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.

a)Time elapsed since loss space closure usually takes place during the first 6 months after the extraction. b)Dental age of the patient c)Amount of bone covering the unerupted tooth e) Delayed eruption of the permanent tooth f) Congenital absence of the permanent tooth g) Presentation of problems to parents

considerations

Evaluate Arch Length

Has the space already been lost? Is there excess space?

Appropriate Radiographs
Succedaneous tooth? Time to Eruption?

Fixed S.M

Band & loop space maintainer. Crown & loop appliance. Lingual arch. Palatal arch appliance. Transpalatal arch. Distal shoe.

Removable S.M
Acrylic partial dentures. Full or complete dentures. Removable distal shoe space maintainer.

NANCE (Transpalatal Arch with Acrylic Button Stop on Palate) TRANSPALATAL ARCH

LOWER LINGUAL HOLDING ARCH (LLHA)

BAND/CROWN and LOOP

DISTAL SHOE

Two types of lingual arch designs are used to maintain maxillary spacethe Nance arch. the Transpalatal arches. 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.

MAXILLARY ONLY Bands on first permanent molars acrylic button that rests directly on the palatal rugae.

Can be used like a Nance. Advantage

Lack of acrylic button

so less tissue irritation and more cleansible

Disadvantage
Lack of anterior stop =

possible tooth shift (?)

PASSIVATIONThe lingual archwire should be completely passive.

MANDIBULAR ONLY Bands on first permanent molars Anterior Stop

Mandibular incisors often erupt lingually and are pushed forward by the tongue LLHA should not be placed with primary incisors

Indications: Bilateral loss. Loss of more than one unit in a quadrant. Loss of primary canines.

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. Unilateral long span

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.)

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.

MAXILLARY or MANDIBULAR Unilateral most typical Can be bilateral if permanent teeth are not present Single tooth span

Stronger than band and loop Cementation failure or loss less likely

Excellent choice if tooth needs a restoration

MAXILLARY or MANDIBULAR Used when second primary molar requires extraction and first permanent molar has not erupted

Should be evaluated with radiograph prior to cementation

Length Position

Will be replaced with another space maintainer when permanent teeth erupt.

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. o No occlusal function is restored because of this lack of strength. o Histologic examination shows that complete epithelialization does not occur after placement of the appliance.
o

Yes, they are possible, however.. High failure rate due to breakage and loss Parent and patient compliance must be exceptional

Advantages Provides functional space maintenance. Opposing teeth prevented from overeruption. Disadvantages: Compliance may be a problem; appliance not worn. Frequent incidences of breakage. Appliance may be lost when removed.

This results in little space loss if canines and molars are present. A prosthesis may be constructed if desired: Space maintenance questionable Esthetics Development of speech

Fixed Bands on second primary molars 0.9 mm wire Teeth fixed to the wire Patient < 3 or questionable cooperation

Removable Posterior Adams clasps or ball clasps Patient > or = 3 years old

Requires immediate space maintenance. Space loss & midline shift is common.

Distal Shoe = 2nd Primary Molar Extraction with unerupted 1st Permanent Molar Nance or Band/Crown Loop = Maxillary problem with 1st Permanent Molars present Lower Lingual Holding Arch = Mandibular Problem with 1st Permanent Molars and Permanent Incisors present Band/Crown and Loop= Primary 1st Molar Extraction

Avoid Hard/Sticky foods (toffee, hard candy, gum, popcorn, etc.). Teeth should be brushed after each meal and the teeth with bands around them should be cleaned especially well. A 3 monthly review is appropriate.

 Inform

the patient not to try to bend the wire for any reason with finger or tongue. Patient to come in for an emergency appointment if the bands come loose or if the space maintainer is damaged in any way. If a tooth erupts under the wire this also needs to be checked.

It is usually safe to remove the space maintainer after the permanent teeth have erupted.