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Space management
2017-2018
Problem??
loss of 1ry or permanent teeth loss of arch integrity
loss of space & arch length circumference
Migration of 1ry...
Growth of the dental arches
A) Maxilla B) Mandible
**Types of spacing between the primary dentition are
classified into:
i- Generalized spacing
ii- Primate spacing
iii- Lee ...
Generalized spacing
• Anteriorly , sometimes posteriorly
primate spacing
• Distal to mand. 1ry canines
• Mesial to max. 1r...
Arch Length (perimeter)
is the distance between the mesial surface of 1st permanent
molar on a side to the mesial surface ...
SIGNS OF DIFFERENT TYPES OF DENTITION
Type of
dentition
Signs
Not crowded
( excess space )
Spacing between incisors
Space ...
1- Nance analysis
2- Moyers mixed dentition analysis
( ballard wylie analysis )
3- Johnston and tanaka analysis
4- Hixon &...
1- Nance analysis:
-Aim
Determine whether the dental
arch will accommodate the
permanent teeth or not.
-Materials needed:
...
-Procedure:
1- X-ray films for the areas of unerupted canine & premolars.
2- Study models for measurements.
3- By means of...
From the measurement of the arch length in mixed dentition we
subtract:
Lower arch -3.4 mm ( 1.7mm x2 )
upper arch -1.8 mm...
2-Moyers mixed dentition analysis :
-The analysis is based on the theory that there is some type of
harmony between the si...
**Advantages:
1- can be completed in the mouth as well as on the casts .
2- may be used for both arches .
3-Johntson and Tanaka analysis:
- Is a variation of Moyer’s analysis where the predictographs are not needed.
* The sum of...
4- Hixon & Oldfather:
- They measured mesiodital widths of unererupted bicuspids on x-ray
film & then added to them size o...
5- Kaplan, Smith & Kenarkf:
- They modified Hixon & Oldfather method by excluding lower
incisors.
- To overcome Hixon-Oldf...
6-Bishara and staely:
-This is the most recent and most universally used method
Space maintaining
decision
Factors affecting decision of space
maintaining
• Time elapsed since loss
of primary tooth
Factors affecting decision of space
maintaining
• chronological age Vs. dental age
Factors affecting decision of space
maintaining
• Amount of bone covering
the unerupted tooth
Factors affecting decision of space
maintaining
• Delayed eruption of
the permanent tooth
Factors affecting decision of space
maintaining
• Congenital absence of
permanent tooth
Factors affecting decision of space
maintaining
• Presentation of problems
to the parents
Space maintainer
Definition, requirement
Definition
* It is an artificial replacement for a
prematurely lost primary tooth or
teeth;
* It is main function is to pr...
General requirements
1. It should maintain the entire mesio-
distal space created by a lost tooth.
2. It must restore the ...
General requirements..
3. It should be esthetically pleasing in
case of ant teeth loss
4. prevent over-eruption of opposin...
General requirements..
5. It must permit maintenance of oral
hygiene.
6. It must not restrict normal growth
& development
Space maintainer
classification
Classification of space maintainers
According to means of retention:
• fixed
• removable
According to function
• functiona...
Fixed space maintainers
Advantages
1. Under control of dentist
2. Minimum fracture
3. More hygienic
Disadvantage
1. not re...
Band and loop
Crown and loop band
Crown with distal shoe extension
Passive lingual arch
Nance holding appliances
Trans palatal arch
Removable space maintainers
Advantages
1. Restore function
2. Aesthetically better
Disadvantage
1. Need cooperation
2. Eas...
Acrylic partial denture
According to Area
1- space maintainers for the 1st
primary molar area
1- Band and loop maintainer :
Fixed - passive - non ...
Construction of band and loop
A) indirect
B) direct
2- stainless steel crown and loop
maintainer
Indications
1- extensive caries in posterior abutment
2- vital pulp therapy i...
S.M for 2nd 1ry molar
Eruption 1st perm.
molar
Band & loop
Crown & loop
Loss of 2nd 1ry molar
before eruption of the
1st p...
I. Band & loop / Crown & loop
1. 1st 1ry molar prep. & crown is contoured
2. Alginate imp. Whlie the crown ( or band ) is ...
II. Acrylic plate S.M
1.1st perm. Molar not completely erupted , but a bulge marks its placed in the oral cavity .
2. RPD ...
Premature loss of anterior teeth?
• 1 Incisors:
• no decrease in intracanine dimensions if loss after
eruption of canines...
• 2 Canines:
• common loss due to ectopic eruption of permanent lateral incisors
• compromises arch length, possibly deep...
Premature loss of posterior teeth: Multiple Teeth
•Following appliances
are indicated:
a)Transpalatal arch
b)Nance applian...
SM: Band and Loop
Indications
1. Loss of primary molar
prior/during period of
eruption of 1st perm M.
2. Anywhere in poste...
SM: Band and Loop
Advantages
1. Easy to construct.
2. Inexpensive.
3. Easily adjusted.
4. Allows eruption of
permanent too...
SM: Band and Loop
Disadvantages
1. Masticatory function.
Not restored
2. Extrusion of opposing dentition.
Not prevented
3....
SM: Band and Loop
Construction
• Band: stainless steel
material 0.005 inches
in thickness
• Crib: portion of the
wire span...
SM: Lingual Arch
Indications
1. Premature loss of
primary posterior
teeth.
2. Base for aesthetic
restoration in loss
of an...
SM: Lingual Arch
Advantages Disadvantages
1. Maintains est. arch form.
2. Allows eruption of perm teeth w/o interference.
...
SM: Fixed Lingual Arch
Construction
• Band: Stainless steel
material 0.005
inches in thickness
(ortho bands)
• Lingual arc...
SM: Nance Appliance
Maxillary arch: multiple tooth loss
Indications:
The same as for fixed lingual arch
Construction:
Band...
Space maintenance for 1st permanent
molar:
1- after eruption of 2nd permanent
molar:
• band and loop
• Temporary modified bridge
• move 2nd molar orthodontically to ...
2- befor eruption of 2nd permanent molar:
• Distal shoe extension is made to guide the eruption of 2nd
permanent molar the...
Ideal condition for extraction
of 1st permenant molars
• Unerupted canines, premolars and 2nd molars are visible on a
radi...
A space maintainer may not be required if
there is:
1. Existence of cuspal interference.
2. Widely spaced primary dentitio...
Suggested that succeeding tooth will most likely
erupt within 6 months if:
1. 75% of the root is present on the
succeeding...
Prior to obtaining the consent, parents should be
informed that:
1. Space maintainer requires monitoring.
2. Patient must ...
space management in Deciduous teeth
space management in Deciduous teeth
space management in Deciduous teeth
space management in Deciduous teeth
space management in Deciduous teeth
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space management in Deciduous teeth

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space maintainer

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space management in Deciduous teeth

  1. 1. Space management 2017-2018
  2. 2. Problem?? loss of 1ry or permanent teeth loss of arch integrity loss of space & arch length circumference Migration of 1ry &/or permanent teeth available space crowding in permanent dentition
  3. 3. Growth of the dental arches A) Maxilla B) Mandible
  4. 4. **Types of spacing between the primary dentition are classified into: i- Generalized spacing ii- Primate spacing iii- Lee way spacing
  5. 5. Generalized spacing • Anteriorly , sometimes posteriorly primate spacing • Distal to mand. 1ry canines • Mesial to max. 1ry canines Lee way spacing • For maxilla 0.9 unilaterally • For mandible 1.7 unilaterally Types of spacing between the primary dentition
  6. 6. Arch Length (perimeter) is the distance between the mesial surface of 1st permanent molar on a side to the mesial surface of the 1st permanent molar on the other side of the arch , over the contact points of the posterior teeth and incisal edges of the anterior teeth.
  7. 7. SIGNS OF DIFFERENT TYPES OF DENTITION Type of dentition Signs Not crowded ( excess space ) Spacing between incisors Space available<required Not crowded ( just sufficient space) Normal contacts between incisors Space available = required Mild crowding Slight overlapping of incisors Space available in arch up to 4mm less than that required Severe crowding Overlapping .rotation or displacement of incisors Space available in arch over 4mm less than that required
  8. 8. 1- Nance analysis 2- Moyers mixed dentition analysis ( ballard wylie analysis ) 3- Johnston and tanaka analysis 4- Hixon & Oldfather 5- Kaplan, Smith & Kenarkf 6- Bishara & staely Arch Length Analysis
  9. 9. 1- Nance analysis: -Aim Determine whether the dental arch will accommodate the permanent teeth or not. -Materials needed: * sharp divider * a set of periapical films * millimeter ruler * brass wire 0.026 inch * card of 3x5 cm for recording measures * a set of study models
  10. 10. -Procedure: 1- X-ray films for the areas of unerupted canine & premolars. 2- Study models for measurements. 3- By means of sharp divider we measure: - the individual mesio-distal width of the perament centrals & laterals from models - the individual mesio-distal width of the perament canine , 1st & 2nd premolars from x- rays - both measurements give the required space for accommodation of all permanent teeth anterior to 1st permanent molar. 4- By means of the brass wire we contour the arch on the model from mesial surface of 1st permanent molar on one side to that of the other side.
  11. 11. From the measurement of the arch length in mixed dentition we subtract: Lower arch -3.4 mm ( 1.7mm x2 ) upper arch -1.8 mm ( 0.9mm x2 ) So this is the amount by which the arch length may be expected to decrease as a result of mesial drifting of the 1st permanent molar. Compare between required space & available space: Required = available arch length adequate Required > available crowding Required < available spacing
  12. 12. 2-Moyers mixed dentition analysis : -The analysis is based on the theory that there is some type of harmony between the size of the incisors canines and premolar. - Predictographes: in which mandibular incisors chosen ( as they erupt first ) , used to predict the size of upper as well as lower posterior teeth - Measure mesio-distal width of each mandibular incisor separately then these measurements are added together , and by the means of predictographs we find the predicted size of permanent teeth more commonly in the 75% range.
  13. 13. **Advantages: 1- can be completed in the mouth as well as on the casts . 2- may be used for both arches .
  14. 14. 3-Johntson and Tanaka analysis: - Is a variation of Moyer’s analysis where the predictographs are not needed. * The sum of widths of mandibular permanent incisors is measured & divided by 2 ** for the lower arch add 10.5 mm to the result *** for the upper arch add 11 mm to the result **** The total is the estimated widths of canines & premolars - Then compare the tooth mass prediction with the total measured arch length to obtain inadequacies in arch length.
  15. 15. 4- Hixon & Oldfather: - They measured mesiodital widths of unererupted bicuspids on x-ray film & then added to them size of lower permanent incisors from casts. - Result is termed “measured value” which is used to determine “estimated value” from their prediction charts.
  16. 16. 5- Kaplan, Smith & Kenarkf: - They modified Hixon & Oldfather method by excluding lower incisors. - To overcome Hixon-Oldfather overprediction they suggested adding: 0.3 mm to value < 20 mm 0.4 mm to values 20-22 mm 0.5 mm to values 23 mm & above
  17. 17. 6-Bishara and staely: -This is the most recent and most universally used method
  18. 18. Space maintaining decision
  19. 19. Factors affecting decision of space maintaining • Time elapsed since loss of primary tooth
  20. 20. Factors affecting decision of space maintaining • chronological age Vs. dental age
  21. 21. Factors affecting decision of space maintaining • Amount of bone covering the unerupted tooth
  22. 22. Factors affecting decision of space maintaining • Delayed eruption of the permanent tooth
  23. 23. Factors affecting decision of space maintaining • Congenital absence of permanent tooth
  24. 24. Factors affecting decision of space maintaining • Presentation of problems to the parents
  25. 25. Space maintainer Definition, requirement
  26. 26. Definition * It is an artificial replacement for a prematurely lost primary tooth or teeth; * It is main function is to preserve the space until the eruption of permanent teeth.
  27. 27. General requirements 1. It should maintain the entire mesio- distal space created by a lost tooth. 2. It must restore the function as far as possible
  28. 28. General requirements.. 3. It should be esthetically pleasing in case of ant teeth loss 4. prevent over-eruption of opposing teeth.
  29. 29. General requirements.. 5. It must permit maintenance of oral hygiene. 6. It must not restrict normal growth & development
  30. 30. Space maintainer classification
  31. 31. Classification of space maintainers According to means of retention: • fixed • removable According to function • functional (Partial denture) • non-functional According to force • active (space regainer) • passive According to area
  32. 32. Fixed space maintainers Advantages 1. Under control of dentist 2. Minimum fracture 3. More hygienic Disadvantage 1. not restore function 2. Not restore ethetics 3. Needs good patient recall system
  33. 33. Band and loop
  34. 34. Crown and loop band
  35. 35. Crown with distal shoe extension
  36. 36. Passive lingual arch
  37. 37. Nance holding appliances
  38. 38. Trans palatal arch
  39. 39. Removable space maintainers Advantages 1. Restore function 2. Aesthetically better Disadvantage 1. Need cooperation 2. Easy breakage 3.less hygienic
  40. 40. Acrylic partial denture
  41. 41. According to Area 1- space maintainers for the 1st primary molar area 1- Band and loop maintainer : Fixed - passive - non functional Most common SM to maintain space of a single tooth .Advantages .Disadvantages *Ease of construction *not restore function *low cost *not prevent over eruption * give room for erupting * cement dissolution.. caries Permanent tooth
  42. 42. Construction of band and loop A) indirect B) direct
  43. 43. 2- stainless steel crown and loop maintainer Indications 1- extensive caries in posterior abutment 2- vital pulp therapy in the posterior abutment N.B the loop may be cut off after eruption of the successor leaving the crown to serve as a restoration Disadvantages: Hard to make adjustements in the loop ,so adapt band and loop ovet a cemented crown is recommended
  44. 44. S.M for 2nd 1ry molar Eruption 1st perm. molar Band & loop Crown & loop Loss of 2nd 1ry molar before eruption of the 1st perm. molar Acrylic plate S.M
  45. 45. I. Band & loop / Crown & loop 1. 1st 1ry molar prep. & crown is contoured 2. Alginate imp. Whlie the crown ( or band ) is put on the abutment tooth . 3. the crown ( or band ) removed from the tooth & placed in the imp. 4. Stone is poured 5. If the 2nd 1ry molar is planned for extraction but had not yet been removed , it’s should be cut off the model 6. Holes stimulate the position of the roots are made in the cast. 7. Loops contoured extending distally and into the holes . 8. Free ends of the loops are soldered to the band or to the crown 9. Sharping and smothing 10.Isolate and dry the tooth 11.Cementation #N.B BEFORE cementation , x-ray is indicated while the S.M is in its position in the mouth to determine whether tissues extension is in the porper relationship with unerupted tooth or not
  46. 46. II. Acrylic plate S.M 1.1st perm. Molar not completely erupted , but a bulge marks its placed in the oral cavity . 2. RPD plate constructed with its distal end mesial to the visible bulge of the 1st perm. molar
  47. 47. Premature loss of anterior teeth? • 1 Incisors: • no decrease in intracanine dimensions if loss after eruption of canines why? Long axis of anterior 1ry teeth is vertical to alveolar bone so, the anterior component of force is zero. • Need SM?: Not necessary
  48. 48. • 2 Canines: • common loss due to ectopic eruption of permanent lateral incisors • compromises arch length, possibly deepens bite, shift of dental midline toward side of loss • -band and loop space maintainer is constructed and the 1st primary molar is used as abutment • What about in case of 1ry upper canine
  49. 49. Premature loss of posterior teeth: Multiple Teeth •Following appliances are indicated: a)Transpalatal arch b)Nance appliance c)Lingual arch d) Removable QuickTime™ and a TIFF (Uncompressed) decompressor are needed to see this picture.
  50. 50. SM: Band and Loop Indications 1. Loss of primary molar prior/during period of eruption of 1st perm M. 2. Anywhere in posterior following a time lapse b/w loss of tooth and eruption of its permanent successor. 3. Loss of 2 post teeth or bilateral situations rarely used
  51. 51. SM: Band and Loop Advantages 1. Easy to construct. 2. Inexpensive. 3. Easily adjusted. 4. Allows eruption of permanent tooth. 5. Non invasive. 6. Painless.
  52. 52. SM: Band and Loop Disadvantages 1. Masticatory function. Not restored 2. Extrusion of opposing dentition. Not prevented 3. Normal distal mvmt of primary cuspids during eruption of perm lateral incisor Not allowed if placed for the early loss of mand 1st primary molar
  53. 53. SM: Band and Loop Construction • Band: stainless steel material 0.005 inches in thickness • Crib: portion of the wire spanning the edentulous space • Loop: portion of the wire contacting the abutting tooth 0.032 inches in diameter
  54. 54. SM: Lingual Arch Indications 1. Premature loss of primary posterior teeth. 2. Base for aesthetic restoration in loss of anterior teeth. 3. Used as a base for habit appliance. QuickTime™ and a TIFF (Uncompressed) decompressor are needed to see this picture.
  55. 55. SM: Lingual Arch Advantages Disadvantages 1. Maintains est. arch form. 2. Allows eruption of perm teeth w/o interference. 3. Not easily displaced. 4. Ease of cleaning for proper OH. 5. Can be modified easily to serve in many situations. 6. Patient comfort. 1. Does not prevent extrusion of opposing teeth. 2. Not advisable to band teeth which are: •Hypoplastic •Hypocalcified •Highly prone to caries. 3. Can promote decay in non- compliant patients.
  56. 56. SM: Fixed Lingual Arch Construction • Band: Stainless steel material 0.005 inches in thickness (ortho bands) • Lingual arch wire: Stainless steel round wire 0.036 inches in thickness
  57. 57. SM: Nance Appliance Maxillary arch: multiple tooth loss Indications: The same as for fixed lingual arch Construction: Bands: Stainless steel material 0.005 inches in thickness Palatal wire: Stainless steel round wire 0.036 inches in thickness
  58. 58. Space maintenance for 1st permanent molar:
  59. 59. 1- after eruption of 2nd permanent molar: • band and loop • Temporary modified bridge • move 2nd molar orthodontically to the 1st molar site if the 3rd molar will erupt in normal position • Single implant
  60. 60. 2- befor eruption of 2nd permanent molar: • Distal shoe extension is made to guide the eruption of 2nd permanent molar then replace by band and loop till time of fixed replacement
  61. 61. Ideal condition for extraction of 1st permenant molars • Unerupted canines, premolars and 2nd molars are visible on a radiograph show no evidence of abnormality • The occlusal relationship is class I • There is milde buccal segment crowding i.e. there is insufficient space for the eruption of canine and premolars
  62. 62. A space maintainer may not be required if there is: 1. Existence of cuspal interference. 2. Widely spaced primary dentition. 3. If succeeding tooth is expected to erupt within 6 months. 4. If present space is not adequate for the succeeding tooth. 5. The possibility of future orthodontic work. 6. Where the opposing 6's are locked into a desirable and stable relationship
  63. 63. Suggested that succeeding tooth will most likely erupt within 6 months if: 1. 75% of the root is present on the succeeding tooth. 2. Less than 1 mm of alveolar bone is covering succeeding tooth. 3. Destruction of the alveolar bone occurred when the primary tooth was lost. 4. Mixed-dentition is in its later stages.
  64. 64. Prior to obtaining the consent, parents should be informed that: 1. Space maintainer requires monitoring. 2. Patient must maintain adequate OH. 3. Appliance may break, requiring repair or replacement. 4. Broken appliances are hazardous to the child and will be ineffective. 5. Even properly maintained appliances may fail to preserve the space. It is necessary to obtain parental awareness and understanding related to space maintenance. QuickTime™ and a TIFF ( Uncompressed) decompr essor ar e neede d to see this picture.

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