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Prepared by: Dr Seyed Ebrahim Jabbarifar Associate professor University of Isfahan Department of Pediatric Dentistry2009
Appropriate Radiographs
Succedaneous tooth? Time to Eruption?
Patient/Family Compliance
Distal Shoe
MAXILLARY or MANDIBULAR Used when second primary molar requires extraction and first permanent molar has not erupted
Distal Shoe
Should be evaluated with radiograph prior to cementation
Length Position
Will be replaced with another space maintainer when permanent teeth erupt.
Distal Shoe
Example of use in partial eruption case.
Nance Appliance
Nance Appliance
Cross Palatal Bracing prevents rotation #3 and #14 around palatal root- this starts mesial migration of #3 and #14 Acrylic Button provides additional stop
Disadvantage
Lack of anterior stop = possible tooth shift (?)
MANDIBULAR ONLY Bands on first permanent molars Anterior Stop = Cinguli of #23-#26
Mandibular incisors often erupt lingually and are pushed forward by the tongue LLHA should not be placed with primary incisors
Omega Loops in area of premolars allow slight adjustment to fit appliance Should not be used to activate appliance
Yes, they are possible, however.. High failure rate due to breakage and loss Parent and patient compliance must be exceptional
Question 1
What tooth was extracted? How old is this child? What is the appropriate space maintainer? Will it have to be replaced with a different space maintainer in the future? If so, with what?
Question 2
What tooth was extracted? How old is the child? What is the appropriate space maintainer? Will it have to be replaced with a different space maintainer in the future? If so, with what?
Question 3
Which teeth were extracted? How old is the patient? What is the appropriate space maintainer? When can the space maintainer be removed?
Question 4
Question 5
Which teeth have been extracted? How old is the child? What is the most appropriate space maintenance?
Somieh Case
Somieh presented for an initial visit at the COD. She has had dental treatment on and off throughout life. She is in no pain, but mom reports that we know she has dental problems.
Ali
Mandibular Arch Only : Chart abnormalities and pathology (including caries ) from the Panorex and Bite Wing Radiographs
Ali
A Moyers space analysis predicted there to be 2.3 mm of excess space in the mandible.
Make a treatment plan and appointment sequence for the mandibular arch only.
Ali
Assuming normal dental development, at what age will the space maintainer you placed no longer be needed?
Ali Case
Ali was referred by his general dentist for tooth decay and crowding. The family does not believe they can afford comprehensive orthodontic care, but does have dental insurance for routine dental care.
Chart any pathology or abnormal findings (including caries) for the maxillary arch only on the odontogram.
Ali
Ali
A Moyers space analysis predicts 1.2 mm of space shortage in the maxilla
Treatment plan and sequence appointments for the Maxillary Arch Only
Ali
Discussion
Question 1
Question 1
Band/Crown and Loop #J-H Will not need replacement. #12 should erupt before #H or J exfoliate
Question 2
Tooth #L extracted. 3-5 y.o. child. What is the appropriate space maintainer? Will it have to be replaced with a different space maintainer in the future? If so, with what?
Question 2
Band/Crown Loop #K-M May need to be replaced by LLHA later. Tooth #M should exfoliate prior to eruption #21.
Question 3
Question 3
Question 4
Question 4
Question 5
Teeth #K and #S extracted. 5-6 y.o. child. Because permanent incisors are not erupted, LLHA not recommended. Options: Reverse band and loop #L-#19 and band and loop #T-#R.
Ali
Ali presented for an initial visit at the Afzal Clinic. He has had dental treatment on and off throughout life. He is in no pain, but mom reports that we know she has dental problems.
Ali
Mandibular Arch Only : Chart abnormalities and pathology (including caries ) from the Panorex and Bite Wing Radiographs
Ali
Teeth Present: 19, K,L,M,23,24,25,26,R,S,T,30
Restorations: SSC #L
Pathology/Caries: #L and #S abscessed, #28 severely ectopic.
Ali
A Moyers space analysis predicted there to be 2.3 mm of excess space in the mandible.
Make a treatment plan and appointment sequence for the mandibular arch only.
Ali Tx Plan
Extract #L,S and T and Place LLHA
#L and S due to abscess #T due to ectopic #28
Appt #1: Fit bands and Impress for LLHA Extract #L Appt. #2: Seat LLHA Extract #S, T
Ali
Assuming normal dental development, at what age will the space maintainer you placed no longer be needed? Answer: When #21,28 and 29 erupt. Around age 12 years
Ali Case
Ali was referred by his general dentist for tooth decay and crowding. The family does not believe they can afford comprehensive orthodontic care , but does have dental insurance for routine dental care.
Ali
Ali
A Moyers space analysis predicts 1.2 mm of space shortage in the maxilla
Treatment plan and sequence appointments for the Maxillary Arch Only
Ali
Teeth Present: #3,A,B,C,7,8,9,10,H,12,J,14 Restorations: #A-MO, #B-DO. Pathology/Caries: #3-M; #A-D; #B-M; #H-D;#J-abscess, #14-MO
Ali
Ali Tx Plan
Extract all maxillary primary teeth
#A,B,J- Multiple caries and near exfoliation TE #C and #H due to root formation #6 and #11
Restore #3 with direct M composite Restore #14-MO Place Nance Space Maintainer- slight space
deficiency, but this will be very beneficial.
Ali Tx Sequence
Appt 1
Fit bands #3 and #14 and Impress for Nance Restore #14 TE #H and #J
Appt 2
Restore #3 Seat Nance TE # A,B,C
Thank You!