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Patient-orientated removable space maintainer as a decompression stent

Article  in  British Journal of Oral and Maxillofacial Surgery · December 2015

DOI: 10.1016/j.bjoms.2015.12.006

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Available online at www.sciencedirect.com

British Journal of Oral and Maxillofacial Surgery xxx (2015) xxx–xxx

Technical note
Patient-orientated removable space maintainer as a
decompression stent
Ok Hyung Nam a , Jung-Woo Lee b , Ki Un Song a , Sung Chul Choi a,∗
a Department of Pediatric Dentistry, School of Dentistry, Kyung Hee University, Seoul, Republic of Korea
b Department of Oral & Maxillofacial Surgery, School of Dentistry, Kyung Hee University, Seoul, Republic of Korea

Accepted 7 December 2015

Keywords: Decompression; Stent; Removable space maintainer; Marsupialisation

Decompression is one of conservative ways to treat odon-

togenic cysts in children.1 This includes opening the cystic
cavity and preserving the patency between the cyst and the
oral environment using a stent. It helps to alleviate cystic pres-
sure, and allows the impacted tooth to erupt spontaneously.
Several decompression stents or tubes have been introduced
and used successfully.2–4 However, it is inevitable that the
child will have some discomfort from repetitive mechani-
cal trauma during the treatment.3 There may also be a risk
of delayed infection because there is no way to prevent
impaction of food or contamination.
Here we describe an alternative technique to minimise Fig. 1. Panoramic radiograph taken at the first visit showing the dentigerous
the possible complications, which consists of a removable cyst around the unerupted right mandibular first premolar. The tooth germ
space maintainer and communicating tube with a retractable of the right mandibular premolars has also been displaced.
cap. The removable appliance can preserve the edentulous
space and recover masticatory function simultaneously.4 The
passage to the cystic cavity can be opened when it needs to
be cleaned, or closed during feeding, by adjusting the cap of
the tube (Eppendorf® PCR tube; Sigma-Aldrich, St Louise,
MO, USA). The use of the capping system may reduce the
risk of delayed infection.
An 8-year-old girl was referred to our clinic with a com-
plaint of painless swelling in the right posterior mandibular
region. The panoramic radiograph showed a large, circular,

∗ Corresponding author at: Department of Pediatric Dentistry, Kyung Hee

University, Seoul, Republic of Korea, Hoeki-dong, Dongdaemoon-ku, 130-

702, Seoul, Republic of Korea. Tel.: +82 2 958 9339; fax: +82 2 965 7247.
E-mail addresses: khupedo2012@naver.com (O.H. Nam),
omsace@gmail.com (J.-W. Lee), mogi-un@hanmail.net (K.U. Song), Fig. 2. An Eppendorf® PCR tube for use as a retractable cap.
pedochoi@khu.ac.kr, pedochoi@gmail.com (S.C. Choi).

http://dx.doi.org/10.1016/j.bjoms.2015.12.006
0266-4356/© 2015 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Please cite this article in press as: Nam OH, et al. Patient-orientated removable space maintainer as a decompression stent. Br J Oral
Maxillofac Surg (2015), http://dx.doi.org/10.1016/j.bjoms.2015.12.006
 YBJOM-4720; No. of Pages 2
ARTICLE IN PRESS
2 O.H. Nam et al. / British Journal of Oral and Maxillofacial Surgery xxx (2015) xxx–xxx
Fig. 3. The extension line was secured firmly with a removable space main-
tainer and Eppendorf® PCR tube using chemically-cured denture resin.
Fig. 4. Irrigation with an intravenous catheter connected to a syringe.
well-defined uniocular lesion around the right mandibular
primary first molar (Fig. 1), so we planned extraction of the
tooth, and decompression.
Impressions were taken with irreversible hydrocolloid
material, and working casts made. The tooth over the cys-
tic area that was to be extracted was removed from the
model. The hole was carefully prepared through the arti-
ficial resin tooth and buccal flange. The Eppendorf® PCR
tube was trimmed to 4–5 mm and adapted to the fabricated
model (Fig. 2). Chemically-cured denture resin was applied
from the junction between the tube and appliance to the
Please cite this article in press as: Nam OH, et al. Patient-orientated removable space maintainer as a decompression stent. Br J Oral
Maxillofac Surg (2015), http://dx.doi.org/10.1016/j.bjoms.2015.12.006
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buccal flange for accurate adaptation and proper bonding with
the appliance (Fig. 3). The extension line for infusing solu-
tion that communicated to the cyst was connected to the cap
of the Eppendorf® PCR tube. The extension line decreased
the irritation of the adjacent soft tissue because it was soft
and resilient. It could also be cut easily to adjust the length
when the cystic cavity decreased in size or the impacted tooth
erupted.
An intravenous catheter, which was flexible enough to
follow the curve, was connected to a syringe for daily clean-
ing of the cystic cavity (Fig. 4). The patient and her guardians
were told how to remove and insert the stent and how to
irrigate the cavity by themselves. She did not complain of
any discomfort and there was no change in the gingiva after
delivery.
The alternative removable space maintainer met the goals
of decompression, and avoided some of the disadvantages of
existing devices.
Conflict of Interest
We have no conflicts of interest.
Ethics statement/confirmation of patient’s permission
The patient’s guardians gave consent.
References
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cystic lesions of the mandible: a prospective study of the effect of decom-
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2. Carter LM, Carr P, Wales CJ, et al. Customised stents for marsupialisation
of jaw cysts. Br J Oral Maxillofac Surg 2007;45:429–31.
3. Kolokythas A, Schlieve T, Miloro M. Simple method for securing a decom-
pression tube for odontogenic cysts and tumors: a technical note. J Oral
Maxillofac Surg 2011;69:2392–5.
4. Wiemer SJ, Pruitt CA, Rallis DJ, et al. Use of a modified removable partial
denture as a marsupialization stent in a pediatric patient. J Oral Maxillofac
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