Management of Space Maintenance Problem in Children

Management of Space Maintenance Problem in Children

B. Space maintenance for the second primary molar area: The loss of second primary molar usually has little effect on teeth in the anterior segment. However, the irregularity will develop in the permanent molar relationship. The end result of premature loss of the second molar is the mesial drifting of the first permanent molar with an impaction of the second premolar.

1. Space maintenance for the second primary molar area after the eruption of the first permanent molar: The same as that recommended when the first primary molar is lost, i.e. band and loop or stainless steel crown and loop.
2. Space maintenance for the second primary molar area before eruption of the first permanent molar: Mesial movement and migration of the first permanent molar will often occur prior to eruption in case of premature loss second primary molar. So a space maintainer that will guide first permanent molar into its normal position is indicated such as crown or band maintainer with distal shoe extension. first primary molar is used as the abutment tooth.
C. Space maintenance for the primary canine area: loss of primary canine occurs before the eruption of the permanent lateral incisor shift of the midline and space closure. If it is lost and there has been no shift in midline or space closure a band or crown and loop maintainer can be used. first primary molar is used as abutment tooth.

D. Space maintenance for the first primary incisors area: If spacing between anterior teeth is present, little possibility that drifting adjacent teeth will occur with resultant loss of space needed for eruption of the permanent teeth. However, if the anterior primary teeth were in contact before the loss or if there is evidence of an arch length inadequacy in the anterior region, a collapse of the arch following loss primary incisors is almost certain. In some patients, even t primary canines drifted mesially out of their normal relationship.

Advantages: 1) Maintain vertical dimension and prevents over eruption of opposing teeth. 2) Restore masticatory function . 3) Restore esthetic in case of anterior tooth loss.
Disadvantages: 1) Often lost or broken. 2) Patient compliance and cooperation essential. 3) Require supervision to assure compliance as well as adjust to changing conditions.
• Cervical clasps adapted to first permanent molars in retention appliance. Finger springs contoured to teeth repositioned. wire placed as far cervically. Finger springs adjusted each 2-3 weeks. • A temporary tooth replacement to improve child's appearance. After the space regained, a new partial denture constructed to serve until time a fixed replacement considered.
• loss of anterior tooth occurs before eruption adjacent tooth maxillary permanent central incisor lost prior eruption lateral incisors, the lateral will drift mesially during its eruption. addition of an acrylic extension into alveolus in guiding the unerupted tooth into position.
F. Space maintenance for area of multiple loss of the teeth: 1. Acrylic partial denture: Indicated when there has been bilateral loss of more than a single tooth it can be easily adjusted to allow for the eruption of teeth. As artificial teeth are included in the denture, it restores normal masticatory function. However, from disadvantages, easily broken from a child.
• If appliance is removed from mouth even for few days, changes denture base and drifting of teeth make it impossible for the child to replace appliance unless extensive adjustment by dentist. Passive lingual arch • child in need of corrective treatment other than infirst permanent molar area? space be maintained for fixed bridge work? Or should second molar be moved forward bodily into area formerly first molar? Classification according to activity: Active. Passive. 크라운 브리지 치아
Classification according to retention means: Fixed. Semifixed. Removable.
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Maintenance deciduous teeth till the correct time that need to extraction