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
Distal Shoe 1. Before \_\_\_\_’s erupt-Ideal for guiding unerupted permanent teeth 2. \_\_\_\_ appliance 3. \_\_\_\_/ Mandible 4. \_\_\_\_ 5. Distal spur ‘digs’ subgingivally 6. Will \_\_\_\_ with normal eruption. Requires timely \_\_\_\_
- BOARDS like to know that you know this situation: Child is younger (before age 6 before eruption of 6 year molar). However there is loss of second primary molar. So 6 year molar behind that tooth hasn’t erupted in yet and band and loop can’t be used because you don’t know where the 6 year molar will go and you don’t want the 6 year molar to erupt mesially and cover over place where the adult premolar needs to come in.
- Distal shoe is fixed device and placed on primary ____.
- There’s a loop that is soldered and spans distance of primary ____. At the distal end of the loop there’s a spur that digs under the gum ____. What this will do is that the spur will dig under the gum and prevent the 6 year molar from drifting mesially to help guide it into the right spot.
- After child is old enough and the 6 year molars have erupted in, the distal shoe is taken off and replaced by a band and loop appliance
6 fixed maxilla unilateral interfere removal
first molar
second molar
subgingivally
Beware!
Band and loop subgingival distal shoe
Here’s an x-ray demonstrating the distal shoe. You have to take an x-ray to see the 6-year molar and make sure that the ____ pin isn’t going to occlude the 6-year molar and that it’s mesial to the tooth it’s inserted near. The correct orientation of the pin is ____ to the tooth.
subgingival
mesial
Space gaining- ACTIVE APPLIACES
Definition:
Restoration of lost space or creating needed space
Space regaining- restoration of lost ____ by relocating permanent teeth that have drifted
vs. Space creating -creating space due to slight ____ due to arch size/tooth size discrepancy, but no ____ occurred
- Goals: Increasing ____
- by ____ permanent molars
- by ____ movement of incisors
- or by ____ arch expansion
arch length crowding space loss arch circumference distalizing labial lateral
Space gaining •Factors to consider for Tx: •1. Position of \_\_\_\_ •2. \_\_\_\_ for proclining incisors? (Patient profile, periodontal status, severity of crowding) •3. Is the maxilla \_\_\_\_?
- You want to consider the position of the bottom molars before you start moving the top molars. Lower molars are harder to move because of the ____. Maxillary molars are much easier to move.
- You want to look at whether or not you want to procline the incisors.
- Take a look at the patient’s face. You want to look at the patient’s gums (____).
- The other thing to look at is if the maxilla is constricted. If it is you’ll have room to expand a little bit. Consider the patient in the back, side-to-side, and front to back.
lower molars contraindications constricted bone quality periodontal status
Space gaining appliances
Selection:
Patient’s age
How many and which primary teeth are missing
Extrusion risk of opposite teeth
Necessity of replacing masticatory surfaces of missing teeth
Space gaining appliances come in the same 3 flavors (Fixed, Removable, Semi-removable). And selection may depend on the same ____
factors
Space gaining appliances
Design
- ____: minimize unwanted/reciprocal movements
- ____: correct amount & direction of force application
- ____: avoid complex movement specially with removable
appliances. Want movements to be predictable. - Occlusal ____ should be eliminated
The same considerations are here for design. The only different point is #2 (____ instead of passivity). You’re goal is to use the amount of force and application of the force to create ____ rather than passive appliance which is used to ____ space.
anchorage activity simplicity interferences activity space hold
Headgear 1. \_\_\_\_ 2. \_\_\_\_ appliance a. Neck strap b. Face Bow c. Bands on U6’s 3. \_\_\_\_ 4. \_\_\_\_ molars 5. Heavily dependent on patient \_\_\_\_
The first example she gave to hold space was the nance.
• Let’s say we’ve already lost the space by premature loss of the second primary molars, so the 6 year molars drifted ____. This device (headgear) works like a charm but no one wants to wear it (for obvious reasons).
• This device is used in the maxilla, it’s typically not used in the mandible. It contains a neck strap, face bow, and bands on the upper 6 year molars.
• It’s used to treat a patient bilaterally and it’s primary job is to distalize the molars back.
• The neck strap has a ____-loaded device you hook the facebow to in order to pull the 6 year molars back.
• This device works GRRRREAT. What sucks is that it heavily depend on patient compliance
maxilla removable bilateral distalizes compliance forward spring
Distal Jet 1. \_\_\_\_ 2. \_\_\_\_ appliance a. Acrylic Palatal Button b. Bands on U4’s c. Screw/Spring rod d. Bands on U6’s upper 3. \_\_\_\_/ Unilateral 4. \_\_\_\_ molars 5. Dependent on Practitioner to activate with wrench
- It’s used in the maxilla, it’s fixed. Headgear is semi-removable. Distal Jet consists of something like a nance but you’re going to put them off of the upper first premolars or the upper first primary molars.
- The teeth are banded, there’s an ____ on the roof of the mouth that’s the main anchor unit. It consists of a screw or ____ in the back which are attached to bands around the 6 year molars.
- The way it works is that the premolar to premolar and acrylic button works as the anchor and the spring loaded device attached to it is what it pushes off of.
- Basically springs off of the 6 year molars are pushing off of the anchoring unit and that’s how we regain the space
- This is bilateral or unilateral.
- Every time you’re activating it you’re compressing the spring and tightening it with a ____ nut. You don’t have to activate both springs if the situation is only ____.
- It’s not patient or parent dependent since you’re the one who keeps the wrench in the patient’s chart. You’re the one that tightens it and the device is ____ in the patient’s mouth
maxilla fixed bilateral distalizes acrylic button spring rod lug one-sided cemented
Haas Rapid Palatal Expander
- ____
- ____ appliance
a. Bands on ____’s & ____’s
b. 2 Acrylic Halves
c. Jackscrew - ____
- Expands Dental/Skeletal ____
- Dependent on ____ compliance
- Bands on upper bicuspids and upper 6 year molars, 2 acrylic halves and a jackscrew. The Hyrex expander, similar alternative, doesn’t have the ____.
- Works bilaterally since you can’t expand one half of the palate without the other
- There’s a growth suture that runs along the roof of the mouth. Before age ____ in girls the suture hasn’t fully fused yet.
- Expander works by partially ____ out teeth and stretching the growth suture out to create more width
- The ____ you are wit an expander, the more skeletal expansion you’ll get. The older you get the less skeletal expansion you’ll have and it’s mostly dental ____ you’ll get
- The best expansion age is around ____
- Parental compliance is needed
maxilla fied U4 U6 bilateral laterally parental acrylic 13/14 tipping younger tipping 8-10
Lip Bumper
- ____
- ____ appliance
a. Bands____’s
b. Lip Bumper - ____
- ____ molars, allows for ____ of incisors, and ____development
• Remember she mentioned there’s no growth suture on the bottom…so expander there doesn’t really work. Lip Bumper is an option
• Consists of 2 bands cemented on the ____ molars and there’s a removable bow that sits around the bottom arch. It’s tucked inside the ____ and cheeks.
• Orthodontist can take it out to adjust it as necessary for the patient. Patient shouldn’t take it out
• Uses the patient’s ____ to drive back the molars
• Pulls patients lower lips and cheeks away from the teeth to allow the natural
development of the bottom arch to allow some ____ and lateral development
• She mentions this point but says it won’t be on the test…Drawback: later on there’s
difficulty with eruption of the ____ year molars because you’re driving the 6 year molars back. Keep the patient in braces a little longer to draw out the 12 year molars better
mandible semiremovable L6 bilateral distalizes proclination lateral
6 year lower lip natural lip pressure proclination 12
