Dental Problems

Clinical Assessment for Space Management

Types of Dental ElevatorsSpace management is one of the concerns for maintaining the tooth alignment. In this article there is a brief discussion on the clinical assessment for space management including space discrepancy analysis, space maintenance and management, ideal requirements and factors governing for the selection of appliance.

Clinical Assessment for Space Management

Clinical Assessment can be carried out following the guidelines laid down recently by the American Academy of Pediatric Dentistry.

  1. Intra-oral examination to:
    • a. Assess the overall oral health status
    • b. Determine the status of patient’s occlusion
  2. Facial analysis

    • a. Determine the asymmetric growth patterns and or lateral deviations of the mandible
    • b. Determine dental, skeletal growth
    • c. Dental and skeletal (occlusal) abnormalities
  3. Functional assessment

    • a. Functional factors
    • b. Habits
    • c. Detect TMJ dysfunction

Apart from above guidelines, the following factors should also be considered before deciding the treatment plan such as:

  • Position of incisors:

    This gives an indication as to the amount of space actually present.

  • Crowding:

    This would indicate 1 mm minimum requirement.

  • Deep of curve of Spee:

    The correction of 1mm depth on either side of the arch yields a 1mm linear space per side.

  • Midlines:

    Shift of the midline may require additional space.

  • Leeway space:

    Whether it is maintained or regained depends on the arch -length analysis done.

Space discrepancy analysis:

Any space management measures should be carried out only after a space discrepancy analysis is done for which the two factors to be considered are as follows:

  1. Space required
  2. Space available

It can either be done by a radiographic method or on study model or combination of both. Though several authors have recommended different analysis, we suggest that at least two of the following be performed rather than rely on a single analysis.

A. Arch perimeter or Moyer’s analysis:

  • The perimeter of the arch is measured from the mesial surface of one permanent molar around to the mesial surface of the opposite molar. The arch can be measured in 4 -6 segments.
  • Size of unerupted teeth:

    A special case involves computation of the size of unerupted teeth, either from radiographs or by ratios based upon correlations between the sizes of permanent teeth. The Moyers analysis is the most commonly used mixed dentition analysis.

B. Radiographic method:

  • It requires clear x-ray films of the unerupted teeth and of the overlying primary teeth. The enlargement ratio for each unerupted permanent tooth is computed by measuring the nearest erupted tooth first in the mouth and then in the radiograph.
  • The equation used is : erupted tooth size in the mouth/erupted tooth size in x-ray *Unerupted toot size in X-ray = Correct tooth size.

C. Hixon and Oldfather:

  • They have suggested a method, which has been stated to be the most accurate. It involves the following measurements.
  • Sum of the maximum mesio-distal diameter of one permanent central incisor and one lateral incisor, with the diameter of the unerupted first and second bicuspids measured on the radiograph taken by the paralleling technique (using a 16-inch cone). The following chart can be used:
  • Measured value -Estimated tooth size

    23 mm -18.4 mm
    24 mm -19.0 mm
    25 mm -19.7 mm
    26 mm -20.3 mm
    27 mm -21.0 mm
    28 mm -21.6 mm
    29 mm -22.3 mm
    30 mm -22.9 mm

D. Tanaka and Johnson:

They used the following measurement:

  • Half the mesio-distal width of 4 lower incisors + 10.5 = Mandibular 3+4+5 in one quadrant.
  • Half the Mesio-distal width of 4 lower incisors + 11.0 = Maxillary 3+4+4 in one quadrant.

Space Maintenance and Management

By tradition and repetition, preventive orthodontics is to many people limited to the procedures implied by the term space maintenance. Thus, it is important to place in proper perspective the terms space maintenance and management.

  • Space maintenance:

    It can be defined as the provision of an appliance (active or passive) which is concerned only with the control of space loss without taking into consideration, measures to supervise the development of dentition.

  • Space management (control):

    It includes measures that diagnose and prevent or intercept situations, so as to guide the development of dentition and occlusion.

  • Space maintainers:

    It can be defined as appliances used to maintain space or regain minor amounts of space lost, so as to guide the unerupted tooth into a proper position in the arch.

Ideal requirements:

The space maintainers used should meet the following conditions:

  • Maintain the desired mesio-distal dimension of the space (intra-arch space maintenance)
  • Should not interfere with the vertical eruption of the adjacent teeth (inter arch space maintenance)
  • Should not interfere with the eruption of the permanent teeth
  • Provide mesio-distal space opening when it is required
  • Maintain individual functional movement of teeth.

Factors governing the selection of appliance:

  • Patient cooperation:

    With removable appliances, greater cooperation is required as compared to the fixed appliances.

  • Appliance integrity:

    In general all types of appliances suffer breakage. But as per Wright and Kennedy (1968), the mandibular removable appliance is the most susceptible to breakage and that the integrity of fixed appliances is better.

  • Maintenance:

    The length of time and the projected maintenance should be considered.

  • Modifiability:

    Anticipation of future modifications is essential.

  • Limitations:

    Loss of the 1st primary molar before eruption of the second premolar while using the band and loop.

  • Cost:

    Directly bonded are the best as time is saved. As laboratory time increases, labor charges increases.

The above article discusses about the clinical assessment for space management including space discrepancy analysis, space maintenance and management, ideal requirements and factors governing for the selection of appliance.

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