THE DIFFERENT MODALITIES FOR SPACE MANAGEMENT IN DENTISTRY ARE EXPLAINED IN A CLEAR AND CONCISE WAY.

1. Space management
DR.VIGNESH R, BDS

2. ❖ Space control refers to a careful supervision of
the developing dentition, it reflects an
understanding of the dynamic nature of occlusal
development.
❖ Space maintaining is utilizing an appliance to
preserve space without necessarily an
awareness of dynamics of the situation.

3. ❖ Space Maintenance is the process of maintaining a space in
a given arch previously occupied by a tooth or group of teeth.
❖ Space maintainer refers to an appliance designed to retain a
given area or space, generally in the primary and mixed
dentitions.
❖ Space Regainer- is a fixed or removable appliance capable
of moving a displaced permanent tooth into its proper
position in the dental arch.

4. Objective of space maintenance:-
o preservation of primate spaces
o integrity of dental arches
o normal occlusal planes
o esthetics
o phonetics.
“ Tooth itself is the best space
maintainer.”

5. Natural forces exerted on teeth

6. Dentition is designed to function as a single unit,
retained spatially by the sum of forces exerted
upon each individual member :
Occlusal forces.
Muscular forces.
Eruptive forces.

7. Nature & prevalence of space loss
• Incidence of premature loss of deciduous molars
Premature loss of teeth- crowding due to rotation,
tipping or bodily movement
• Rate & time of space closure-
➢ earlier the tooth loss- greater the space loss
➢ greatest space loss occurs in the first 6 months
after extraction
• Amount of space closure- maximum in the
maxillary region due to premature loss of the 2nd
deciduous molars

8. • Direction of space closure
Maxillary extraction sites close by- mesial movement
of posterior teeth
Mandibular- distal migration of anterior teeth
• Effect of caries
severe interproximal caries- at least 1mm of space
loss

9. Variables Influencing Space
Maintainer Programme
1. Oral musculature and habits.
maxillary arch- proclination
mandibular arch- cuspid extraction- shift of midline
2. Time elapsed since extraction.
maximum loss in the first six months
3. Dental age, eruption pattern, bony covering.
• 4-5 months for an erupting tooth to pass through
1 mm of bone
• tooth lost due to infection- bone not a reliable
predictor
• Ectopic eruption & root resorption- delays / hastens
exfoliation time

10. 4. Available space.
Amount of space available and required should be measured
5. Interdigitation.
Occlusion stabilized by increased cuspal height & proper
interdigitation
6. Anomalies of teeth.
Hamper eruption- complete radiographic assessment
7. Sequence of eruption.
2nd deciduous molar lost prematurely- 2nd molar is erupting –
space maintenance needed

11. Indications of Space Maintainers.
If the space after premature loss of primary teeth
show signs of closing.
If the use of space maintainer will aid in or make
the future orthodontic treatment less involved.
If the need for treatment of malocclusion at a later
date is not indicated.

12. Contraindications
If the radiograph of extraction region shows one
third of the root of succudaneous tooth already
calcified.
When space left by prematurely lost primary tooth
is greater than the space needed for permanent
successor as indicated radiographically.
If the space shows no signs of closing.

13. Contraindications
When there is general lack of sufficient arch length
and where space maintainer would further
complicate existing malocclusion.
When succidaneous tooth is absent.
When there is no bone observed radiographically
overlying the erupting permanent tooth, which
suggests that the tooth will erupt within a few
months.

14. Treatment Planning
(Space Maintainers)

15. ➢ Complete & accurate medical history and examination to evaluate
general & dental health of patient.
➢ Full – mouth radiographic survey or panoramic radiograph –
cephalogram.
➢ Diagnostic models for analysis.
➢ Variables affecting space maintenance programme are considered.
➢ Appliance selection.

16. Appliance selection depends on:-
❖ Patient cooperation.
Removable appliances- greater cooperation
❖ Integrity of the appliance.
Mandibular removable appliance most susceptible
to breakage
❖ Maintenance- length of time the appliance has to
be worn
❖ Modifiability - future modifications
❖ Limitation
❖ Cost- direct bonded are the best- less time- but
high charges

17. Pre-requisites for Space Maintainers.

18. They should maintain the mesiodistal
dimension of space created by lost tooth.
They should be functional if possible, to the
extent of preventing over eruption of opposing
tooth.
Should be as simple and strong as possible.
Should not interfere with normal occlusal
adjustments.
Should not interfere with erupting teeth.

19. Should maintain individual functional
movement of teeth.
Should not interfere with normal vertical
eruption of adjacent teeth.
Simple design, easy construction and
placement.
Should be easily adjustable.
Should not restrict normal growth and
developmental process.

20. Must not endanger remaining teeth by imposing
excessive stresses on them.
Should not interfere with mastication, speech or
deglutition.
Must be easily cleansed.
Should be durable and corrosion resistant.
Should have reasonable cost.

21. Probable sequelae to premature loss of
individual tooth

22. First primary molar
Loss may be maxillary, mandibular or both, unilateral or
bilateral.
Potential for space loss when first deciduous molar is lost
depends on the different stages of eruption of first
permanent molar.
➢ When first deciduous molar is extracted before active
eruption of first permanent molars, there is no influence on
the arch to cause space loss.
➢ Potential for space loss is great during eruption of first
permanent molars since it exerts a strong eruptive force
against the distal crown surface of second deciduous molar

24. Lower first permanent molar erupts directly against
the deciduous distal crown surface.
Maxillary first permanent molar erupts distal ward &
rotates & swings forward once cusp tips are through
the tissue.

25. Second primary molarSecond primary molars
serve as a buttress for
permanent molar eruption.
Maxillary permanent
molar erupts distally &
swings forward to contact
distal of second primary
molar.
If it is missing during
this time, permanent
molar continues to swing
mesially until it contacts
distal of first primary
molar.

26. If mandibular primary second molar is lost early,
permanent molar will continue its mesial eruption
pathway & become mesially tipped.

27. Primary canines
Most probable cause is erupting laterals resorbing the roots
of primary canines.
If the loss is unilateral, - midline shift to the side of space
loss due to migration of larger permanent incisor segment
into the space.
Decrease in arch circumference - due to lingual tipping of
permanent incisors - from the force of orbicularis and its
associated muscles.

28. Primary incisors
➢ Primary incisors become spaced with growth to
accommodate larger permanent incisors- space
maintainers are not necessary to maintain space
which is getting increased with growth of jaw.
➢ As far as speech development, esthetics, social
trauma for child are concerned, space maintainers
should be given.

29. Effects of premature loss of
primary molars on premolars.

30. 1. Eruption of premolars will be delayed in children who lose
primary molars at 4 or 5 Yrs of age and before.
❖ If primary molars are lost after 5 Yrs, there will be a
decrease in delay of premolar eruption.
❖ At 8-10 Yrs, premolar eruption resulting from premature
loss of primary molars is greatly accelerated.
2. Premolar eruption accelerated in presence of long –
standing necrosis.

31. 3. Mesial drift of permanent first molar will lead to:-
❖ Second premolar impaction
❖ Deflected and impacted second premolar.
❖ Deflected and ectopically erupting second premolar
❖ Second premolar erupting into normal position.

32. Classification of
Space Maintainers.

33. Hitchcock
Removable or fixed or semi fixed
Banded/ bonded
Functional or non functional
Active or passive
Certain combinations of the above.

34. Advantages of removable type
space maintainers
❖ Easy to clean and permits teeth to be cleansed.
❖ Maintains or restores the vertical dimension.
❖ Can be used in combination with other preventive
procedures.
❖ Can be worn part time allowing circulation of blood to the
soft tissues.
.

35. ❖ Serves in functions like esthetics, phonetics and mastication
❖ Helps keeping the tongue in bounds.
❖ Stimulates eruption of permanent teeth.
❖ Caries detection can be made easily.
❖ Room can be made for permanent teeth to erupt without
changing the appliance.

36. Disadvantages of Removable
Space Maintainers.
May be lost or can be broken by the patient.
Patient may not wear it.
Lateral jaw growth can be restricted if clasps are
incorporated
May irritate underlying soft tissues.

38. Advantages of Fixed Space Maintainers
Easy manipulation.
Does not interfere with passive eruption of abutment.
Jaw growth is not hampered.
Can be used for uncooperative patient.
Masticatiory function is restored if pontics are placed.

40. Disadvantages of Fixed Space Maintainers.
❖ Elaborate instrumentation with expert skill is needed.
❖ May result in decalcification of tooth material under
bands.
❖ May be harmful to the abutment tooth due to
development of torque forces resulting in appliance
breakage.
❖ Supra eruption of opposing teeth if pontics are not used.
❖ If pontics are used, it interferes with vertical eruption of
abutment.

41. Fixed space maintainers are appliances utilizing
bands or crowns for their construction
Band and loop,
Crown and loop ,
Band and bar,
Lingual arch,
Palatal arches like transpalatal arch and nance palatal holding
arch,
Distal shoe.

42. Band and Loop Space Maintainer
Is a unilateral fixed appliance indicated for
space maintenance in the posterior segments
when single tooth is lost.

47. Indications.
a. In controlling space created by early loss of
first primary molar.
b. Bilateral loss of first primary molars.
c. When second primary molar is lost after the
eruption of first permanent molar.
d. Premature loss of primary canines.

48. Advantages
I. Effective space maintainer for unilateral loss of
single tooth.
II. Economical to make and construction is simple.
III. Less chair time if pre-formed bands are used.

49. Disadvantages.
i. Decalcification under the bands.
ii. Will not prevent continued eruption of
opposing teeth.
iii. Does not restore chewing function.
iv. Limited to maintenance of single tooth
space.

50. Construction of Appliance
S Stainless steel band is adapted to the tooth
posterior to the edentulous area. Pre – formed
bands may also be used.
S Full length alginate impression is taken with the
band in place.
S Band is removed from the tooth and positioned
in the impression.

51. S Impression is poured in stone and cast is
made.
S Mesial end of the loop should rest on the
area just below the greatest curvature on the
proximal of the tooth mesial to the space.

52. The distal ends of the loop should
overlap mesial one third of the buccal
and lingual surfaces of the band, just
above free gingival margin. The arms
should run on each side of alveolar
ridge close to the gingiva. Anterior part
of the loop is secured in position, distal
ends are soldered on to the band.
Finishing is done later on.

53. Lingual Arch
Use – indicated to preserve the spaces
created by multiple loss of primary
molars when there is no loss of space
in the arch.
Modifications are also in use.

54. Advantages
Excellent source of anchorage.
Causes little or no inconvenience to
patient.
Less bulky than removable space –
maintainers.
Less conspicuous.

55. DISADVANTAGES.
Decalcification under bands.
Arch wire may become embeded in
soft tissue .
Wire may become distorted by
masticatiory forces.

56. FABRICATION
Stainless steel bands adapted around
the teeth distal to the space. Arch
design should be directed toward
minimizing maintenance problems.
Arch wire should contact the erupted
permanent incisors at the cingulum.

57. Should be located 1-2mm lingual to
posterior teeth to permit satisfactory
eruption of the premolars in a
buccolingual plane.
Arch wire is soldered on the mid third
of the band lingually.

58. Distal Shoe Space Maintainer
Early designs made of cast gold
WILLET DISTAL SHOE.
Roche’s distal shoe was used later.

59. INDICATIONS.
When second primary molar is lost
before eruption of first permanent
molar.

60. CONTRAINDICATIONS.
1. Inadequate abutment due to multiple
loss of teeth.
2. Poor oral hygiene.
3. Medically compromised patients.
4. Congenitally missing first permanent
molar.

64. Rate of Space Closure
Maxilla
D : 0.8mm/Yr.
E : 2.0mm/Yr.

65. Amount of Space Closure.
Maxilla Mandible
D E D E
1st year 1.3mm 2.8mm 1.8mm 2.4mm
2nd year 1.8mm 4.5mm 2.7mm 3.1mm
3rd year 3.2mm 8.0mm 3.3mm 4.5mm

66. Hinrichsen.
a. Fixed Appliances.
Class - I a ) Non functional types.
1. BAR TYPE.
2. LOOP TYPE.
Class – I b ) Functional types.
1. PONTIC TYPE.
2. LINGUAL ARCH TYPE.
Class – II a ) Cantilever type (distal shoe,
band & loop).
b) Removable acrylic partial dentures.