1. IT AIN’T SCARY! Space Maintenance

2. ARCH CIRCUMFERENCE

3. MESIAL VECTOR OF FORCE

4. ERUPTIVE FORCE

5. What happens? A scenario: IF S IS LOST but NO SPACE MAINTENANCE

6. SPACE IS LOST! The 1st Permanent Molar and the Second Primary Molar Move Mesially. It’s the Mesial Vector of Force. Ever’body Knows That!

7. What happens? IF S IS LOST and SPACE MAINTENANCE IS PROVIDED

8. The Space Maintainer Transmits the Mesial Vector of Force to The Canine and Space is Maintained for the First Premolar…Unless… SPACE IS MAINTAINED

9. The Primary Canine is Shed before the First Premolar Erupts (Sequence of Eruption)...

10. Or there is no primate space to accommodate the size difference between the primary incisors and the permanent incisors. In cases of no primate spacing, the erupting lateral may resorb the root of the primary canine, causing its early exfoliation.

12. Not necessarily out if the child is closely monitored. So in these cases, band and loops are out. Right?

13. How About a Lingual Arch? O.K, if Closely Monitored

14. Because the Permanent Incisors Erupt Behind The Primary Incisors and the Arch Wire May Interfere With the Eruption. WHY?

15. Stupid Space Maintainer Joke

16. Every Kind of Space Maintainer Needs Monitoring

17. Wires Are Bent, Solder Joints Break

18. Bands Get Loose

19. Abutments Exfoliate

20. Biology Deviates

21. Every Kind of Space Maintainer Needs Monitoring

22. Kinds of Space Maintainers

23. Lower Lingual Holding Arch

24. Removable Space Maintainers

25. Maxillary (Nance) Holding Arch

26. Maxillary Holding Arch

27. Maxillary Holding Arch

28. Transpalatal Arch

29. Band and Loop

30. No Yes Crown and Loop

31. One Arm Bandit Band and Hemi-Loop

32. Distal Shoe

33. Distal Shoe

34. Removable Distal Shoe

35. How D’ya Like My Band and Loop ?

36. Lets talk about... You’re Outta Here.

37. Arch Circumference and…

38. Tanaka and Johnston Method: One half the sum of widths (mm) of 4 permanent incisors + 10.5 mm for mandibular arch (11mm for maxillary arch) = combined widths of permanent cuspid and bicuspids. Tooth Size and…

39. Leeway Space and...

40. When Teeth Emerge Normal If Primary tooth is lost before 8 years (later) If Primary tooth is lost after 8 years (earlier)

41. Making Space Maintainers • Do it Yourself ? • Time and Materials • Have a Professional Dental Lab Do it? • Find a Competent Laboratory for Orthodontic Appliances • Know How to Write a Proper Prescription

42. Longevity of Space Maintainers • 301 Space Maintainers in 141 Patients • Ages: 3 yrs 3 months to 22 yrs. • .Followed for 5 years (Qudeimat and Fayle, JPD July/August, 1998)

43. Longevity of Space Maintainers • Cement Loss 36% • Breakage 24% • Failure in 63% • Design Problem 10% • Lost 9%

44. Median Survival Time = 7 months Band and Loop = 13 mos. Lower Lingual Holding Arch = 4 mos. All Bilateral Space Maintainers = 5 mos Remakes had longer survival time (10 months) Highest breakage was in LLHA Failure of solder joints = 11% Longevity of Space Maintainers

45. Longevity of Space Maintainers

46. Making Space Maintainers Fitting Bands Making Impressions Making Models

47. Requirements for a Space Maintainer Design Maintains Space (Duh!) Is Easily Cleaned Is Easily Inserted Is Comfortable to Patient

48. Duh!

49. Duh? Is the remaining space adequate for the permanent tooth mass? Is the super-erupted maxillary 2nd primary molar a space maintainer?

50. Requirements for a Space Maintainer Economical Does Not Interfere With Speech Does Not Impede Normal Growth or Eruption of Teeth Restores Function