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Space maintainers

-are indicated for pediatric patients who have lost their primary teeth at the age of four years old .

They are defined by " J.C Brauner" as : An applianced designed to retained a given area of space , generally in the primary and mixed dentition .

Also defined by Boucher's clinical dental terminology as : a fixed or removable appliance designed to preserve the space created by premature loss of a tooth

Fixed space maintainers is a space maintainer not intended to be removed by the patient , while removable space maintainers is a space maintainer designed for easy removal for cleansing and/or adjustments .

Requirements of a space maintainer :

  1. Should maintain the desired proximal dimension of space
  2. Should not interfere with eruption , speech , mastication
  3. Simple & strong
  4. Easily cleansable
  5. Does not restrict normal growth

Indications of a space maintainer :

  1. If the space after premature loss of deciduous teeth shows signs of closing
  2. If tooth is not ready to erupt

Contraindication of space maintainers :

  1. If the space shows no signs of closing
  2. when there is general lack of sufficient arch length and where space maintainer would further complicate existing malocclusion
  3. When succedaneous tooth is absent
  4. No bone observed radiographically overlying the erupting tooth
  5. when space available is greater than that of required

Classifications of space maintainers

According to Hitchkoch =

  • Removable or fixed or semifixed
  • with bands or without bands
  • functional or not functional
  • active or passive
  • certain combinations of the above

According to Raymond C. Thurow = 

  • Removable
  • Complete arch ( lingual arch )
  • Individual tooth

According to Hinrichsen ( 1962 ) =

  • Fixed appliance ( Class 1 [ non functional types- bar type , loop type ] , [ functional types - pontic type or lingual arch type  ] , class 2 )
  • Removable

Removable space maintainers :

According to Brauer J.C removable appliances may be indicated when : aesthetics is of importances , abutment teeth cannot support fixed appliance , cleft palate to be closed with the denture , when unerupted permanent teeth are expected not to erupt within 6 months , or the child has reached a mental age of two and a half years .

Removable appliances are contraindicated in : uncooperative child , Patient who are allergic to acrylic , epileptic child

Advantages of removable appliance : Easily cleaned , can be worn part time , facilitates chewing , band construction , keeps tongue in bounds .

Disadvantages : may be lost or broken , child may not wear it , jaw growth may be restricted if claspes are incorporated , inrritate the underlying soft tissues .

Types of removable appliances : Acrylic Partial denture , Complete dentures , or removable distal shoe .

 

Fixed space maintainers

Advantages of fixed type : Bands are used without tooth preparation or with minimum preparation of stainless steel crowns are used , does not interfere with passive eruption of abutment , jaw growth is not hampered , succedaneous permanent teeth are well guided to their positions , can be used for uncooperative children , masticatory functions are restored if pontics are placed 

Disadvantages : Elaborate instrumentation with expect skill is needed , results in decalcification of tooth material under the bands , Supra-eruption of opposing teeth if pontics are not used .

Types of fixed space maintainers :

  • Band and loop ( when single tooth is missing , contraindicated in high caries activity and if more than one teeth is missing  )
    • Modifications of band and loop : Crown and loop
  • Lingual arch ( bilateral loss of molars after eruption of permanent incisors in lower arch )
  • palatal arches ( nance palatal holding arch , transpalatal arch )
  • Distal shoe appliance ( when second deciduous molar is extracted or lost before eruption of first permanent molar )

Steps in fabricating fixed maintainers :

  1. Band selection ( select the smallest band that will fit over the height of countour of the teeth , seated with finger pressure )
  2. Alginate impression taken
  3. Pour impression
  4. Draw design of band loop on cast
  5. Cementation
  6. maintanance and evaluation
  7. applicance removal

 

 

 

 

 

 

 

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