Space maintenance Flashcards
What are the indications for primary tooth extractions?
Non-restorable tooth Irreversible pulpitis/pulp necrosis --with internal/external resorption --or non-strategic tooth Acute abscess or cellulitis Aggressive periodontitis Orthodontic reasons --interference with eruption --serial extractions --unilateral loss of primary canine --ectopic eruption of permanent maxillary canine Submerged/ankylosed teeth Dental trauma
What are the different types of pediatric posterior forceps? What are their advantages?
150S and 151S
More easily placed into a child’s mouth
Concealed by dentist’s hand
Adapts to the primary tooth
Which instruments are contraindicated in pediatric extractions?
Cowhorns
Any instrument that could damage the permanent successor
What is the technique for tissue reflection in pediatric patients?
Detach gingival tissue
Curette works well for primary teeth
What is the technique for elevation in pediatric patients?
Gentle force Use finger guard Maintain hand rest Support mandible Support alveolus
Why does aspiration occur and what are the clinical signs?
Poor visibility Unexpected movements Did not use gauze throat screen or poor head control Signs: Choking Coughing Wheezing Cyanosis
What to expect when there is a root fracture?
Aggressive retrieval can damage permanent tooth
If visible and easily mobile, take it out, if not, leave it to resorb
Typically resorbs but make sure that you notify parent!
What are some of the complications around damage to permanent tooth buds?
Permanent teeth may be damaged during extraction or extracted, immediately reimplant
What are the key components of behavior guidance for extractions?
TSD
Distraction
N2O
Profound anesthesia
Head control
Prepare patient and parent for pressure of ext
Consider saving exts for last part of procedure
What are the general principles for space maintenance?
Premature loss of primary teeth = loss of arch length (sometimes)
Prevent caries or restore early so you don’t have to ext
natural tooth is always the best space maintainer
What are the factors to consider for space maintenance?
Specific tooth lost Time elapsed since tooth lost Pre-existing occlusion Favorable space analysis Presence and root development of permanent sucessor Amt of alveolar bone covering the permanent tooth successor Patient health status Patient cooperative ability Active oral habits Oral hygiene
Where do we typically not do space maintenance?
Anterior
Where is universally indicated for space maintenance?
Posterior
Tooth distal can drift mesially and tooth mesial can drift distally
Which anterior tooth lost prematurely leads to significant space problems?
Canines
T/F
Premature loss in the primary dentition generally accelerates the eruption of the successor
F
Generally delays eruption
What are some considerations for space maintenance in the primary dentition?
Appliances must be monitored, adjusted, potentially replaced for longer period
Abutments may exfoliate or interferre with eruption of adjacent teeth
Increased risk of decalcification/decay?
Doing more harm than good?
What are some considerations for space maintenance in the mixed dentition?
Time since primary tooth lost
Acceleration of successor if root is 2/3 developed
How much alveolar bone over successor? 6mo for each mm
Most space lost occurs within 6 mo
Don’t maintain inadequate space!
Congenitally missing successors
–maintain space for future fixed/implant
–let space close
How much crowding present?
–Adequate space and minor crowding should be maintained
–If crowded already, get ortho consult
Space maintenance is unnecessary when primary first molars are lost and which conditions are met?
Space loss negligible if permanent first molars are erupted and in occlusion and primary second molar remain
What are the indications for band and looP?
unilateral loss of primary first molar before eruption of permanent first molar, or unilateral loss of primary second molar after eruptions of permanent first molar
bilateral loss of primary molar before eruption of permanent incisors
Contraindications for band and loop?
Edentulous space is more than 1 tooth
Indications for LLHA?
Bilateral tooth loss after eruption of permanent incisor in mandible
Edentulous span more than 1 tooth in mandible
Contraindications for LLHA?
Permanent incisors unerupted
Indications for Nance and TPA?
Bilateral tooth loss in maxilla
Edentulous span more than one tooth in maxilla
Don’t have to wait for permanent incisors
TPA may be cleaner, may also allow for tooth movement
How to fabricate appliances?
Fit bands
Take alginate (quadrant impression easier to tolerate)
Fabricate in office or lab
Distal shoe indications?
Loss of primary second molar before eruption of permanent first molar
What are the adverse effects of appliances?
Dislodged/broken/lost Plaque accumulation Caries Interference with successor eruption Undesirable tooth movement Inhibition of alveolar growth Soft tissue impingement Pain
