Space Maintenance

ARCH CIRCUMFERENCE

MESIAL VECTOR OF FORCE

ERUPTIVE FORCE

A scenario: IF S IS LOST but NO SPACE

MAINTENANCE
What happens?

SPACE IS LOST!
The 1st Permanent Molar and the Second
Primary Molar Move Mesially.
Its the Mesial Vector of Force.

IF S IS LOST and SPACE MAINTENANCE

IS PROVIDED
What happens?

SPACE IS MAINTAINED
The Space Maintainer Transmits the Mesial Vector
of Force to The Canine and Space is Maintained
for the First PremolarUnless

The Primary Canine is Shed before the First

Premolar Erupts (Sequence of Eruption)...

Or there is no primate space to accommodate

the size difference between the primary
incisors and the permanent incisors. In cases
of no primate spacing, the erupting lateral may
resorb the root of the primary canine, causing
its early exfoliation.

So in these cases, band and loops

are out. Right?
Not necessarily out if the child is
closely monitored.

How About a Lingual Arch?

O.K, if Closely Monitored

WHY?

Because the Permanent Incisors Erupt Behind The Primary

Incisors and the Arch Wire May Interfere With the Eruption.

Every Kind of Space Maintainer

Needs Monitoring

Wires Are Bent, Solder Joints Break

Abutments Exfoliate

Biology Deviates

Lower Lingual Holding Arch

Removable Space Maintainers

Maxillary (Nance) Holding Arch

Maxillary Holding Arch

Maxillary Holding Arch

Transpalatal Arch

Band and Loop

Crown and Loop

No

Yes

Band and Hemi-Loop

One Arm Bandit

Distal Shoe

Distal Shoe

Removable Distal Shoe

How Dya Like My Band and Loop ?

Arch Circumference and

Tooth Size and

Tanaka and Johnston Method: One half the sum

of widths (mm) of 4 permanent incisors + 10.5
mm for mandibular arch (11mm for maxillary
arch) = combined widths of permanent cuspid
and bicuspids.

Leeway Space and...

When
Teeth
Emerge
Normal
If Primary tooth
is lost before 8 years (later)
If Primary tooth
is lost after 8 years (earlier)

Making Space Maintainers

Do it Yourself ?
Time and Materials

Have a Professional Dental Lab Do it?

Find a Competent Laboratory for
Orthodontic Appliances

Know How to Write a Proper

Prescription

Longevity of Space
Maintainers
301 Space Maintainers in 141 Patients
Ages: 3 yrs 3 months to 22 yrs.
.Followed for 5 years
(Qudeimat and Fayle, JPD July/August, 1998)

Longevity of Space
Maintainers

Cement Loss 36%

Breakage 24%
Failure in 63%
Design Problem 10%
Lost 9%

Longevity of Space Maintainers

Median Survival Time = 7 months
Band and Loop = 13 mos.
Lower Lingual Holding Arch = 4 mos.
All Bilateral Space Maintainers = 5
mos
Remakes had longer survival time
(10 months)
Highest breakage was in LLHA
Failure of solder joints = 11%

Longevity of Space Maintainers

Making Space Maintainers

Fitting Bands
Making Impressions
Making Models

Requirements for a Space

Maintainer Design
Maintains Space (Duh!)
Is Easily Cleaned
Is Easily Inserted
Is Comfortable to Patient

Duh!

Duh?
Is the remaining space adequate
for the permanent tooth mass?
Is the super-erupted maxillary
2nd primary molar a space maintainer?

Requirements for a Space

Maintainer
Economical
Does Not Interfere With Speech
Does Not Impede Normal
Growth or Eruption of Teeth
Restores Function

Is Your Kid
Irresponsible?
Hyperactive?
Athletic?

Does Your Kid...

Have Oral Habits?
Have a Dog?
Eat in the Cafeteria?

Any Questions?