Pedodontics - preventive orthodontics, a simple outline about space maintainers.. needs,indications,contra indications,types

1. SUBMITTED BY
SUBINA NAZRIN
3rd BDS
DEPARTMENT OF PEDIATRIC DENTISTRY

2. SPACE
MAINTAINERS

3. DEFINITION
• This term was coined by JC Brauer
in 1941.It is defined as the process of
maintaining a space in a given arch
previously occupied by a tooth or a
group of teeth
• Boucher :it is a fixed or removable
appliance designed to preserve the
space created by the premature loss of
a primary tooth or a group of teeth

4. Space maintainers are devices
used to maintain or regain the
space following the loss of
deciduous tooth or teeth

5. Five milk teeth

7. Permanent(1,2,3,) Teeth
are Erupted & Milk Teeth
(D,E)

8. This is a case of decay in
Milky Tooth

9. Witout treatment the milk
tooth starts breaking

10. Removing the decayed tooth

11. Because of open space the first
permanent molar will start tilting
forward

12. 6 Has Tilted Closing The
Spacement For 5

13. The Second Premolar is
trapped now

14. A space maintainer can be used to
prevent such a situation

15. W hy is it necessary
to use a space
maintainer?

16.  If a child loses a baby tooth
early through decay or
injury, the child's other
teeth could shift and begin
to fill the vacant space.
When the child's permanent
teeth emerge, there's not
enough room for them. The
result is crooked or crowded
teeth and difficulties with
chewing or speaking.

19. This is a ideal case where a
space maintainer would have
helped

20. The best space maintainer is
a primary tooth

21. Causes…..
• Premature loss of teeth
• Interproximal caries
• Ectopic eruption of 1st permanent
molars
• Delayed eruption
• Ankylosis of primary molars
• Disproportionate tooth size,etc

22. INDICATIONS
1. If the space shows signs of closing.
2. If the use of space maintainer will
make the future orthodontic less
complicated.
3. If the need for treatment of
malocclusion at a later date is not
indicated.

23. INDICATIONS(contd….)
4. When the space should be
maintained for two year or more.
5. To avoid supra eruption of
opposing tooth.
6. To improve the masticatory
system and restore dental health.

24. CONTRAINDICATIONS
1. if the radiograph shows that the
2.
3.
4.
5.
succedant tooth will erupt soon.
If the radiograph shows one third of the
root of is already calcified.
When the space left is greater than the
needed for the permanent as indicated
from radiographically.
If the space shows no signs of closing.
When the succedenous tooth is absent.

25. Requirements
• It should maintain the
entire space created by
the tooth
• It must restore function
• Prevent supraeruption of
opposing tooth
• It should be simple in
construction

26. Contd……
• It should be strong enough to
withstand occlusal forces
• Should permit maintenance of
oral hygiene
• Must not restrict the growth of
jaws
• It should not exert undue forces
of its own

27. CLASSIFICATION OF SPACE
MAINTAINER
The classification of the space
maintainers can be summarized in
the following
According to function:
Functional
Non-functional

28. According to activity:
Active
Passive
According to retention:
Fixed
Semi fixed
Removable

29. Commonly used Space
maintainers
 BAND & LOOP
 CROWN & LOOP
 LINGUAL ARCH HOLDING DEVICE
 NANCE’S PALATAL HOLDING DEVICE
 TRANS PALTAL
 DISTAL SHOE
 REMOVABLE SPACE MAINTAINER

30. BAND AND
LOOP
Most commonly
used
Unilateral fixed
appliance
Used in posterior
segments

31. CROWN AND LOOP

32. CROWN AND LOOP
 Stainless steel crown is
used as an abutment
 Stronger than band
and loop
 Cementation failure or
loss are less likely
 Excellent choice if tooth
needs a restoration

33. LINGUAL ARCH HOLDING
DEVICE

34. Bands on first
DEVICE molars
permanent

35. Anteriorly it rests
at the cinguli of
the Incisors

36. LINGUAL ARCH HOLDING
DEVICE
 Mandibular
incisors often erupt
lingually and are
pushed forward by
the tongue
 LLHA should not be
placed with primary
incisors

37. NANCE PALATAL ARCH SPACE
MAINTAINER
It’s a simple
maxillary
lingual arch
but does not
contact
anterior teeth

38. Bands on first
permanent
molars

39. It has an acrylic
button in the mid
palate

40. TRANSPALATAL ARCH

41. TRANSPALATAL ARCH
 Can be used like a
Nance.
 Advantage Lack of
acrylic button so
less tissue irritation
and more cleansable
 Disadvantage Lack
of anterior stop =
possible tooth shift

42. DISTAL SHOE SPACE
MAINTAINER
Used when second primary
molar requires extraction and
first permanent molar has not
erupted

43. DISTAL SHOE SPACE
MAINTAINER
Primary
canine and
first molar
(c,d)

44. Primary second molar
(e),has been extracted
and permanent first
molar has not been
erupted

45. Should be evaluated with radiograph
prior to cementation
– Length
– Position

46. Will be replaced with another space
maintainer when permanent teeth erupt.

47. REMOVABLE SPACE MAINTAINERS
a.Non-functional types
b.Functional types

48. It is like a removable partial denture Not only
Mesiodistal space but also the vertical space
is maintained. masticatory Function is
restored in functional type Esthetics & speech
improvement is seen

49.  removable unilateral space maintainers
 They are too small and present swallowing
and choking dangers for children.

50. SPACE MAINTENANCE IN MAXILLARY
PRIMARY DENTITION
MISSING
TOOTH
SUGGESTED
TREATMENT
REASON
Incisor
No space
maintenance
required
No consequence.
Exception if
incisors are lost
prior to primary
canine eruption

51. canine
Band& loop
space
maintainer
Decrease
possibility of
midline shift
I molar
Band /crown & Prevents loss of
loop space
arch dimension
maintainer
II molar
Distal shoe
space
maintainer
Guides I
premolar into
proper position
Prevents loss in
arch dimension

52. SPACE MAINTENANCE IN
MANDIBULAR PRIMARY DENTITION
MISSING
PRIMARY
TOOTH
SUGGESTED
TREATMENT
REASON
canine
Band & loop
space
maintainer
Band/crown
loop space
maintainer
Decreases
possibility of
midline shift
Prevents loss
of arch
dimmension
I molar

53. II molar
Distal shoe
space
maintainer
Guides I
permanent
molar into
position
Prevents loss
in arch
dimension

54. Our Objective….
 Our primary objective is to make a study
model for better understanding of the use
of Space maintainers.
 We have 3 instances….
 The first one is the normal
situation,where we have the deciduous
teeth harbouring the permanent teeth

55. Our Objective….
 The 2nd one is when we have a premature loss of
Deciduous teeth
 The 3rd one shows the space maintainer
incorporated into the space