SEMINAR ON

SPACE MAINTAINER AND REGAINER

DEPARTMENT OF PEDODONTICS

SUBMITTED TO:- Dr. JASHEENA SINGH Prof. and H.O.D Department of pedodontics

GUIDED BY:- Dr. SUBHASH SINGH SUBMITTED

BY:- (MDS,Sr. Lecturer)

ANKUR SAHU Dr. GARIMA SINGH Final year

(MDS,Sr. Lecturer) Roll

no.- 10 Dr. SHIVIKA MEHTA Batch- B (MDS,Sr. Lecturer)

CONTENTS

• 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.”

IDEAL REQUIRMENTS

1. It should maintain the desired mesiodistal dimension of the space created by loss of tooth

2. It should not interfere with eruption of occluding teeth.

3. It should not interfere with the eruption of the replacing permanent teeth.

4. It should provide mesiodistal space opening when it is required.

5. It should not interfere with speech, mastication.

INDICATIONS• When malocclusion exists or abnormal oral habits

are present.• Delayed eruption of permanent teeth.• Congenital absence of permanent teeth.• Maximum closure occurs within 6 months after

extraction, therefore it is best time to insert an appliance.

CONTRAINDICATIONS• When there is no alveolar bone overlying the crown

of erupting teeth and there is sufficient space for its eruption.

• When gross space discrepancy present requiring future extractions and orthodontic treatment.

• When succeeding tooth is congenitally absent and space closure is required.

CLASSIFICATION

1. ACCORDING TO HITCHCOCK:a) Removable, fixed or semifixed

b) With bands or without bandsc) Functional or non functionald) Active or passive

e) Certain combinations of above.2. ACCORDING TO RAYMOND C THROW: a) Removable

b) Complete arch- Lingual arch- Extraoral anchorage

c) Individual tooth space maintainer

3. ACCORDING TO HEINRICHSEN:

a) Fixed space maintainer

Class 1-Non functional

- Bar type- Loop type

Functional-Pontic type-Lingual arch type

Class 2-Cantilever type (distal shoe, band and

loop)

b) Removable space maintainer

APPLIANCE THERAPY

Fixed space maintainers-

Band & loop space maintainer.Crown & loop space maintainer.Lingual arch.Palatal arch appliance.Transpalatal arch.Distal shoe.Band & Bar type space maintainer.Bonded space maintainer

Removable space maintainers-

Acrylic partial dentures.Full or complete dentures.Removable distal shoe space maintainer.

FIXED SPACE MAINTAINER“Space maintainers which are fixed or fitted onto the teeth are called fixed space maintainers.”

ADVANTAGES:-• Patient cooperation is not required.• Jaw growth is not hampered.• Masticatory function is restored if pontics are placed.

DISADVANTAGES• Instrumentation with skill is required.• Cement loss and solder failure occur • It results in decalcification of tooth material under the bands.

BAND AND LOOP

Unilateral, fixed, non functional and passive space maintainer.

• INDICATIONS:-1. Unilateral loss of primary 1st molar.2. Bilateral loss of primary molar before

eruption of permanent incisors.3. Loss of 2nd primary molar.

•CONTRAINDICATION:-1. High caries activity.2. Marked space loss.3. More than one adjoining teeth is missing.

•

CONSTRUCTION

SEPERATION OF TEETH Orthodontic separators can placed if tight inter proximal contacts are present for creating space for band material.

METHODS:1. BRASS WIRE

2. ELASTIC THREADS

3. OTHERS

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.

2. FESTOONING

• The process of contouring the band in order to follow the gingival margin proximally.

• The level of band at marginal ridge is also adjusted such that it is approximately 1mm below mesial and distal marginal ridges.

• )

3. TRIMMING

• Adjusts the occluso-cervical length of the band by

reducing buccal and lingual side if required.

4. FOLDED FLAP METHOD

• Band is folded neatly against the lingual surface of the tooth.

• The folded over remnant is then spot welded.• Buccally it should placed just below the level

where the opposing cusps touch the grooves.• Lingually it should placed just below deepest

portion of deep developmental groove.

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.

LOOP CONSTRUCTION

• The loop is constructed of 0.030 inch to 0.035 inch and is soldered to the band.

• The loop should be parallel to edentulous ridge and should contact the abutment tooth below the contact point.

• The faciolingual dimension of the loop should be approximately 8mm

SOLDERING

It is the process by which the two metals are joined together by an

intermediary metal of a lower fusion temperature.

CEMENTATION

Band is cemented with glass ionomer cement, polycarboxylate or zinc phosphate cement with tooth.

MODIFICATIONSCrown and loop space maintainer

- if abutment tooth is grossly carious.Reverse band and loop

- if distal abutment tooth cannot be banded.

Band and bar space maintainer- both the abutment teeth are banded.- bar is placed in between them insteadof loop.

Occlusal rest is given on the tooth.- To overcome the disadvantage of appliance

slipping gingivally.Bonded space maintainer.

- no band is placed.- loop is bonded with resin on teeth.

LINGUAL ARCH

• It is bilateral, fixed or semifixed, nonfucnctional , passive space maintainer.

• INDICATIONS

Bilateral loss of posterior teeth after the eruption of

permanent incisors in lower arch.

• CONTRAINDICATIONSIt should not given before the eruption of

permanent incisors because it may interfere with eruption of permanent incisors.

MODIFICATIONS

Semi fixed or removable lingual arch - Band is fixed and arch wire is removable.

Canine spurs- Spur added to the arch wire at distal end of canine and prevent distal collapse of

the canine.

Looped lingual arch- 1 or 2 ‘U’ loops incorporated in arch wire to

make it active.

Ellis loop lingual arch wires - Preformed arch wires.- Time saving

TRANSPALATAL ARCH

It is used in maxillary arch. The arch wire is soldered to both sides, straight,

without

button and without touching the palate.INDICATION

• It is indicated when there is unilateral loss of

deciduous molar.

CONTRAINDICATION• It is not given in bilateral missing case because

both permanent molars can move mesially simultaneously.

NANCE PALATAL ARCH

• It extends up to the rugae area and is embedded in an acrylic button.

INDICATION- Bilateral loss of the deciduous molar.- Combined with a habit breaking appliance.

CONTRAINDICATION- Palatal lesions- If either of the molars has not erupted.- Patients allergic to acrylic.

DISTAL SHOE

(Intralveolar Appliance/Eruption guidance appliance)

• It is unilateral, fixed, non functional and passive space maintainer.• It is intra-alveolar appliance, in which portion of the appliance is

extending into alveolus.

• INDICATIONS- Early loss of second deciduous molar

before the eruption of first permanent molar.

• CONTRAINDICATIONS- Inadequate abutments due to multiple loss of teeth.- poor oral hygiene- Poor patient cooperation.- Congenitally missing first molar.- Medically compromised patient.

Blood dyscrasias

Immunosuppression

Chronic inflammatory disease

Congenital cardiac defect

Sub acute bacterial endocarditis

Rheumatic fever

diabetes

MEDICAL CONDITIONS

• Early version was called as Willet’s distal shoe and was made of cast gold and had bar type gingival extension.

• Present design which is commonly used is Roche’s modified distal shoe and had a ‘ V ‘ shaped gingival extension.

REMOVABLE SPACE MAINTAINER

Definition:They are the space maintainer that can be

removed and reinserted by the patient into the oral cavity.

Types:It can be functional or non functional.

FUNCTIONAL NON FUNCTIONAL

• INDICATIONS

- Multiple teeth loss is seen.- Masticatory function is important.- Premature loss of anterior teeth having effect

on speech and esthetics.- When space maintainer is required for short

period.

• CONTRAINDICATIONS

- Uncooperative patients.- Epileptic patient. - Patient allergic to acrylic.

SPACE REGAINERS• It is removable or fixed, active space maintainers.• The main goal of space regainer is the recovery of lost

arch width or improved eruptive position of succedaneous teeth.

INDICATION• When there is need to re-establish about 3 mm or less

of space.

TYPES

1. fixed space regainer

2. removable space regainer

REMOVABLE SPACE REGAINERS

• It consists of retentive components like Adams and clasp, an active component such as springs and screw and acrylic base plat.

• It takes about 3-4 months to regain 3mm of space.

• TYPES

Free end loopFree end loop Split saddleSplit saddle Sling shotSling shot Jack screwJack screw

REMOVABLE SPACE REGAINERREMOVABLE SPACE REGAINER

Free end loop space regainer

• Labial arch wire with back action loop spring is constructed.

• Base of appliance is made of acrylic resin.

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.

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.• Space is opened by expanding the plates anteroposteriorly.

FIXED SPACE REGAINER

HOTZ LINGUAL HOTZ LINGUAL ARCHARCH LIP BUMPERLIP BUMPERGERBER SPACE GERBER SPACE

REGAINERREGAINEROPEN COILOPEN COIL

FIXED SPACE REGAINERFIXED SPACE REGAINER

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.

• It consists of an open coil inserted into a “U” shaped wire.• The wire is inserted into the molar tube on the band.

GERBER SPACE REGAINER

• It is used where the lower first permanent molar has drifted mesially ,but the premolar or cuspid has not drifted distally.

HOTZ LINGUAL ARCH

LIP BUMPER

• Indicated when bilateral movement is desired.• It is used to distalize molars and to align lower

incisors.• It consists of

- heavy labial arch wire - acrylic flange is prepared over it in the anterior

region such that it does not contact the lower anteriors.

• It is used to relieve the lip pressure.• It align lower incisors under tongue pressure. pre-treatment post-treatment

CONCLUSION

• The best space maintainer is a well maintained primary tooth. But when these are lost, it is essential to have space management strategy that is giving the space maintainer. But if space maintainer is not used, then it may result in the removal of some teeth along with costly orthodontic treatment in future.

REFERENCES

1. Dentistry for the child and adolescent ; McDonaldAveryDean ; 8th edition

2. Textbook of Pedodontics ; Shobha Tandon; 2nd edition

3. Pediatric dentistry; Pinkham Casamassimo Fields McTigue Nowak; 4th edition

4. Principle and practice of pedodontics; Arathi Rao; 3rd edition

5. Internetdentalbooks-drbassam.blogspot.com

depts.washington.edu/peddent/AtlasDemo/space024.html