Dental Problems

Fixed Space Maintainers – Illustration

Oral Precancer ErythroplakiaFixed space maintainers are of various types. The various types of fixed space appliance include Band and loop, Lingual arch wires, distal shoe space maintainer, nance palatal arch and transpalatal arch. In this article, there is a brief discussion on the indications, contraindications and limitations or disadvantages of

fixed space maintainers

. Let us examine them.

Fixed space maintainers.

Band and loop fixed space maintainer:

Indications:

  • Premature loss of any primary first molar
  • Where the unerupted premolar is more than 2 years from clinical eruption and root length is less than ½.

Contraindications:

  • Extreme crowding or space loss
  • High caries activity

Limitations or disadvantages:

  1. Seldom used for space loss of more than one tooth
  2. Nonfunctional
  3. Migration of the loop gingivally (semi fixed)
  4. Loss of E before eruption of 4

Lingual arch wires:

Indications:

  1. Bilateral loss of posterior teeth (rarely used in primary dentition)
  2. Minor movement of the anterior teeth
  3. Maintenance of leeway space
  4. Space regaining

Contraindications:

  1. Before the eruption of the mandibular incisors (can be modified)

Limitations or disadvantages:

  1. Loss of cementation and solder are most commonly associated with this appliance
  2. May cause untoward movement

Distal shoe space maintainer

Indications:

  1. Early loss or removal of the second primary molar prior to the eruption of the first permanent molar is the prime indication in the maxillary arch with bilateral space loss, 2 appliances may be used.

Contraindications:

  1. Inadequate abutments due to multiple loss
  2. Poor patient or parent co-operation
  3. Congenitally missing first molar
  4. Medical conditions such a blood dyscrasias, CHD. Rh: fever, diabetes or generalized debilitation

Limitations or disadvantages:

  1. Over extension causes injury to the permanent tooth bud i.e., second premolar
  2. If under extended, it may allow the molar to tip into the space or over the band
  3. Prevents complete epithelialization of the extraction socket
  4. Ronnermann and thilander (1979) have discussed the path of eruption and stated that the drifting takes place only after eruption through the bony covering. The lower first molar normally erupts occlusalward to contact first the distal crown surface and uses that buttress for uprighting. Isolated cases should eb considered ectopic eruption

Nance palatal arch space maintainer:

Indications:

    1. Bilateral loss of the deciduous molars

Combined with a habit breaking appliance (on the acrylic button)

Contraindications:

  1. Palatal lesions
  2. If either of the molars has not erupted

Limitations or disadvantages:

  1. May cause tissue hyperplasia and infection due to poor oral hygiene

Transpalatal arch:

Indications:

  1. Best in cases where unilateral loss of space is seen

Contraindications:

  1. Bilateral loss

Limitations or disadvantages:

  1. May cause both the molars to tip together

The above article discusses briefly about the

fixed space maintainers

.

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