Space management for children teeth l Pediatric dentistry MCQs

Space management for children teeth l Pediatric dentistry & dentistry for children

MCQs for dental students

 

Preventive procedures in pediatric dentistry

• Preventive procedure are the treatment modalities which are instituted in the anticipation of a problem which may likely to develop if the given preventive procedure are not instituted well on time.

 

The basic preventive procedure in pediatric dentistry include:

1. Space maintenance.
2. Pit and fissure sealant.
3. Management of high frenal attachment.
4. Infant oral health care.
5. Bottle weaning.
6. Management of developing crossbite.
7. Extraction of supemumery teeth in the developing dentition
8. Management of ankylosis
9. Removal of occlusal prematurities .
10. Management of ectopic eruption discovered in radiograph
11. Correction of abnormal musculature

 

Space management:

• Refers to all those procedure which are carried out in order to diagnose and prevent or intercept the irregularities in the developing dentition as a result of premature loss of the primary teeth so that a normal development of dentition and occlusion can take place.

1. Space management has three component which include space maintenance, space regainment and space supervision.
2. Space maintenance refers to the maintenance of the mesiodistal width of the space created due to premature loss of the primary teeth so as to prevent any space loss and the subsequent complication of the space loss.

 

Premature loss of primary teeth

• especially primary molar results in rapid loss of the space due to drifting of the adjacent teeth into the space.

 Consequences of the space loss

1. Drifting of the adjacent teeth into the space.
2. Loss of arch length.
3. Extrusion of the opponent teeth.
4. Crowding in the anterior region.
5. Ectopic eruption of the permanent teeth.
6. Impaction or awkward eruption of the succdaneous teeth.
7. Mesial migration of posterior teeth.
8. Abnormal development of permanent dentition and occlusion.
9. Midline shift.
10. Compromised health of periodontal tissue.
11. Increased risk of caries.
12. Increased risk of development of parafunctional habit and subsequent sequel.
13. Speech alteration.
14. TMJ problem may emanate.
15. Compromised aesthetics.
16. Decreased chewing efficiency.

 

The factors which can Speed the rate of loss of space after premature fall of the primary teeth

1. Presence of abnormal musculature.
2. Presence of Para functional oral habits
3. Any existing malocclusion
4. Stage and sequence of eruption of dentition.

 

 The factors which should be considered before planning for the process of space maintenance

 

1. The time elapsed since the loss of the teeth:

• This is an important factor as the space loss occurs rapidly after the loss of tooth and maximum space loss is seen in first 6 month. Space maintaining device should be planned immediately after the loss of tooth.

 

2. Dental age of the patient:

• Developmental age of the patient is more important in predicting the eruption status of a given tooth. A tooth erupt into the oral cavity (occlusal level) when 3/4 of its root is completed. An evaluation of amount of root formed in the radiograph is an important parameter to predict the timing of eruption of the tooth.
• Loss of a primary molar much early can substantially delay the eruption of the succedaneums teeth. The primary tooth loss near the age of exfoliation or after 7 year of age result in less delay ( approximately 6 month as compared to delay of one year if the same tooth fall before the age of 7 year ).

 

3.  The bone covering the developing permanent tooth :

• The amount of bone covering over the developing permanent tooth bud is another reliable predictor of emergence of the given tooth. Presence of thick bone over the permanent tooth can substantially delay the eruption of that tooth. It has been estimated that erupting premolar may take 4-5 month to traverse 1 mm of the overlying bone. The absence of overlying bone due its destruction as a result of infection can results in early emergence of the teeth.

 

4. Sequence of eruption of the adjoining teeth:

• The sequence of eruption of the adjoining teeth has a profound influence on the speed and rate of space loss. This can be exemplified from a case where there is premature loss of primary second molar and the permanent second molar is ahead of its eruption from the second premolar. In this case, the actively erupting second molar will pressurizes the drift of permanent first molar into the extraction space and increases the rate and amount of space loss. The sequence of eruption of the adjoining teeth, thus should be evaluated radio graphically, in order to plane the required preventive measures.

 

5. Delayed eruption of the teeth:

• If the permanent tooth is delayed in eruption, space maintenance should be planned till the time tooth erupt . If the primary tooth is retained, it should be extracted to facilitate the eruption of the tooth and a space maintaining device should be inserted till the time tooth erupt. Surgical exposure or orthodontic measure or both should also be considered in such cases.

 

6. Congenital absence of the permanent teeth:

• Under these circumstances, the space should be maintained till the time a fixed prosthesis can be planned

 

Classification of space maintainer

 

Fixed, semifixed and removable

• A fixed space maintainer is ideally banded on the both side of an extraction space. E.g., Band and bar, lingual arch, nance holding arch, transpalatal arch.

• Semifixed space maintainer: Space maintainer which are banded only on one tooth. The closed loop may or may not be in contact with the adjacent teeth. E.g. Distal shoe space maintainer, Band/ crown and loop space maintainer.

• Removable space maintainer are the space maintainer which can be removed from and reinserted onto the given arch by the patient himself. E.g. Partial denture.

 

Active and passive

• Active space maintainer are those which put pressure on the tooth . Space regainer are the active space maintainer.

• Passive space maintainers are space maintainer which do not put any undue force on the abutment or adjacent tooth and are passively banded.

• Functional space maintainer is space maintainer which incorporates pontic or teeth in order to serve the function of mastication and esthetic.

• Non functional space maintainer function only to maintain the space and do not have any other function.

 

Fixed and semifixed space maintainer

1. Band and loop space maintainer
2. Band and bar space maintainer
3. Crown and loop space maintainer
4. Distal shoe space maintainer
5. Lingual arch space maintainer
6. Transpalatal arch space maintainer
7. Nance arch space maintainer

 

Advantages of fixed, semifixed space maintainer :

1. Bands and crowns are used which require minimum or no tooth preparation.
2. They do not interfere with passive eruption of abutment teeth.
3. law growth is not hampered.
4. The Succedaneous permanent teeth are free to erupt into the oral cavity.
5. They can be used in uncooperative patients. Masticatory functions is restored if pontics are placed.

 

Disadvantage of fixed, semifixed space maintainer :

1. Elaborate instrumentation with expert skill is needed.
2. They may result in decalcification of tooth material under the bands.
3. Supra eruption of opposing teeth can take place if pontics are not used.
4. If pontics are used it can interfere with vertical eruption of the abutment tooth and may prevent eruption of replacing permanent teeth if patient fails to report.

Removable space maintainers 

1. Acrylic partial dentures.
2. Full or complete dentures.
3. Removable distal shoe space maintainer.

Advantage of removable space maintainer :

1. Easy to clean and permit maintenance of proper oral hygiene.
2. Maintain or restore the vertical dimension.
3. Can be worn part time allowing circulation of the blood to the soft tissues.
4. Room can be made for permanent teeth to erupt without changing the appliance.
5. Stimulate eruption of permanent teeth.
6. Help in preventing development of tongue thrust habit into the extraction space.

 

Disadvantage of removable space maintainer :

1. May be lost or broken by the patient.
2. Uncooperative patients may not wear the appliance.
3. Lateral jaw growth may be restricted, if Clasps are incorporated.
4. May cause irritation of the underlying soft tissues.

 

Indication of removable space maintainer :

1. When aesthetics is of importance.
2. In case the abutment teeth cannot support a fixed appliance.
3. In cleft palate patients who require obturation of the palatal defect.
4. In case file radiograph reveals (that the unerupted permanent tooth is not going to erupt in less than five months time.
5. If the permanent teeth have not fully erupted it may be difficult to adapt bands.
6. Multiple loss of deciduous teeth which may require functional replacement in the form of either partial or complete dentures.

 

Contraindications of removable space maintainer :

1. Lack of patient cooperation.
2. Patients who are allergic to acrylic material.
3. Epileptic patients.

 N.B :

• Unilateral fixed space maintainer :Band and loop Crown and loop and Distal shoe.
• Bilateral fixed space maintainer :Lower lingual holding arch, Transpalatal arch and Nance appliance.

Space maintainer and their indication

Band and Loop Space Maintainer is indicated in:

1. Unilateral loss of first primary molar.
2. Unilateral loss of primary second molar after the eruption of first permanent molar.
3. Bilateral loss of primary molar before the eruption of permanent incisors.

Crown and Loop Space Maintainer:  

• are indicated instead of band and loop space maintainer if the abutment tooth is highly mutilated or is endodontically treated.

1. Distal shoe (intra-alveolar space maintainer) is indicated for the single loss of second primary molar prior to eruption of the first permanent molar. It is also known as Roche’s appliance.
2. Lingual arch is indicated for the multiple loss of primary molar in the lower arch.

Nance holding arch :

• space maintainer with acrylic button step on palate is indicated for the multiple loss of primary molar in the upper arch.

Transpalatal arch :

• is indicated for premature loss of multiple molar in only one side of the upper arch with other side being totally intact.