Space maintenance

Question 1

What are the indications for primary tooth extractions?

Answer 1

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

Question 2

What are the different types of pediatric posterior forceps? What are their advantages?

Answer 2

150S and 151S
More easily placed into a child’s mouth
Concealed by dentist’s hand
Adapts to the primary tooth

Question 3

Which instruments are contraindicated in pediatric extractions?

Answer 3

Cowhorns

Any instrument that could damage the permanent successor

Question 4

What is the technique for tissue reflection in pediatric patients?

Answer 4

Detach gingival tissue

Curette works well for primary teeth

Question 5

What is the technique for elevation in pediatric patients?

Answer 5

Gentle force
Use finger guard
Maintain hand rest
Support mandible
Support alveolus

Question 6

Why does aspiration occur and what are the clinical signs?

Answer 6

Poor visibility
Unexpected movements
Did not use gauze throat screen or poor head control
Signs:
Choking 
Coughing
Wheezing
Cyanosis

Question 7

What to expect when there is a root fracture?

Answer 7

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!

Question 8

What are some of the complications around damage to permanent tooth buds?

Answer 8

Permanent teeth may be damaged during extraction or extracted, immediately reimplant

Question 9

What are the key components of behavior guidance for extractions?

Answer 9

TSD
Distraction
N2O
Profound anesthesia
Head control
Prepare patient and parent for pressure of ext
Consider saving exts for last part of procedure

Question 10

What are the general principles for space maintenance?

Answer 10

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

Question 11

What are the factors to consider for space maintenance?

Answer 11

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

Question 12

Where do we typically not do space maintenance?

Answer 12

Anterior

Question 13

Where is universally indicated for space maintenance?

Answer 13

Posterior

Tooth distal can drift mesially and tooth mesial can drift distally

Question 14

Which anterior tooth lost prematurely leads to significant space problems?

Answer 14

Canines

Question 15

T/F

Premature loss in the primary dentition generally accelerates the eruption of the successor

Answer 15

F

Generally delays eruption

Question 16

What are some considerations for space maintenance in the primary dentition?

Answer 16

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?

Question 17

What are some considerations for space maintenance in the mixed dentition?

Answer 17

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

Question 18

Space maintenance is unnecessary when primary first molars are lost and which conditions are met?

Answer 18

Space loss negligible if permanent first molars are erupted and in occlusion and primary second molar remain

Question 19

What are the indications for band and looP?

Answer 19

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

Question 20

Contraindications for band and loop?

Answer 20

Edentulous space is more than 1 tooth

Question 21

Indications for LLHA?

Answer 21

Bilateral tooth loss after eruption of permanent incisor in mandible
Edentulous span more than 1 tooth in mandible

Question 22

Contraindications for LLHA?

Answer 22

Permanent incisors unerupted

Question 23

Indications for Nance and TPA?

Answer 23

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

Question 24

How to fabricate appliances?

Answer 24

Fit bands
Take alginate (quadrant impression easier to tolerate)
Fabricate in office or lab

Question 25

Distal shoe indications?

Answer 25

Loss of primary second molar before eruption of permanent first molar

Question 26

What are the adverse effects of appliances?

Answer 26

Dislodged/broken/lost
Plaque accumulation
Caries
Interference with successor eruption
Undesirable tooth movement
Inhibition of alveolar growth
Soft tissue impingement
Pain