial arch wire over which an acrylic flange is prepared in anterior region such that it does not contact the lower anteriors. It can be used in cases where second molar is erupted Lip bumper: . Besides. spurs can be added across the canines. The arch is then forced forward and posts slipped into place. A spaced coil spring is selected which will slide on the wire and is cut about 2-3 mm longer than the distance from the anterior stop to the molar tube.It is used when: Lower first permanent molar has drifted mesially. The band is cemented with the springs compressed. Evidence of sufficient space between first molar and developing second molar Anchorage for movement is achieved as the arch contacts all the teeth. Up to 4 mm of space can be regained in an effective and efficient manner. but premolar or cuspid has not drifted distally. Hotz lingual arch: . After adjustment. the posts in the passive position should be approximately 1mm distal to their passive positions over the lumen of their tubes. Gerber space maintainer: .
Efforts are made to make the mandibular teeth erupt before .014” round wire is then inserted in an open coil spring and activated REMOVABLE SPACE REGAINERS Free end loop: -It utilizes a labial arch wire for stability and retention.4. Primary teeth are extracted serially to allow normal eruotion sequence i. The pressure can be used to distalize molars by incorporating loops in the arch wire just before it enters the buccal tube or utilizing the coil spring. with a back action loop spring constructed of 0. Movement of the permanent molar is achieved by activating the free end of the wire loop at specific intervals of time.025 wire in form of a buccal and a lingual loop. The appliance is activated by periodic spreading of the loops.e 3. A 0. where it is doubtful by mixed dentition analysis whether there will be space for all teeth.025 wire.3. The dentist clinically guides the eruption of the teeth and development of the occlusion. The base of appliance is made of acrylic resin.5 in the maxilla. Anterior space regainer: -Labial tubes are directly bonded to lateral incisors. SPACE SUPERVISION It is done in cases.The functional part of the appliance consists of an acrylic block that is split bucco-lingually and joined by 0. Split saddle: . PRINCIPLES It should be begun only when the mandibular cuspid and premolar show at least one third to one fourth of root development. The activator block is split with a disk after appliance has been processed.Instead it is used to relieve the lip pressure. Removable space regainers with jack screw: -It incorporates an expansion screw in edentulous space. Sling shot: -It consists of a wire elastic holder with hooks instead of wire spring that transmits a force against molar to be distalized.5 in the mandible and 4. Space is opened by expanding the plates antero posteriorly. The distalizing force is produced by the elastic stretched on the middle of the lingual surface of the molar to be moved.
maxillary teeth and care should be taken that a late mesial shift of the mandibular first permanent molar does not occur. STEP 1. STEP 2: Removal of primary 1st molar and slicing the mesial surface of the 2nd primary molar. STEP 2. FLUSH TERMINAL PLANE (END TO END) PROTOCOL : The protocol for space supervision with a flush terminal plane is quite similar to that for a mesial step – with one important exception. there usually is insuffient space for eruption of 1st premolar. Removal of mandibular primary cuspid and tipping of the maxillary 1st molar distally. Several months after the primary canine has been removed. it is necessary to achieve class I molar relationship by guidance of the eruption of the maxillary first molar or its movement distally. MESIAL STEP (class I) PROTOCOL : This protocol is used when there is a normal skeletal profile and the first permanent molar has already achieved a class I molar relationship at the time of instituting space supervision. This is to prevent the mesial drifting of the first permanent molar and to cause the second premolar to erupt before second permanent molar. The purpose of this is to align the incisors and to make the canine erupt before the premolar. STEP 3: A lingual arch wire is inserted and extraction of 2nd primary molar. Since the molars are not in class I relationship and a late mesial shift cannot be allowed to occur. permanent canine can no longer erupt normally without moving into labioversion. STEP 3. A lingual arch wire is inserted and extraction of 2nd primary molar. A space supervision problem . After canine has arrived arrived in the arch. DISTAL STEP (CLASS II) PROTOCOL : In the mesial step protocol and flush terminal plane protocol the problem seen is in a balanced or nearly balanced facial skeleton. This is to allow the canine to erupt distally and hasten the eruption of first premolar. Removal of primary 1st molar and slicing the mesial surface of the 2nd primary molar. STEP 1: Removal of the primary canine is begun when the mandibular permanent canine has clearly begun root formation.
as no clinically useful correlation has been shown to exist between the size of the primary teeth and those of the permanent dentition. it is accepted at the start that insufficient space is available and therefore extraction of permanent teeth is ultimately necessary. vertically and mediolaterally. like the excess space left by the extraction of the teeth . Rule 5. The discrepancy must be at least 5mm in all the four quadrants. There must be a class I molar relationship bilaterally. The more a case deviates from these rules. Rule 4. The dental midlines must coincide. The difference between space supervision cases and gross discrepancy problem is largely one of strategy. So Eisner suggested few rules to prevent unwanted complications : Rule 1. Rule 2. Gross discrepancy problems are treated by serial extractions. As a general rule a dentist should not extract permanent teeth as a part of orthodontic therapy unless they have the technical skill to correct all the sequelae of those extractions. Rule3. Gross discrepancy problem cannot be diagnosed until the early mixed dentition.combined with a distal step is a much more serious problem and the space problem is quite secondary to the skeletal contributions to the class II. . The facial skeleton must be balanced anterioposteriorly . In the gross discrepancy problem . There must be neither an open bite nor a deep bite. Actually serial extraction therapy includes both the space supervision as well as gross discrepancy therapy. The basic skeletal dysplasia must be treated and the teeth positioned in the best way possible to accommodate after the skeletal correction is over. the goal is to squeeze all permanent teeth into what obviously is minimal space. In space supervision. GROSS DISCREPANCY PROBLEM Gross discrepancy problems are those in which there is a great and significant difference between the size of all the permanent teeth and the space available for them within the alveolar arch perimeter. the more difficult it will be to treat them.
Flores-Mir C et al. NiTi bonded space regainer/maintainer. Lin YT. 2012 Jan. The Transpalatal Arch: An Alternative to the Nance Appliance for Space Maintenance. 1988 Wei SY. 2009 May. J Indian Soc Pedod Prev Dent 2010.REFERENCES Graber TM. Scientific foundations and clinical practice.3 . Gill DS. Total patient care. Evidence indicates minimal short-term space loss after premature loss of primary first molars. Space maintenance. Nwabueze I.19(3):155-62.94(1):38-40 DaBell J. Three-dimensional space changes after premature loss of a maxillary primary first molar. Oueis H. Ashley P. Ari Kupietzky . 2009 Nov.138(3):362-8. Handbook of Orthodontics. Int J Paediatr Dent.9th edition Pinkham JR.2nd edition Moyers RE. Pediatric Dentistry May/Jun2007 V 29 No. Park K. 2008 Jul-Aug. Int J Paediatr Dent. J Mich Dent Assoc. Immediate and six-month space changes after premature loss of a primary maxillary first molar. Pediatric Dentistry. 4th edition Stewart RE. 2010 Jan.28:113-5 Laing E. 1988 Simon T. 2007 Mar.30(4):297-302. Lin YT. Negi KS.19(6):383-9 Tunison W. Dentistry for the child and adolescent. Stenger J.Space maintenance in the primary and mixed dentitions. Kim JY. Pediatric dentistry. Eli Tal. Huang GJ.141(1):77-8. Dental arch space changes following premature loss of primary first molars: a systematic review. Principles and practice. Jung DW.4th edition McDonald RE. Lin WH. Naini FB. J Am Dent Assoc. J Am Dent Assoc. Pediatr Dent.
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