This document discusses space maintainers, which are appliances used to preserve space for permanent teeth when primary teeth are lost prematurely. It describes different types of fixed and removable space maintainers, including band and loop, crown and loop, lingual arch, Nance palatal arch, and distal shoe appliances. Guidelines are provided for when different space maintainers should be used based on the missing primary tooth in both maxillary and mandibular arches. The importance of early space maintenance in guiding eruption of permanent teeth and preventing malocclusion is also emphasized.

1. SYNOPSIS
 INTRODUCTION
 SPACE MAINTENANCE
 CHANGES FOLLOWINGPREMATURE LOSS OF TEETH
 SPACE CLOSURE
 SPACE ANALYSIS
 SPACE MAINTAINERS
 TREATMENT PLANNING FOR SPACE MAINTAINERS
 CLASSSIFICATION OF SPACE MAINTAINERS
 BAND & LOOP SPACE MAINTAINER
 CROWN & LOOP SPACE MAINTAINER
 LINGUAL ARCH SPACE MAINTAINER
 NANCE PALATAL ARCH
 TRANS PALATAL ARCH APPLIANCE
 DISTAL SHOE APPLIANCE
 REMOVABLE SPACE MAINTAINERS
 SPACE MAINTENANCE IN DECIDIOUS DENTITION
 SPACE MAINTENANCE IN PERMANENT DENTITION
 CONCLUSION
 REFERENCE
SPACE MAINTAINERS
VESTA ENIDLYDIA-R
IV BDS
PEDODONTICS SEMINAR

2. 1
INTRODUCTION-
SPACE MANAGEMENT
CHANGES FOLLOWING
PREMATURE LOSS OF TEETH

3. 2
ETIOLOGY OF SPACE
CLOSURE/CONTRIBUTING
FACTORS
 Inclination of the long axis of molar
 Path of least resistance
 Influence of buccal musculature
 Effect of the position of center of
rotation of mandible
PLANNING FOR SPACE
MAINTAINANCE-FACTORS
INVOLVED ARE
 Time lapse since lost
 Dental age of patient
 Amount of bone covering the unerupted
tooth
 Sequence of eruption of teeth
 Delayed eruption of permanent teeth

4. 3
 Congenital absence of permanent teeth
 Presence of oral habits
 Existing malocclusion
SPACE ANALYSIS
Commonly used mixed dentition analyses are
 Hays & nance analysis
 Moyers analysis
 Tanaka johnston analysis
SPACE MAINTAINER
TREATMENT PLANNING FOR
SPACE MAINTAINER
PROPER EXAMINATION
COLLECTION OF DIAGNOSTIC DATA

5. 4
ANALYSIS OF TOOTH DEVELOPMENT
STAGE
ANALYSIS OF TOOTH SIZE
ANALYSIS OF SPACE AVAILABLE
PREDICTION OF GROWTH & FUTURE
OCCLUSAL RELATIONSHIPS
CLASSIFICATION OF SPACE
MAINTAINERS
ACCORDING TO HINRICHSEN (1962)
1.FIXED
a.Non-functional types
Bar type
Loop type
b.Functional types
Pontic type
Lingual arch type

6. 5
Cantilever type
Distal shoe type
Band and looptype
2.REMOVABLE
a.Non-functional types
b.functional types
COMMONLY USED SPACE
MAINTAINERS
 BAND & LOOP
 CROWN & LOOP
 LINGUAL ARCH HOLDING DEVICE

7. 6
 NANCE’S PALATALHOLDING
DEVICE
 TRANS PALTALARCH
 DISTAL SHOE
 REMOVABLE SPACE MAINTAINER
BAND & LOOP SPACE
MAINTAINER
Most commonly used
Unilateral fixed appliance
Used in posterior segments
CROWN & LOOP SPACE
MAINTAINER
Stainless steel crown is used as an abutment

8. 7
Stronger than band and loop
Cementation failure or loss less likely
Excellent choice if tooth needs a restoration
LINGUAL ARCH SPACE
MAINTAINERS
MANDIBULAR ONLY
 Bands on first permanent molars
 Mandibular incisors often erupt
lingually and are pushed forward by the
tongue
 LLHA should not be placed with
primary incisors

9. 8
NANCE PALATAL ARCH
MAXILLARY ONLY
Bands on first permanent molars
It’s a simple maxillary lingual arch but does
not contact anterior teeth
It has an acrylic button in the mid palate
TRANS PALATAL ARCH
APPLIANCE
Can be used like a Nance.
Advantage
Lack of acrylic button so less tissue irritation and
more cleansible
Disadvantage
Lack of anterior stop = possible tooth shift

10. 9
DISTAL SHOE APPLIANCE
MAXILLARY or MANDIBULAR
Used when second primary molar requires
extraction and first permanent molar has not
erupted
DISTAL SHOE SPACE
MAINTAINER (contd)

11. 10
Should be evaluated with radiograph prior to
cementation
– Length
– Position
Will be replaced with another space maintainer when
permanent teeth erupt.
REMOVABLE SPACE
MAINTAINERS

12. 11
a.Non-functional types
b.Functional types
CLASSIFICATION OF REMOVABLE
SPACE MAINTAINERS
REMOVABLE SPACE
MAINTAINERS
It is like a removable partial denture
Not only Mesiodisatal space but also the vertical
space is maintained
Mastigatory Function is restored in functional type
Esthetics & speech improvement is seen

13. 12
SPACE MAINTENANCE IN
MAXILLARY PRIMARY DENTITION
MISSING
TOOTH
SUGGESTED
TREATMENT
REASON
Incisor No space
maintenance
required
No
consequence.exception
if incisors are lost prior
to primary canine
eruption
canine Band& loop
space
maintainer
Decrease possibility of
midline shift
I molar Band /crown &
loop space
maintainer
Prevents loss of arch
dimmension
II molar Distal shoe
space
maintainer
Guides I premolar into
proper position
Prevents loss in arch
dimension

14. 13
SPACE MAINTENANCE IN
MANDIBULAR PRIMARY
DENTITION
MISSING
PRIMARY
TOOTH
SUGGESTED
TREATMENT
REASON
canine Band & loop
space
maintainer
Decreases
possibility of
midline shift
I molar Band/crown
loop space
maintainer
Prevents loss
of arch
dimmension
II molar Distal shoe
space
maintainer
Guides I
permanent
molar into
position
Prevents loss

15. 14
in arch
dimmension
SPACE MAINTENANCE IN MIXED
DENTITION –MAXILLARY
MISSING
PRIMARY
TOOTH
SUGGESTED
TREATMENT
REASON
Lateral incisor Extract antimere Decrease possibility
of midline shift
canine Extract antimere Decrease possibility
of midline shift
I molar  Prior to eruption
of permanent
lateral incisors
removable space
maintainers
 After eruption of
permanent lateral
incisors extract
antimere
 Guides
permanent
lateral incisors
into proper
position and
 Prevents
midline shift

16. 15
II molar nance appliance Prevents loss in arch
diameter
SPACE MAINTENANCE IN MIXED
DENTITION – MANDIBLE
MISSING
TOOTH
SUGGESTED
TREATMENT
REASON
Lateralincisor Extract antimere Decreases possibilityof midline
shift
Canine Priorto eruptionof
permanentlateralincisor
removablespacemaintainer
After eruptionof permanent
incisorslingualarchspace
maintainer
1.Requiresonlyminor adjustment
to afford normalpositioningof
permanentincisors
2.decreases possibilityof midline
shift
1.Decreasesthe possibility of
midlineshift
2.preventslingualtippingof
permanentlateralincisors
I molar Priorto eruptionof
permanentlateralincisorr
band/crownspacemaintainer
After eruptionof permanent
incisorslingualarchspace
maintainer
1.preventsloss in arch dimension
2.does not interferewith eruption
of permanentincisors
1.preventsloss in arch dimension
2.preventsdistolateral
repositioningof deciduouscanine
II molar Priorto eruptionof
permanentlateralincisorr
1.preventsloss in arch dimension
2.does not interferewith eruption

17. 16
band/crownspacemaintainer
After eruptionof permanent
incisorslingualarchspace
maintainer
of permanentincisors
1.Preventsmesialtippingof
permanentI molar
2.preventsloss in arch dimension
CONCLUSION
It has been stressed that importanceof healthy, properly
aligned deciduous teeth lays a foundationfor the future dental
health of the child, and preservationof primary teeth incluates
the habit of preventing of dental diseases such as malocclusion
at an early age…….
So it is been said that
PREVENTION IS BETTERTHAN CURE…..
Hence extra care should be given for maintaining deciduous
dentition…..
REFERENCES
MY SINCIERE THANKS TO
DR.XAVIER.MDS
DR.SARAVANAN.MDS

18. 17
DR.SANGEETHA.BDS
DEPARTMENT OF PEDODONTICS
THANK‘U’HAVEAGREATDAY….