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Space maintainers I Flashcards

1
Q

How does tooth loss change the balance in the arch? (2)

A
  • Changes in the spaces

* In very short time: weeks- 6 months

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2
Q

Tooth loss, the time that takes to lose space depends on…? (4)

A
  • Dental development
  • Phase of mixed dentition
  • The tooth that is lost
  • The moment of tooth loss
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3
Q

The effects of the premature tooth loss will vary depending on some factors such as: (6)

A 
• Tooth that has been lost
• Number of teeth lost
• Moment of the loss
• If the 1st permanent molar (1M) has already erupted or not
• If the 1M has intercuspidation or not
• Presence of habits
•Mesial force of the posterior teeth while they erupt
•Non-treated interproximal caries, fractures or premature
loss of the primary tooth
•Agenesis
•Ankylosis
•Ectopic eruption of 1M
•Dental malpositions
•Ostodental discrepancy
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4
Q

What are the causes of loss of space? (5)

A
  • Mesial force of the posterior teeth while they erupt
  • Non-treated interproximal caries, fractures or
    loss of primary tooth
  • Agenesis
  • Ankylosis
  • Ectopic eruption of the first permanent molars
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5
Q

Loss of space: mesial force of the posterior teeth while they erupt? (4)

A

•Mesial drift tendency
•Upper teeth> Lower teeth
•It happens when the tooth is lost, disappearing the
contact point
•The posterior tooth drifts towards the space, loosing
space and arch length

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6
Q

Loss of space: Non-treated interproximal caries, fractures or loss of primary tooth? (4)

A
  • Mostly lower canines and primary molars
  • There is a loss of mesio-distal diameter
  • The 1M migrates towards mesial
  • There is space loss
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7
Q

Loss of space: Agenesis? (5)

A

•Less frequent in primary dentition than in permanent dentition.
•The most frequent are the agenesis of: 2nd lower premolar, upper
lateral incisor, 2nd upper premolar, lower lateral incisor
•54% of the cases do not have occlusal alterations
•16% of the cases need an orthodontic treatment
•30% of the cases are resolved by doing extraction of the
primary tooth and closing the space

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8
Q

What is Ankylosis?

A

Anatomical fusion between the

alveolar bone and the dental cement

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9
Q

Loss of space: Ankylosis? (3)

A 
• It interrupts the tooth eruption
•The tooth looses contact with
adjacent and antagonistic teeth
•Clinic managment: Similar to
premature loss of primary teeth
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10
Q

Loss of space: Ectopic eruption of the first permanent molars? (2)

A
  • Atypical and premature reabsorption of the distal
    root of the second primary molar.
  • There is a mesial inclination of the permanent
    molar, producing space loss
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11
Q

Factors that reduce the space loss or the osteodental discrepancy? (7)

A 
There are physiological spaces in the primary dentition that
may buffer both:
•Anterior diastemas
•Eruption towards labial of the upper incisors
•Primate space
•Leeway space of Nance
     •0,9mm upper hemiarch
     •1,7mm lower hemiarch teeth
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12
Q

When a tooth is totally or partially lost it is necessary to…

A

preserve the space

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13
Q

The best way to maintain

the space is …?

A

to keep the primary molars until they exfoliate naturally

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14
Q

Space maintainers may recuperate…

A

the space that once existed, but will never create more space than once existed

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15
Q

We will discard the use of space maintainers in those situation where …

A

there is great osteodental

discrepancy as there will not be enough space even though we keep the space we have

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16
Q

We have to distinguish between the necessity of early treatment or wait for … (2)

A
  • The malocclusion to consolidate
  • Do not do unnecessary efforts when the solution to
    the problem is only partial
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17
Q

We will use space maintainers when the arch length is …

A

Enough for the permanent teeth to erupt but because of the factors already seen there has been a loss of length

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18
Q

Clinical study of space loss? (7)

A
  • Occlusal relationship
  • Phase of dentition
  • Tooth germ stage of development
  • Sectors where the tooth loss has happened
  • Arch affected
  • Amount of space lost
  • Osteodental discrepancy
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19
Q

Clinical study of space loss: Occlusal relationship - What happens when there is a loss of a 2nd primary molar? (2)

A
  • there will be an alteration of the occlusion on the side of the loss
  • Because of this we must evaluate the occlusion on the contralateral side and at the
    canine level.
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20
Q

Clinical study of space loss: Occlusal relationship - What happens with the upper 1st molar? (2)

A
  • will suffer a mesio-lingual rotation on its palatal root, becoming more prominent the distobuccal cusp
  • We determine the level of rotation drawing a line that goes from the DB to ML cusps
    of the molar. It should end distal to the canine.
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21
Q

Clinical study of space loss: Occlusal relationship - We will have recuperation of the space by…?

A

Desrotating the molars and making a distal movement

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22
Q

Clinical study of space loss: Phase of dentition? (3)

A

Mixed dentition or early permanent dentition.

Difficulties:
• Retention of the othodontic appliance
• Long time of retention

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23
Q

Clinical study of space loss: Tooth germ stage of development? (4)

A

•It will give us an idea of the time is going to take for the
permanent tooth to erupt
•The clinic emergency happens when 2/3 of the root has developed
•There will be a premature emergency if there has been a big bone
destruction
•1mm of bone covering the tooth —6 months to erupt

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24
Q

Clinical study of space loss: Sectors where the tooth loss has happened: Incisors? (2)

A
  • It does not produce space loss

- There are functional and esthetic problems

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25
Clinical study of space loss: Sectors where the tooth loss has happened: Canines? (2)
- Reduction of arch length caused by incisors and 1st premolar. - We will recuperate the space by vestibulazing the incisors
26
Clinical study of space loss: Sectors where the tooth loss has happened: Molars? (2)
- Reduction of arch length - The space will be recuperated by desrotating, straightening distalizating the 1M as long as the 2M has not erupted yet
27
Clinical study of space loss: Arch affected?
- Upper 1M: Desrotation or distalization | - Lower 1M: Straightening or distillation
28
Clinical study of space loss: Amount of space lost? (2)
• <2/3 of the space necessary for the permanent tooth to erupt: Distalazation, straightening or desrotation • >2/3 of the space necessary for the permanent tooth to erupt: Orthodontic treatment.
29
Clinical study of space loss: Osteodental discrepancy? (2)
- Space-Tooth size - Is it enough just by maintaining the space or do we have to create more space?
30
What is a space maintainer?
Series of appliances specifically designed to | preserve the space a tooth has left
31
Space maintainers must fullfil these conditions? (6)
1. Simple design 2. Easy to clean and maintain 3. They must let a normal bone development 4. Compatible with the oral tissues 5. Resistant 6. They admit little modifications
32
Contraindications in the use of space maintainers: (5)
- No bone covering the tooth that must erupt - The space > mesiodistal dimension required for the permanent tooth to erupt in correct alignment (Check-ups) - Great negative osteodental discrepancy (complex orthodontic treatment will be needed) - Agenesia of the permanent tooth and do not want to place an implant - Space has already been lost
33
Space maintainers are classified by? (3)
- Kind of space (interproximal or terminal) - Tooth lost - Necessity of additional functions
34
Space maintainers depending on kind of space ? (2)
Fixed | Removable
35
Space maintainers depending on tooth lost? (4)
- Incisors - Canines - Molars - Multiple losses
36
Space maintainers depending on necessity of additional functions? (2)
- Aesthetic | - Functional
37
Fixed space maintainers? (2)
Made of bands or crowns that are place in the adjacent teeth and a wire that covers the space left
38
Fixed space maintainers advantages? (2)
* They are used continuously | * They do not need the cooperation of the patient
39
Fixed space maintainers disadvantages?
Risk of caries
40
Fixed space maintainers indications? (5)
- Replace primary incisors, canines and molars - When it is indicated to place a preformed crown on the molar that we are going to use as a pillar - Non-collaborative patients -The eruption of the permanent tooth is not expected for a long period of time - Patients allergic to the acrylic
41
Fixed space maintainers types?
- Fixed in one side | - Fixed in both sides
42
Fixed space maintainer: fixed in one side? (3)
- Band and loop - Crown and loop - Distal shoe space maintainer (propiceptive)
43
Fixed space maintainer: fixed in both sides? (3)
- Transpalatal bar - Lower lingual arch - Nance appliance
44
Fixed space maintainer: fixed in one side: Band and loop BANDA ANSA - composed of?
Unilateral fixed space maintainer. It is composed of: •Band •Loop
45
Fixed space maintainer: fixed in one side: Band and loop BANDA ANSA - characteristics? (5)
- Made of 0,9 wire - U shaped, covering the space - It rests under the contact point of the adjacent tooth - It leaves free the alveolar process - It is welded to the band
46
Fixed space maintainer: fixed in one side: Crown and loop CORONA ANSA composed of? (2)
* Preformed metallic crown | * Loop
47
Fixed space maintainer: fixed in one side: Crown and loop CORONA ANSA characteristics? (5)
- Made of 0,9 wire - U shaped, covering the space - It rests under the contact point of the adjacent tooth - It leaves free the alveolar process - It is welded to the crown
48
Fixed space maintainer: fixed in one side: Propioceptive? (2)
• Based on the stimulation of the ligament periodontal (proprioceptive receptors) to guide to the germ of the first permanent molar in its free eruption. • Consists of a band adapted to the first temporary molar and a wire loop that exercises pressure on the mucosa. The pressure is applied to 1 mm deep.
49
Unilateral fixed space maintainer advantages? (4)
- Does not require the patients collaboration - Easy to do and cheap - Good resistance - It permits good hygiene
50
Unilateral fixed space maintainer disadvantages? (2)
- It does not avoid the extrusion | - It does not reestablish the mastication
51
Unilateral fixed space maintainer can be changed by? (2)
-Lingual arch when lower incisors and 6 erupt - Transpalatal arch when upper 6 erupt
52
Fixed space maintainer: fixed in both sides - Lower lingual arch?
Bilateral fixed space maintainer
53
Fixed space maintainer: fixed in both sides - Lower lingual arch composed of? (2)
* Two bands on 36 and 46 | * Arch
54
Fixed space maintainer: fixed in both sides - Lower lingual arch characteristics? (4)
- Made of 0,9 wire - Goes over the lingua surface of the teeth - It rests on the incisors cingulum - It is welded to the bands
55
Fixed space maintainer: fixed in both sides - transpalatal bar composition? (2)
* Two bands on 16 and 26 | * Arch
56
Fixed space maintainer: fixed in both sides - transpalatal bar characteristics? (4)
- Made of 0,9 wire - Goes over the palate - It has a central omega orientated towards distal - It is welded to the bands
57
Fixed space maintainer: fixed in both sides - Nance composition? (2)
* Two bands on 16 and 26 | * Arch
58
Fixed space maintainer: fixed in both sides - Nance characterisitcs? (3)
- Made of 0,9 wire - Goes over the palate - Acrylic button against the palatal mucosa
59
Bilateral fixed space maintainer advantages? (4)
- Does not require the patients collaboration - Easy to do and cheap - Good resistance - It permits good hygiene
60
Bilateral fixed space maintainer disadvantages? (2)
- It does not avoid the extrusion | - It does not reestablish the mastication
61
Fixed space maintainers every appliance must be removed one a year to... (4)?
* Clean the tooth * Inspect for caries * Apply fluor *then we recement it
62
What is a removable space maintainer? (2)
- Appliances made of acrylic and wire arches that give retention. - Screws and resorts may be added when we are trying to recuperate space
63
Removable space maintainer limitations? (3)
- They are used when the patient wants - They may break - They may be lost
64
Removable space maintainers | Indications? (10)
- To replace primary incisors and molars - When mastication needs to be reestablished - aesthetics - Patients that will come to follow-ups - Collaborative patients - Patients with high risk of caries - Easy to do and cheap - Easy to clean - It gives back mastication and esthetics - It avoids the extrusion of the antagonistic
65
Removable space maintainers inconveniences?
It depends of the patients collaboration
66
Removable space maintainer types? (2)
- Active | - Passive
67
Active removable space maintainers? (2)
‣ Recuperation of space | ‣ Placement of active elements
68
Passive removable space maintainers? (2)
‣ Replacement of anterior teeth ‣ Proprioceptive space maintainer
69
Considerations to take in to account when choosing the space maintainer (6)
1. It may be uni or bilateral 2.Space we must maintain 3.Presence of treatments on the arch that may be future extractions 4.Eruption of the permanent molars 5.Integrity of the pillar 6.Eruptive sequence (Make panoramic X-ray)
70
Space maintainer technique: everytime it is possible, we take the measurement of...
the space maintainer before doing the extraction
71
Space maintainer technique? (3)
1. Adapt the band or crown 2. Take measures with alginate 3. Fill the laboratory sheet
72
Space maintainer technique: extraction/cementation? (2)
- The day of the extraction and cementation of the space maintainer, cement first the maintainer it it is possible. - In band and loop and crown and loop first do the extraction
73
Follow ups with space maintainers are important because? (4)
``` •Space maintainers may need adjustments •We must extreme the vigilance of the eruption sequence •The maintainer may break •The maintainer may have to be removed ```
74
Recommendations for space maintainers? (5)
* Have good oral hygiene * Have good hygiene of the maintainer * Good collaboration from the patient * Go to the clinic if there is any problem * Go to the follow ups
75
Complications for space maintainers? (5)
* Impactation of the maintainer * Interference with the permanent tooth eruption * Maladjustment of the appliance * Occlusal interference * Break of the maintainer
76
Removal of space maintainer? (3)
1. Crown and loop and band and loop: When the tooth achieves the maximum mesio-distal diameter 2. Bilateral space maintainers: Once the tooth has erupted completely 3. Removable space maintainers: The acrylic is removed as the different teeth start erupting.

Peds II (11 decks)

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