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

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) b) c) d) Removable, fixed or semifixed With bands or without bands Functional or non functional 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 1Non functional - Bar type - Loop type Functional -Pontic type -Lingual arch type Class 2Cantilever type (distal shoe, band and loop)

b) Removable space maintainer

APPLIANCE THERAPY
Fixed space maintainersBand & 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 maintainersAcrylic 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 Johnsons 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.

MODIFICATIONS
Crown 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.

CONTRAINDICATIONS
It 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.
MEDICAL CONDITIONS

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

 Early version was called as Willets distal shoe and was made of cast gold and had bar type gingival extension.

Present design which is commonly used is Roches 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
REMOVABLE SPACE REGAINER

Free end loop

Split saddle

Sling shot

Jack screw

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

FIXED SPACE REGAINER

OPEN COIL

GERBER SPACE REGAINER

HOTZ LINGUAL ARCH

LIP BUMPER

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.

GERBER SPACE REGAINER

It consists of an open coil inserted into a U shaped wire. 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.

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. Internet
dentalbooks-drbassam.blogspot.com depts.washington.edu/peddent/AtlasDemo/space024.html