Dental Problems

Bonded Space Maintainers

toothPreventive orthodontics includes those procedures which promote the normal occlusion development and helps in preventing malocclusion. These malocclusions are the important public issues because most of them can be intercepted or prevented, but they not life threatening. Premature loss of the primary molars are due to trauma or knockout or abscess or due to any other cause which can often cause an undesirable teeth drifting and loss of space. But, an immediate insertion of the space maintainers as to preserve the arch length can help in limiting or preventing malocclusion development. In this article, there is a brief discussion on the bonded space maintainer which is designed for the premature loss of the bilateral mandibular deciduous 1st molar.

Bonded space maintainer.

Bonded space maintainer is simple to fabricate and it saves a lot of visits to the dental office and chair side time.

  1. These were suggested by Palmer (1978) as they would be helpful in reducing the time for appliance construction.
    • A triangular mesh pad is adapted to the mesial surface of distal abutment and to the distal surface of anterior abutment. For additional retention, the mesh can be compared contoured to extend onto a small area of the lingual and buccal aspects.
    • The space maintainer tube is welded on the post mesh, while the wire with the correct length is welded anteriorly.
    • A vacuum molded template is then formed over the space maintainer. After removal of the template, the appliance is cleaned and bonded.
  2. A variation was suggested by Arrum and Marstander (1983). They found a round, multi strand orthodontic wire 0.032 inch diameter to be more satisfactory than an ordinary round wire. They also used in auto-polymerizing composite resin.
  3. A new universal space maintainer has been suggested by Athanasios (1984).
    It consists of a solid steel foil pad bases and 2 sections.
  • a. Round retainer wire
  • b. Stainless steel tubing

Only 2 variations -left and right -are sufficient. The pads can be used for direct bonding after the wire length is marked and the excess is cut.

Advantages stated are as follows:

  1. Easy, fast and economical to produce
  2. No bands or impressions are necessary
  3. It can be completed in one appointment
  4. Can be used for posterior spaces of any length
  5. Possibilities of decalcification and periodontal damage are decreased.
  6. Can be used on partially erupted teeth and is esthetic.
  • A 3D instant space maintainer which is patented by Rocky Mountain has been described by Wilson and Wilson (1984). It is pre-fabricated and available in 2 forms.
    • Upper right + lower left and
    • Upper left + lower right

    The 0.030”truchrome construction is said to resist distortion. The 3d post-tube provides a secure fit. It also allows to be tightened with a slight adjustment. The bar position is adjusted to the first bicuspid just below the contact point.

    Features include an instant plug in and removal, secure lock in, resist deformation, removable for hygiene, can be sued for space regaining, time and cost -saving and can also be converted to a functional space maintainer.

  • Modified bonded space maintainer
    • Coican (1992) has presented a case report where the conventional band and loop was contraindicated because the first molar was partially erupted. A removable appliance was rejected due to lack of retention, short clinical crowns and the patient’s age. A second molar bracket was bonded to the buccal surface of the erupting first molar. A full size rectangular wire segment is used to span the edentulous space and provide light contact against the deciduous first molar.
    • Liegeois et al (1999) have also described a modified bonded space maintainer. Slots and occlusal shores are prepared on the primary teeth and a sanitary pontic is placed in the edentulous area to make it functional. The alloy used is chrome cobalt.

The above article discusses about the

bonded space maintainer


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