SPACE MAINTAINERS

Ths. Bs. Lưu Minh Quang

SPACE MAINTENANCE

Space maintenance can be defined as the provision of an appliance (active

or passive )which is concerned only with the control of space loss without
taking into consideration measures to supervise the development of
dentition.
Space maintainers are appliances used to maintain space or
regain minor amounts of space lost, so as to guide the
unerupted tooth into a proper position in the arch.
Requirements for an ideal SM:

1. it should maintain the space in A-P and Vertical dimention.

2. it should be simple in fabrication.
3. it should be strong enough to withstand the functional forces.
4. it should not exert excessive stress on adjoining teeth.
5. it must permit maintenance of oral hygiene.
6. it must not restrict normal growth & development and natural
adjustments which take place during the transition from deciduous to
permanent dentition.
7. it should not come in the way of other functions.
Presentation of problems to parents
Take sufficient time to explain to parents:
- Reasons of space maintainer.
- Notices of space maintainer placement: tongue,
oral hygiene, speech…
- Following-up at home.
 CLASSIFICATION OF SPACE MAINTAINERS

Popular classification:
• Removable or fixed or semi-fixed.
• With bands or without bands.
• Functional or non-functional.
• Active or passive.
• Certain combinations of the above.
 PLANNING FOR SPACE
MAINTENANCE

The following considerations are important to the dentist when space maintenance
is considered:
1) Time elapsed since loss

When a primary tooth is removed & all factors indicate the need for space
maintenance,it is best to insert an appliance as soon as possible after the
extraction.Often the best approach,if possible,is to fabricate an appliance before the
extraction & deliver it at the extraction appointment.
2) Dental age of the patient-
- The chronologic age of the patient is not so important as the
developmental age or dental age.
- A panoramic x-ray is needed
3) Amount of bone covering the unerupted tooth-

- if there is bone covering the crowns,it can be readily predicted that eruption will not occur for many
months, a space-maintaining appliance is indicated.

- a vertical maintainer should be needed to protect permanent teeth from early eruption in case of
underdeveloped aveolar bone.

4) Sequence of eruption of teeth-

- the dentist should observe the relationship of developing & erupting teeth
adjacent to the space created by the untimely loss of a tooth.
- Dental age- panoramic x ray.
5 ) Delayed eruption of the permanent tooth-
In case of impacted permanent tooth,it is necessary to extract
the primary tooth,construct a space maintainer & allow the
permanent tooth to erupt at its normal position.
If the permanent teeth in the same area of the opposing
dentition have erupted,it is advisable to incorporate an occlusal stop
in the appliance to prevent supraeruption in the opposing arch.
f) Congenital absence of the permanent tooth
Orthodontist consultation is needed todecide the space management plan:
Two opts: close or maintain?
 APPLIANCE THERAPY
Fixed space Removable space
maintainers-
• Band & loop space maintainers-
maintainer.
• Acrylic partial dentures.
• Crown & loop
appliance. • Full or complete dentures.
• Lingual arch.
• Removable distal shoe
• Palatal arch appliance.
space maintainer.
• Transpalatal arch.
• Distal shoe.
• Esthetic anterior space
maintainer.
• Band & Bar type space
maintainer.
 Four appliances generally used to
maintain space in the primary dentition
are-
• The Band & Loop
• The Lingual Arch
• The Distal Shoe
• The Removable Appliance
 FIXED SPACE MAINTAINERS

Space maintainers which are fixed or fitted onto the teeth are called
fixed space maintainers.
ADVANTAGES:
1. Bands and crowns are used which require minimum or no tooth
preparation.
2. They do not interfere with passive eruption of abutment teeth.
3. Jaw growth is not hampered.
4. The Succedaneous permanent teeth are free to erupt into the
oral cavity.
5. They can be used in un-co-operative patients.
6. Masticatory functions is restored if pontics are placed.
DISADVANTAGES:
1. Elaborate instrumentation with expert skill is needed.
2. They may result in decalcification of tooth material under the bands.
3. Supra eruption of opposing teeth can take place if pontics are not used.
4. If pontics are used it can interfere with vertical eruption of the abutment
tooth & may prevent eruption of replacing permanent teeth if patient fails to
report.
 REMOVABLE APPLIANCE
• The appliance is typically used when more than one
tooth has been lost in a quadrant.
• It is often the only alternative because there are no
suitable abutment teeth and bacause the cantilever
design of the distal shoe or the band and loop is too
weak to withstand occlusal forces over a two-tooth span.
• Not only can the partial denture replace more than one
tooth, it also can replace occlusal function.
• Two drawbacks of the appliance are retention and
compliance.
Advantages:

1. Easy to clean and permit maintainance of proper oral

hygiene.
2. Maintain or restore the vertical dimension.
3. Can be worn part time allowing circulation of the
blood to the soft tissues.
4. Room can be made for permanent teeth to erupt
without changing the appliance.
5. Stimulate eruption of permanent teeth.
6. Help in preventing development of tongue thrust
habit into the extraction space.
DISADVANTAGES:

1. May be lost or broken by the patient.

2.Patient’s co-operation required
3. Lateral jaw growth may be restricted, if
clasps are incorporated.
4. May cause irritation of the undrelying
soft tissues.
5. Need to be ajust frequently
Indication:
1. When aesthetics is of importance.
2. In case the abutment teeth cannot support a fixed
appliance.
3. In cleft palate patients who require obturation of the
palatal defect.
4. In case the radiograph reveals that the unerupted
permanent tooth is not going to erupt in less than five
months time.
5. If the permanent teeth have not fully erupted it may be
difficult to adapt bands.
6. Multiple loss of deciduous teeth which may require
functional replacement in the form of either partial or
complete dentures.
CONTRAINDICATIONS-

1.Lack of patient co-operation.

2.patients who are allergic to acrylic material.
3.Epileptic patients.
 BAND & LOOP APPLIANCE
(FIXED,NON FUNCTIONAL,PASSIVE SPACE MAINTAINER)

It is used to maintain the space of a single

tooth.
Inexpensive & easy to fabricate.
It does not restore the occlusal function of the
missing tooth.
 Indications
Unilateral loss of the primary first molar before or after eruption of the
permanent first molar.
Bilateral loss of a primary molar before the eruption of the permanent
incisors.
 LINGUAL ARCH
(FIXED,NON FUNCTIONAL,PASSIVE MANDIBULAR
ARCH APPLIANCE)

Used to maintain the posterior space in the

primary dentition.
The lingual arch is often suggested when teeth
are lost in both quadrants of the same arch.
Belong to those group of space control
appliances which not only control
anteroposterior movements but also are capable
of controlling & preventing an arch perimeter
distortion,by controlling the lingual collapse of
single tooth or segments of the arch.
•It consist of a round stainless steel or precious alloy wire, 0.32 to
0.40 inches in diameter closely adapted to the lingual surfaces of
the teeth & anchored to bands on the first permanent molars.

•The means used to anchor the archwire to the bands will define
whether the lingual arch is of a removable or fixed type.

•Because the permanent incisor tooth buds develop & erupt

somewhat lingual to their primary precursors,a conventional
mandibular lingual arch is not recommended in the primary
dentition (bilateral band & loop appliances are recommended in
this situation.)
PASSIVATION-
The lingual archwire should be completely
passive.This is done by heating the wire to a dull
brownish appearance,while keeping the wire
gently in place on the cingula with an old
instrument.
• The maxillary lingual arch is feasible in the primary
dentition because it can be constructed to rest away from
the incisors.
• Two types of lingual arch designs are used to maintain
maxillary space-
• the Nance arch.
• the Transpalatal arches.
• These appliances use a large wire(36 mil) to connect the
banded primary teeth on both sides of the arch that are
distal to the extraction site.
• The difference b/w the two appliances amounts to where
the wire is placed in the palate.The Nance arch incorporates
an acrylic button that rests directly on the palatal
rugae.The Transpalatal arch(TPA) is made from a wire that
traverses the palate directly without touching it.
 NANCE ARCH OR NANCE SPACE HOLDING APPLIANCE
(FIXED,NON-FUNCTIONAL,PASSIVE,MAXILLARY ARCH APPLIANCE)

Nance(1947) described the “preventive lingual wire”.

It consists of bands on the upper molars,with the arch
wire extending forward into the vault.
 CONSTRUCTION-
• The acrylic button is present on the slope of the
palate & provides an excellent resistance against
forward movement(U loop).The wire should
extend from the lingual of bands to the deepest
& most anterior point in the middle of hard
palate.
• ‘U’ bend is given in the wire for the retention of
the acrylic 1-2mm away from the soft tissue.
 TRANSPALATAL ARCH
(FIXED,NON-FUNCTIONAL,PASSIVE
APPLIANCE)
• The arch is soldered to both sides, straight without
a button & without touching the palate.
• The basis of the appliance is that the migration &a
rotation is caused by rotation around the lingual
root. By preventing this, space loss is prevented by
the appliance.
• Cross arch anchorage can be used if only one of the
primary molars is lost & both the permanent
molars are erupted.
 DISTAL SHOE
(INTRA-ALVEOLAR,ERUPTION GUIDANCE APPLIANCE)

• Used to maintain the space of a primary second

molar that has been lost before the eruption of
the permanent first molar.
• An unerupted permanent first molar drifts
mesially within the alveolar bone if the primary
second molar is lost prematurely.The result of
the mesial drifts is loss of arch length & possible
impaction of the second premolar.
DISADVANTAGES-
• Because of its cantilever design & the fact it is
anchored on the occlusally convergent crown of the
primary first molar,the appliance can replace only a
single tooth & is somewhat fragile.
• No occlusal function is restored because of this lack of
strength.
• Histologic examination shows that complete
epithelialization does not occur after placement of the
appliance.
Case 11
Case 11
 Case 7
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