This document discusses space maintenance in dentistry. It defines space maintenance as preserving the integrity of a normal occlusion after tooth loss. It discusses several factors related to space maintenance including force magnitude and duration, as well as causes of space loss like caries. Common space maintainers include band and loop, crown and loop, and removable appliances. The document provides guidelines on selecting the appropriate space maintainer based on the missing tooth and its successor. It also reviews advantages and disadvantages of different space maintainer types.

2. It is defined as the action taken to preserve the
integrity of what appears to be a normal occlusion
at a specific time.

3. 1. Parent counseling
2. Caries control
3. Space maintenance
4. Exfoliation of deciduous teeth
5. Abnormal frenal attachments
6. Treatment of locked permanent first molars
7. Abnormal oral musculature and related habits

5. Force
•Application
•Elimination
 Effects of Force
• On bone and teeth
• Tension  Bone Formation
• Compression  Bone Resorption
 Magnitude of Force
• >7-8gram
 Duration of Force
• >4-6 hours

12. In case of proximal decay, the adjacent tooth
tends to tilt into the proximally decayed area
resulting in the loss of arch length, thereby
resulting in lesser space for the succedaneous
tooth to erupt m their rightful place and
position

13. • Caries initiation can be prevented by diet counseling, topical
fluoride application, pit and fissure sealants and educating
parents (prenatal counseling and postnatal counseling).

15. •Prevention and timely restoration of
carious teeth.

18. Space Maintainer
A fixed or removable appliance used to maintain
space created by the premature loss of a tooth.

19. Best Space Maintainer is a Primary Tooth

20. Space of prematurely lost teeth usually
change in the following 6 months period
Causes loss of arch length, resulting in
• Crowding in permanent dentition
• Impaction of permanent tooth
• Esthetic problems
• Malocclusion

21. Time elapsed since tooth loss:
• Maximum space loss occurs during first 6 months
after extraction
Dental Age:
• Teeth erupt when 3/4th of the root is developed,
regardless of the child’s chronologic age
Sequence of eruption
Amount of bone covering the unerupted tooth
Delayed eruption of the permanent tooth
Congenital absence of permanent tooth

22.  Radiograph shows that successor tooth will
erupt soon
 Radiograph shows two third of the root of is
already formed
 When successor tooth is absent and plan is
to close the space

23. According to function:
• Functional
• Non-functional
According to activity:
• Active
• Passive
According to retention:
• Fixed
• Removable

24. Commonly Used Space Maintainers
Band & Loop
Crown & Loop
Lingual Holding Arch
Nance’s Palatal Holding Device
Transpalatal Arch
Distal Shoe
Removable Space Maintainer

25. REASONSUGGESTED TREATMENTMISSING TOOTH
No consequence. Exception
if incisors are lost prior to
primary canine eruption
No space
maintenance
required
Incisor
Decreases possibility of
midline shift
Band & loop space
maintainer
Canine
Prevents loss of arch
dimension
Band /crown & loop
space maintainer
1st Molar
Guides 1st permanent molar
into proper position.
Maintains arch
Distal shoe space
maintainer, band &
loop, lingual arch
2nd Molar

26. Advantages:
 They do not interfere with passive eruption of
abutment teeth
 Jaw growth is not hampered
 Successor permanent teeth are free to erupt into the
oral cavity
 They can be used in uncooperative patients

27. Disadvantages:
 Elaborate instrumentation with expert skill is needed
 They may result in decalcification of tooth material
under the bands
 Supraeruption of opposing teeth can take place if
pontics are not used
 May involve lab work and are expensive

28. Most commonly used
Unilateral fixed appliance
Used in posterior segments

29. Stainless steel crown is used as an abutment
Stronger than band and loop
Cementation failure or loss are less likely
Excellent choice if tooth needs a restoration

30. Bands on first permanent molars
Should not be placed with primary incisors

32. Bands on first permanent molars
Acrylic button in the mid palate

33. Can be used like a Nance
Lack of acrylic button so less tissue irritation
and more cleansable
Lack of anterior stop = possible tooth shift?

34. Used when second primary molar requires
extraction and first permanent molar has not
erupted
Should be evaluated with radiograph prior to
cementation
– Length
– Position

35.  Should extend at least 1 mm below the marginal ridge
 Replace with another space maintainer when permanent
tooth erupts
 Contraindications:
• Patient at risk of developing infective endocarditis
• Immunocompromised individuals

36. Typically used when more than one tooth is lost
Partial denture can replace occlusal function and
help in improving esthetics

37. Advantages:
1. Easy to clean and permits maintenance of proper oral
hygiene
2. Maintains vertical dimension
3. Can be worn part time allowing circulation of the blood to
the soft tissues
4. Room can be made for permanent teeth
5. Help in preventing development of tongue thrust habit
into the extraction space

38. Disadvantages:
1. May be lost or broken by the patient
2. Uncooperative patients may not wear the appliance
3. Lateral jaw growth may be restricted, if clasps are
incorporated
4. May cause irritation of the underlying soft tissues

43. • They deflect adjacent teeth and erupt in abnormal positions.
• They should be identified and extracted before they cause
displacement of other teeth.

44. Thick and fleshy maxillary labial frenum may cause the development of diastema
/excess spacing between the teeth, which in turn may not allow the eruption of
succedaneous teeth. Surgical correction of the high frenal attachments is therefore
advised . The tongue should also be assessed for ankyloglossia/ tongue-tie.

45. • Diagnosis –blanch test.
• Treated at an early stage for prevention.

51. Thank you!