Space Maintenance Flashcards
Orthodontic Treatment
I. Early/ Initial Phase Orthodontic Treatment
Treatment designed to prevent ____ with normally developing occlusion and correct problems in developing occlusion
Early Tx should reduce the severity of ____ and may ____ it.
II. Later Phase Orthodontic Treatment
May be required to completely ____ the malocclusion after ____ teeth have erupted.
Ortho treatment is categorized into two major phases of treatment. The Early/Initial phase is really ages ____ where there are still a fair amount of baby teeth and some adult teeth. The later phase of treatment (Phase 2) is the ____ years where primarily adult teeth are mainly present. Early treatment doesn’t necessarily eliminate need for Phase 2 treatment in pre-teen/teen years but it does make the lives of orthodontists easier.
interferences
malocclusion
eliminate
correct
permanent
7-10
teen/pre-teen
Early Treatment Dental Indications
- Lack of ____
- Loss of space
- Premature ____
- Maleruption/Impactions
- ____/Malalignment
- Traumatic Occlusion
space
exfoliation
malposition
Causes of Space Loss
• Premature loss of ____ teeth
• Unrestored ____ carious lesions
• Loss of permanent ____ as a result of trauma
• ____ missing teeth
• Dental malformation resulting in small teeth such as ____ incisors
Crowding
Ectopic eruptions
Impactions
Arch asymmetries
- The culprit for space loss is teeth that are ____. Primarily it’s the neighboring adult teeth that are drifting.
- Unrestored proximal lesions - The ____ of the tooth is being lost due to decay and the baby tooth (which is a place holder for adult teeth), it is losing it’s width and ability to hold place for adult teeth that need to come in.
- Dental malformation resulting in ____ teeth - This will be a less effective place holder or space maintainer of the neighboring teeth for the adult tooth underneath it.
primary proximal incisors congenitally peg laterals
drifting
width
smaller
Generalizations Re: Space Loss
• The longer time without primary tooth/space holder, the ____ the space loss
• Most often space loss occurs after the early loss of primary ____, Mx>Mn
• Rate of space loss is ____ > Mn
• Direction of drift is
• ____ for teeth Distal to loss site
• ____ for teeth Mesial to loss site
• We lose space faster in the maxilla than the mandible and it’s usually due to ____. In the maxilla it’s spongy and in the mandible has more ____ bone. Teeth don’t drift as quickly in the mandible compared to the maxilla.
•
• A kid with loss of primary molar in the maxilla needs a space maintainer if there isn’t an adult tooth coming in soon to replace it.
greater second molars maxilla mesial distal
bone quality
lamellar
Arch Asymmetries
If we lose a tooth early, overall drifting can happen fairly easily Top Left: The front teeth are drifting into space where primary tooth was lost. Patient will look \_\_\_\_ since teeth are shifting .
asymmetric
Impaction
Impaction is a term for a tooth that won’t ____. The tooth in the red box is impacted. Canine is still very far from the surface to erupt.
erupt
Space maintenance- PASSIVE APPLIANCES •Definition: \_\_\_\_ of spaces left by primary incisors, primary canines, primary molars, and some times the primate spaces •Goals: •Avoid future \_\_\_\_ •Allow for \_\_\_\_ eruption pattern
•Factors to consider for Tx:
•1. Potential ____ in the arch or arches.
2. ____ of emergence of the permanent teeth
preservation crowding normal eruption space loss timing
Factors in Tx
- Consider Potential for space loss in the arch or arches:
____ of permanent teeth adjacent to the edentulous side
Permanent teeth are a lot less set in their ways in ____ people. The adult 6 year molar is more prone to movement than their neighboring teeth. Additionally, ____ teeth are less set in their ways because they’re anchored by the teeth underneath. Adult dentition is new to the mouth and still erupting and they’re taking their cues from the surrounding ____.
A common site for a missing tooth in the back due to decay is the second ____. In the front, primary canines commonly are missing/lost early due to ____ and getting pushed out. The lower adult incisors drift into that spot
position
younger
baby
environment
primary molar
crowding
Factors in Tx
- Timing of emergence of the permanent teeth
Where are they in development?
Know the eruption sequence and dental age of your patient.
Clues: a. radiographic root formation (____ root formation -> eruption)
b. amount of ____
1/2 to 3/4
overlying bone
Space maintaining appliances
FIXED
REMOVABLE
SEMIREMOVABLE
These are the 3 flavors of space maintaining appliances. ____ is cemented/can’t be taken out. ____ is hybrid which ortho can take out periodically to adjust. It has components similar to a fixed device.
Selection:
Patient’s ____
How many and which primary ____ are missing
Extrusion ____ of opposite teeth
Necessity of replacing ____ surfaces of missing teeth
fixed semiremovable age teeth risk masticatory
Space maintaining appliances
- ____: abutment teeth must support occlusal pressure
- ____: avoid causing movement of the abutment teeth
- ____: allow easy manipulation
- ____: erupting permanent tooth, the occlusion, etc
- We have to carefully choose the teeth meant to serve as abutments/anchors
- Want to avoid causing movement on abutments. Want to ____ space, not create space
- Simplicity for sanity of you and the patient
- Device may perform too well and subject erupting teeth to interference
anchorage passivity simplicity interferences hold
Examples
- ____
- crown and loop
- ____
- palatal holding arch
- ____
- nance holding arch
- ____
- crown and bar with occlusal surface
- bar incorporated in amalgam restoration
band and bar
band and loop
lingual holding arch
crown and bar
Nance Holding Arch
- ____
- ____ appliance
a. Band U6’s
b. Acrylic Button - ____
- Will not interfere with normal ____
- Holds ____’s from drifting mesialy when U E’s are prematurely lost
Nance Holding Arch: Commonly used in preteen but can be used as space holding appliance for smaller child. In maxilla, common scenario is loss of primary second molars.
• NOT ____ until ortho wants it out
• Consists of bands on 6-year molars and an acrylic button that sits on the roof of the mouth. The button is what the molars rest against so they don’t drift ____ (mesially). The roof of the mouth is being used as the ____ device.
• It’s nice to use for a bilateral situation so ____ separate devices don’t have to be made (one time lab fee).
• Won’t interrupt normal eruption. Doesn’t have to be monitored as closely compared to other devices.
maxilla fixed bilateral eruption U6 removed forward abutment two
Lower Lingual Holding Arch 1. \_\_\_\_ 2. \_\_\_\_ appliance 3. \_\_\_\_ 4. Will not interfere with normal \_\_\_\_
• Similar scenario but on bottom arch
Would make it uncomfortable
• Device contouring of the teeth in the front.
• Fixed, bilateral, won’t interfere with normal
eruption
• Front teeth are being used as ____ to hold back 6 year molars from drifting.
mandible fixed bilateral eruption abutments
Band and Loop 1. \_\_\_\_ appliance 2. \_\_\_\_/ Mandible 3. \_\_\_\_ 4. Will \_\_\_\_ with normal eruption. Requires \_\_\_\_ removal
Situation unilaterally (in just one arch) in either just the maxilla or mandible where baby tooth is prematurely being lost, we have this fixed appliance.
• Consists of band around ____ or primary molar and a wired loop that is soldered over the span where we’re trying to save ____
• Band will touch tooth on the other side and is banded to the tooth that’s on the other side. It’s a wired bridge essentially.
• USED IN UNILATERAL SITUATION (losing tooth on one side)
• WILL INTERFERE with eruption of adult teeth
• See patient every ____ months and take x-ray as adult tooth is beginning to erupt. Once that happens device has to come out.
fixed maxilla unilateral interfere timely molar space 6
