Maintainers Flashcards
What is the importance of maintaining the integrity of the dental arch from the most premature period in the development of the human being allows a normal occlusion
Guide to eruption for the permanent teeth
Adequate establish of occlusion in permanent dentition
phonetic function
chewing function
aesthetic function
prevention of oral habits
When does the most common loss occurs __ months after the loss of a primary tooth
Within 6 consecutive month after the loss of a primary tooth
Children may experience premature tooth loss
local: caries , trauma
systemic: premature birth, cerebral palsy, syndrome/ disorders
teeth have a strong tendency to move ____ even before they erupt into the mouth
This phenomenon is called
mesially
mesial thrust tendency
Premises for the use of maintainers: 6
DA TES TIE CAS ANAB TP
dental age of the patient
tooth eruption sequence
time elapsed since extraction
degree of crowding and available space
anomalies or absence of permanent teeth
tooth type and position
the provision of an appliance which is concerned only with the control of loss, considering measures to supervise the dentition development
Maintenance
appliances used to maintain or regain the mayor amount of so that they can guides the eruption of the permanent teeth into a proper position.
Maintainers
Most important function of maintenance is to
maintain the mesiodistal relationship
The maintenance of the arch length in the primary and early permanent dentition is important fo the
Normal development of the occlusion
premature loss of primary teeth can result in the
In the loss of the arch length leading a malocclusion
the pattern of loss depends on many factors including:
age, stage of development in which teeth has bee lost, he presence of crowding or space.
maintainers function
- maintain arch length and perimeter
- prevent loss
- prevent the development of a malocclusion or reduce its severity
requirements that a maintainers must have
- maintain the desire proximal space
- it should not interfere with the eruption of the permanent successor teeth
- it should not interfere with the opposite tooth
- it must provide enough mesiodistal for permanent teeth
- it should not interfere with phonation, chewing ot functional jaw movement
- they should be simple in design
- easy to clean and maintain
Ideal characteristics of the maintainers
simple
strong and stable
passive not cause the movement
do not increase the risk of caries development
general consideration to place a maintainers
- time elapsed after loss
- px dental age
- amount of space lost
- tooth eruption sequence
- late eruption of permanent teeth
general consideration to place a maintainers
Where closure usually occurs in the fits six months, therefore the maintainer should be placed as soon as possible
Time elapsed after loss
general consideration to place a maintainers
Where the stage of root development of the successor tooth should be evaluated, regardless of the child’s age
Px dental age
general consideration to place a maintainers
Where if a situations in which ⅔ of the existing fo the correct positioning of the permanent tooth has been lost there will be a need for orthodontic treatment to correct these deviations
Amount of space lost
general consideration to place a maintainers
Where the relationship of the developing teeth and adjacent eruptions must be observed in the created by the premature loss of any dental organ
Tooth eruption sequence
general consideration to place a maintainers
Where it occurs due to partial impaction or deviation in the eruption path of the permanent successor teeth. In this case, extraction of the temporary tooth and placement of the space maintainer are almost indicated.
Late eruption of permanent teeth
Consequences of premature loss
- decrease in the perimeter and length of the arch with the consequent deviation from the midline
- causing malocclusions such as **crowding, ectopic eruption or impaction of permanent tooth*
- alteration of the molar and canine relationship
changes in the vertical plane such as deep bites, and in the transverse plane such as crossbites. - structural changes may occur in the bone tissue according to the age at which tooth loss occurs and defects may occur in the height of the alveolar bone
- at the soft tissue level, anomalies caused in the gingival mucosa may be favored and oral habits such as atypical swallowing in edentulous spaces may be generated compromising aesthetics and may produce alterations in phonetic development
however not every premature loss of a temporary tooth will be treated systematically by placing a maintainer and they not always have the same characteristics
!
This planning should have a general vision of the px seeking to preserve the total perimeter of the dental arch and maintain the of the tooth lost prematurely
For an adequate planning, the dx must be analyzed with the aim of individualizing each case the most appropriate way
with:
clinic exam
x-ray
dental casts
Planning for the maintenance
Types of maintainers
- unilateral
- band and loop - bilateral
- lower lingual arch
- transpalatal arch
- nance appliance
- removable acrylic appliance
Types of unilateral maintainers
Band and loop
Types of bilateral maintainers
lower lingual arch
transpalatal arch
nance appliance
removable acrylic appliance
Indicated for the loss of the first primary molar
It is indicated to maintain the for a missing second primary molar, only if we have the presence of the first permanent molar
Band and loop
Advantages of Band and loop
allows the eruption of permanent teeth
easy to construct and adjust
not expensive
non invasive or painful
bilateral loss of the mandibular primary molars after eruption of the permanent incisors
unilateral loss of more than one tooth in the mandibular arch
Lower lingual arch
it is design of a bilateral band on molars that are connected by a heavy wire that rests on the cingulum of the anterior incisors
Lower lingual arch
bilateral loss of the maxillary primary molars
unilateral loss of more than one tooth in the maxillary arch
Nance appliance
its design is bilateral bands on the first molars that are connected by a heavy wire, and the arch wire is directed toward the palatal surface and is embedded in an acrylic button resting on the soft tissue
Nance appliance
Bilateral loss of the maxillary primary molars
unilateral loss of more than one tooth in the maxillary arch
- solo cuando se pierde otro diente además del posterior, uno anterior o premolar, si solo se cae posteriores siempre es mejor poner un nance
Transpalatal arch
its design of a bilateral bands on the first molars that are connected by a heavy wire that transverse the hard palate without touching soft tissue.
Easier to clean, not very stable as the nance bottom
Transpalatal arch
there has been a loss of more than one tooth in a quadrant, and the permanent molars haven’t erupted yet
in the mandibular primary dentition, a loss of the second primary molars along with the both first primary molars
Removable acrylic appliance
Procedure within the field of interceptive orthodontics that can be applied in cases of bone-dental discrepancy where the supporting bone is less that the sum of the size of the dental material
Serial extraction
was the first to propose in one of his dental treatises, the extraction of deciduous teeth to achieve greater alignment of the permanent teeth
Pierre Fauchard
Its and interceptive orthodontic procedure
it’s a timed planned sequential extraction of certain deciduous teeth followed by the removal specific permanent teeth in order to guide the eruption of permanent teeth into a favorable position
Serial extraction
2 basic principales of serial extraction
- Arch length / tooth size discrepancy
- Physiologic tooth movement
First basic principal for serial extraction
Arch length / tooth size discrepancy
when there is an excess of tooth material, compared to the arch length, specific extraction of some teeth has to be done so that the rest of the teeth can be guided to a normal occlusion
Second basic principal for serial extraction
physiologic tooth movement
Human dentition shows a physiologic tendency to move towards an extraction space. But if we choose to remove some specific teeth, the rest of them which are in the eruption process, will be guided by the natural forces into extraction spaces
Indication for serial extraction
- premature loss of primary teeth
- arch length deficiency and tooth size discrepancy
- crowded maxillary and mandibular incisors
- class I malocclusion
Contraindications for serial extraction
- severe class II or CLass III
- cleft palate cases
- extensive caries of first permanent molar
Serial extraction methods
- Dewey method
- Tweed method
- Nance method
extraction of deciduous canines
followed by deciduous first molars an finally first premolars
Dewey method
extraction of deciduous first molar
followed by the first premolar then the deciduous canines and laterals
Tweed method
extraction of deciduous first molar,
followed by the first premolars then the deciduous canines
Nance method
