Space Maintainers - Columbia University

Space Management in the Space Maintainers
Primary Dentition
“ A space maintainer is an intra-oral appliance
S.Lal, DDS used to preserve arch length following the
premature loss of primary teeth/tooth.”
Failure to maintain space
results in Malocclusion „ This allows the permanent teeth to erupt
unhindered into proper alignment and
1. Drifting / tipping of teeth occlusion.
2. Loss of arch length
3. Midline shift „ A space maintainer is recommended after the
4. Crowding of permanent teeth untimely loss of a primary tooth.
5. Impactions
6. Orthodontic intervention including Types of Space maintainers:

extractions 1. Unilateral vs Bilateral
2. Anterior vs posterior
3. Fixed vs Removable

Basic concepts…. Space Management

1. Space closure occurs during the first 6 „ Space loss occuring
months after extraction. It is best to insert from mesial tipping
the appliance as soon as possible following of primary second
the exttraction. molar secondary to
proximal caries
2. Loss of space occurs primarily due to a
tipping movement of teeth (mesially or
distally). In the maxillary molar region,
space loss occurs due to rotation (mesial-in)
in conjunction with mesial tipping.

3. Erupting premolars usually require 4-5
months to move through 1mm of bone as
measured on a BWXR.

Space Management Space management

„ Space closure from „ Impacted maxillary
an untimely loss of a premolar due to
maxillary primary space loss
first molar

Band and Loop Crown and Loop

Indication: „ Restores a grossly
„ Unilateral or bilateral decayed abutment
tooth.
loss of a primary
molar. „ Removal of
appliance for
adjustments is
difficult.

Space Management Distal Shoe space maintainer

„ The role of Indication:
Chronological age „ Loss of a primary
and Dental age
when considering second molar before the
space maintainance. eruption of the first
permanent molar.
Contraindications:
„ Poor oral hygeine
„ Medically compromised
pt.

Transpalatal Bar Nance Appliance

„ Indicated for „ Indicated for loss of
bilateral loss of multiple primary teeth
primary maxillary (bilaterally)in the
molars. maxillary arch.

„ Hygenic „ Acryllic button provides
„ May not prevent the increased stability.
Appliance prevents
mesial tipping of tipping and rotation
teeth movt of molars.

„ Acryllic button may
cause difficulty in
maintaining hygiene in
the rugae area.

Lower Lingual Arch Lower Lingual Arch

Indications: „ Modification of LLA
„ Bilateral loss of primary with omega loops.

teeth in the mandibular „ Activation of loops
arch during transitional help flare anteriors
dentition. with some distalising
„ Maintainace of arch of permanent
perimeter and incisor molars.
positions.
„ Contraindicated in
primary dentition.

Lower Lingual Arch Removable Space Maintainers

„ Modified LLA with Indications:
clasps to prevent „ Loss of multiple teeth
distal tipping of
lateral incisors. bilaterally (anterior
and/or posterior)
„ In the absence of
abutment teeth.
¾ The acryllic resin or
modified Hawley space
maintainers restore
esthetic, function and
prevent supereruption
of opposing teeth.

Fabrication of a Fabrication of a
Space Maintainer Space Maintainer

„ Selection of molar „ Seat band 1mm
bands. below marginal
ridges with the aid
„ Trial and error of a band seater.
leading to a snug fit.
„ Adapt bands to the
„ # indicates mesial contours of the
surface. tooth.

„ Separators may be
needed for tight
contacts.

Fabrication of a Space Management for the
Space Maintainer anterior region

„ Take alginate
impressions with the
bands in the pts. mouth

„ Remove and place
bands onto the
impression.

„ Stablize bands with
wire/paperclips.

„ Pour the models with
plaster and send to the
lab with order form.

Space Regaining Space Regaining

„ Modified Band and „ Removable space
Loop with spring regainer with jack-
coils. screw.

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