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Space Maintenance

IT AIN’T SCARY!. Space Maintenance. ARCH CIRCUMFERENCE. MESIAL VECTOR OF FORCE. ERUPTIVE FORCE. What happens?. A scenario: IF S IS LOST but NO SPACE MAINTENANCE. SPACE IS LOST!. The 1st Permanent Molar and the Second Primary Molar Move Mesially.

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Space Maintenance

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  1. IT AIN’T SCARY! Space Maintenance

  2. ARCH CIRCUMFERENCE

  3. MESIAL VECTOR OF FORCE

  4. ERUPTIVE FORCE

  5. What happens? A scenario: IF S IS LOST but NO SPACE MAINTENANCE

  6. SPACE IS LOST! The 1st Permanent Molar and the Second Primary Molar Move Mesially. It’s the Mesial Vector of Force. Ever’body Knows That!

  7. What happens? IF S IS LOST and SPACE MAINTENANCE IS PROVIDED

  8. The Space Maintainer Transmits the Mesial Vector of Force to The Canine and Space is Maintained for the First Premolar…Unless… SPACE IS MAINTAINED

  9. The Primary Canine is Shed before the First Premolar Erupts (Sequence of Eruption)...

  10. 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.

  11. Not necessarily out if the child is closely monitored. So in these cases, band and loops are out. Right?

  12. How About a Lingual Arch? O.K, if Closely Monitored

  13. Because the Permanent Incisors Erupt Behind The Primary Incisors and the Arch Wire May Interfere With the Eruption. WHY?

  14. Stupid Space Maintainer Joke

  15. Every Kind of Space Maintainer Needs Monitoring

  16. Wires Are Bent, Solder Joints Break

  17. Bands Get Loose

  18. Abutments Exfoliate

  19. Biology Deviates

  20. Every Kind of Space Maintainer Needs Monitoring

  21. Kinds of Space Maintainers

  22. Lower Lingual Holding Arch

  23. Removable Space Maintainers

  24. Maxillary (Nance) Holding Arch

  25. Maxillary Holding Arch

  26. Maxillary Holding Arch

  27. Transpalatal Arch

  28. Band and Loop

  29. No Yes Crown and Loop

  30. One Arm Bandit Band and Hemi-Loop

  31. Distal Shoe

  32. Distal Shoe

  33. Removable Distal Shoe

  34. How D’ya Like My Band and Loop ?

  35. Lets talk about... You’re Outta Here.

  36. Arch Circumference and…

  37. 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. Tooth Size and…

  38. Leeway Space and...

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

  40. 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

  41. 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)

  42. Longevity of Space Maintainers • Cement Loss 36% • Breakage 24% • Failure in 63% • Design Problem 10% • Lost 9%

  43. 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

  44. Longevity of Space Maintainers

  45. Making Space Maintainers Fitting Bands Making Impressions Making Models

  46. Requirements for a Space Maintainer Design Maintains Space (Duh!) Is Easily Cleaned Is Easily Inserted Is Comfortable to Patient

  47. Duh!

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

  49. Requirements for a Space Maintainer Economical Does Not Interfere With Speech Does Not Impede Normal Growth or Eruption of Teeth Restores Function

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