040103 - passive space control

7/30/2019 040103 - Passive Space Control

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PASSIVE SPACE CONTROL

Dr S.E. Jabbarifar;Isfahan Dental

School,Pediatric Dentistry Departement

2009


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Prerequisite knowledge

Understand that arch length is greatest at age

four years

Tooth position is maintained by balance offorces shift vs. drift

Greatest amount of space closure within

first 6 months of premature tooth loss

Sequence & timing of exfoliation/eruption


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Space control vs. space

maintenanceSpace control

Dynamic

Careful ongoing supervision

Space maintenance

Utilization of appliance to preserve existing

spaceNot always the rule!


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Variables influencing

space controlOral musculature & habits

Time elapsed since extraction

Dental age, eruption sequence & bony

covering

Available space

Interdigitation

Absence of anomalies


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Considerations in

premature 1o tooth lossPreserve the arch length!

Causes:

Anterior primarily trauma, cariesPosterior primarily caries

If space lost:

Space maintenanceSpace regaining

No treatment


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Space loss in primary

and mixed dentitionsUnrestored

interproximal caries

reduce arch

circumference!

first line of defense =

Class II & SSC

restorations

Natural tooth is the best

space maintainer


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Planning for space

maintenanceNo medical contraindications

Patient must be dentally fit

Patient must be able to demonstrate

good OH


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Planning for space

maintenanceParents must all understand costs involved

Parents must understand importance of & bewilling to attend regularly for appliance

supervision/maintenance teeth lost in

primary dentition stage may cause delayed

eruption of succedaneous teeth

Periodic recementation may be required


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Primary Incisors


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Primary Incisors


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Primary Incisors

Why replace primary incisors?

Primarily for esthetic reasons

Rarely see long-term effects on speech

development and function

Once 1o cuspids have erupted in occlusion

the anterior arch length is established


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Primary Incisors

Problems with replacement:

Appliances are weak

High maintenanceclose monitoring reqd

Frequent alterations as dentition changes

Appliance may enhance caries risk


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Primary Incisors


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Primary Incisors


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Primary Incisors


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Primary Incisors


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Primary Canine

Loss due to trauma or caries rare

Space maintainer: B&L vs. RPD

Must be removed to accommodate lateral

No space maintainer:

Midline shift

Lingual collapse in mandible


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Premature loss of

primary molars


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Band-loop space

maintainerIndications:

Unilateral loss of the 1st primary molar before

eruption of the 1st

permanent molar Unilateral loss of the 1st or 2nd primary molar after

eruption of the 1st permanent molar

Bilateral loss of the 1st primary molars before

eruption of the permanent incisors and 1st

permanent molars

Bilateral loss of the 2nd primary molars aftereruption of the 1st permanent molar


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Early loss of the 1st

primary molar


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Early loss of the 2nd

primary molar


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Other indications

Deflection of

succedaneous

tooth


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Band-loop space

maintainer

FABRICATION & DESIGN


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Band-loop fabrication

Technique:

Properly fitting band on abutment tooth

(pg. 389 Pinkham)Segmental impression

(compound/alginate)

Remove band from tooth & secure inimpression

Create working model


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Sectional

impression tray

Green or red

compound


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Band-loop design

Loop should be wide

enough bu-li to allow

eruption of bicuspid

(8 mm)

Loop should not restrict

physiologic movement

of adjacent teeth (eg.lateral movement of

primary canine)


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Band-loop design

Loop should not

impinge on soft

tissue

Loop should be in

close approximation

to ridge


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Band-loop cementation

Apply floss ligature

Try-in / seat bandcompletely

Loop should contactabutment below contactpoint

No soft tissueimpingement

Cementation in properlyisolated, dry field

Check/adjust occlusion


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Try it in first!


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Loop impingement


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Loop impingement


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Loop impingement


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Lingual arch


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Lingual arch

Indications:

Bilateral single or multiple tooth loss inmandible

Not recommended when primary incisors

still present


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Lingual arch


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Lingual arch design

Archwire should rest

on cingulae of

incisors 1-1.5 mmabove gingival

margin

Removable vs.soldered


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Lingual arch design

Solder joint should

be in mid-third and

parallel to band

Wilson loops

Archwire should bebelow plane of

occlusion posteriorly


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Lingual arch fabrication

Fit molar bands

Compound/alginateimpression

accurate especially

in lingual sulcus &

lower incisor area


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Lingual arch fabrication

Secure bands in

impression

create working model


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Lingual arch

cementationCheck for passivity

on the model and in

the mouth beforecementation

Archwire should be

in contact with lowerincisor cingulae


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Lingual arch

cementationDry field

GI orpolycarboxylate

cement

No soft tissueimpingement


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Transpalatal arch


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Transpalatal arch

Rarely recommended for bilateral tooth

loss in maxilla

Can prevent mesio-palatal rotation of

palatal root of Mx 1st permanent molar

but allows mesial tipping of molars &space loss


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Transpalatal arch

May have an indication for use when

one side of the arch is intact but several

primary teeth are missing contralaterally

Some designs incorporate omega loop:

when active can prevent bodily

movement of molars


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Nance arch


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Nance arch

Used commonly in maxilla for bilateral

tooth loss

Incorporates acrylic button in contact

with palate to prevent molars from

tipping

Can be very unhygenic


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Nance arch


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Nance arch fabrication

Bands fitted on

molars

Mx impression in

compound/alginate

Working model


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Archwire will

traverse the palatalvault


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Adapted archwire is

soldered to bands

Acrylic button is

added to embed the

wire


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Completed arch

ready for try-in and

cementation

Ensure acrylic

button in firm

contact with palate


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Crown-loop space

maintainer


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Crown-loop space

maintainerIndications:

As for band-loop

Abutment tooth requires full coverage SSC

due to multi-surface caries or pulp

treatment


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Crown-loop fabrication

Abutment tooth prepared for SSC

Properly contoured SSC seated, but not

cementedCompound impression

SSC placed into impression

Working modelAnother SSC fitted and cemented with

temporary cement


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Crown-loop space

maintainer


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Crown-loop space

maintainer


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Crown-loop space

maintainer


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Crown-loop cementation

Temporary SSC removed, under LA if

necessary

Try-in crown-loop to verify loop

contours

Cementation in dry field


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Crown-loop space

maintainerDisadvantages:

If solder joint fails, there is no way to repairthe appliance without entire re-make

Cost is higher (extra SSC)


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Band-loop over SSC

Band can be fitted

over SSC asalternative to crown-

loop


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Bonded space

maintainerDifficult to retain due

to shearing forces of

occlusion

Flexure in function

will de-bond

Difficult to adjust


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Removable appliances

Indicated for mulitple primary tooth loss

when no suitable abutment teeth exist

Need to restore occlusal function overlonger span

Clasping difficult for primary teeth

therefore retention a problemCompliance issues


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Removable appliances


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INTRA-ALVEOLAR SPACE

MAINTENANCE

D362/QP362Division of Orthodontics and Paediatric Dentistry

2004-2005

Karen M. Campbell, DDS


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Premature loss of the

2nd

primary molar

If the 1st permanent

molar is erupted,can use

conventional B & L

from 6 to D


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Premature loss of the

2nd

primary molar

Band & loop from D

to 6

Difficult to band Ds

Indications for


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Indications for

intra-alveolar space

maintenance

Premature loss of

the 2nd primarymolarprior to the

eruption of the 1st

permanent molar


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Contraindications

Medically compromised:

Cardiac patients requiring SBE prophylaxis

Immunosuppression

Chemotherapy/radiation therapy, pre-BMT

Demonstrated lack of commitment to

follow-up


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Distal Shoe

Provides a guiding

plane for theeruption of the 1st

permanent molar


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Dentists responsibility

Mark on the working

model the distalterminus of the

appliance


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Dentists responsibility

Provide measurement

from radiograph

Mark depth of shoe withcut on model

Shoe should be 1 mm

below mes marginal

ridge of the 1st

permanent molar


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Completed appliance


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Immediate insertion

Follows extractioncan better visualizeplacement of shoe

Area alreadyanesthetized

eliminates potentialfor 1st permanentmolar drift


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Cemented appliance


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Crown with distal shoe

D prepared for SSC; E to be extracted at later appt


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Segmental impression with crown inserted


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Tooth temporized with SSC


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Extraction of the E and preparation for cementation


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Cementation Confirmation by radiograph


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F ll i ti f


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Following eruption of

the 1st

permanent molarDistal shoe no longer appropriate 1st

permanent molar may tip mesially

above shoeParents must be aware of need for

second appliance from the beginning

Conventional B & L or lingual arch maybe required

D b k f th


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Drawbacks of the

applianceCan only replace a single tooth due to

its cantilever design

Inherent lack of strengthCannot restore occlusal function

Ds are very difficult to fit bands

Epithelium perforated in area of distalshoe

040103 - passive space control

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