Types Of Space Maintainers

Fixed Bilateral Space Maintainer

This photograph shows an example of a fixed bilateral space maintainer. The patient is four years of age. The appliance is cemented on the two second primary molars. Fixed bilateral space maintainers on the mandibular arch often are called lingual arch space maintainers.
Mandibular fixed bilateral space appliances generally are preferred by clinicians over removable space maintainers. Fixed appliances are easier to maintain and they are less likely to be removed, damaged, or lost by the child.
The photograph demonstrates another variation on the bilateral use of fixed unilateral space maintainers. In this case, a fixed unilateral band and loop space maintainer was used on one side and a fixed unilateral crown and loop space maintainer was used on the other side. Crown and loop space maintainers can be used when a stainless steel crown is needed on a tooth which also is an abutment for a space maintainer.
However, often band and loop space maintainers are used over stainless steel crowns. The rationale for using a band and loop space maintainer over a stainless steel crown is that if the band and loop appliance is no longer needed or if it fails, replacing the stainless steel crown will not also be necessary.

Mandibular Removable Bilateral Space Maintainer

  A mandibular removable bilateral space maintainer is shown on a six year-old. This youngster prematurely lost the mandibular right and left first and second primary molars. The disadvantages of a removable appliance are that it may not be worn by the patient and it is more susceptible to breakage or loss by the patient. To reiterate, most clinicians prefer to place fixed space maintainers if possible.

Fixed Unilateral Appliance

This photograph shows an example of a fixed unilateral appliance on the maxillary left side for a seven year-old patient. The photograph demonstrates the appliance after cementation. This appliance is referred to as a band and loop space maintainer and is a favorite among many clinicians

The photograph presents a variation on the band and loop space maintainer; a mandibular left crown and loop space maintainer is shown. Note how the stainless steel wire is soldered to the stainless steel crown and the wire is bent so that it is adapted closely to the tissue. The crown and loop space maintainer is a type of fixed unilateral space maintainer where stainless steel crown therapy was necessary on the abutment tooth

Bilateral Band And Loop Space Maintenance

This photograph shows two band and loop space maintainers, an example of the bilateral use of fixed unilateral band and loop space maintainers. These are very common types of unilateral space maintainers, and they often are used bilaterally.

Distal Shoe Space Maintenance

This appliance is called a distal shoe space maintainer or a distal extension space maintainer. It is used to prevent first permanent molars from moving mesially with the premature loss of second primary molars. The example shown is a crown with a distal extension segment soldered to the crown. The distal segment is extended into the tissue against the unerupted first permanent molar. The distal extension, also called a distal shoe, is used when the second primary molars are lost prior to the eruption of the first permanent molars (i.e., very premature loss).

Maxillary Removable Bilateral Space Maintenance

 This photograph shows a maxillary removable appliance, in this case a maxillary removable bilateral space maintainer. As suggested previously, removable appliances are not commonly used because of problems with the appliance not being worn and the frequent incidence of breakage and loss.
The photograph shows a maxillary fixed bilateral space maintainer. This type of space maintainer also is known as a Nance Holding Arch or a Nance Appliance. Note the small acrylic button which will rest against the palatal tissue with this appliance. Some clinicians object to the button since it can create tissue irritation. Therefore, it is important that patients and parents be instructed to make sure that the patient meticulously flosses under the acrylic button. The Nance Holding Arch is used in situations where premature bilateral loss of maxillary primary teeth has occurred.

Prosthetics For Maxillary Anterior Teeth

The appliance demonstrated in this photograph is used to replace missing maxillary anterior primary teeth. Cases like this are discussed at length later in the chapter and in the chapter covering pediatric restorative dentistry (it is an example of a type of maxillary anterior prosthesis).

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