Space maintenance 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.
Planning for Space Maintenance
The following considerations are important to the dentist when space maintenance is considered after the untimely loss of primary teeth:
Time elapsed since loss: If space closure occurs, it usually takes place during the first 6 months after the extraction. When a primary tooth is removed & all factors indicate the need for space maintenance, it is best to insert an appliance as soon as possible after the extraction. Often the best approach, if possible, is to fabricate an appliance before the extraction & deliver it at the extraction appointment.
Dental age of the patient: The chronologic age of the patient is not so important as the developmental age. Gron studied the emergence of permanent teeth based on the amount of root development, as viewed on radiographs, at the time of emergence. She found that teeth erupt when three-fourths of the root is developed, regardless of the child’s chronologic age.
Amount of bone covering the unerupted tooth: If there is bone covering the crowns, it can be readily predicted that eruption will not occur for many months, a space-maintaining appliance is indicated.
Sequence of eruption of teeth: The dentist should observe the relationship of developing & erupting teeth adjacent to the space created by the untimely loss of a tooth.
Delayed eruption of the permanent tooth: In case of impacted permanent tooth, it is necessary to extract the primary tooth, construct a space maintainer and allow the permanent tooth to erupt at its normal position. If the permanent teeth in the same area of the opposing dentition have erupted, it is advisable to incorporate an occlusal stop in the appliance to prevent supraeruption in the opposing arch.
Congenital absence of the permanent tooth: If permanent teeth are congenitally absent, the dentist must decide whether it is wise to hold the space for many years until a fixed replacement can be provided or it is better to allow the space to close. If the decision is made to allow the space to close, there will rarely if ever be bodily movement of the teeth adjacent to the space. Therefore, orthodontic treatment will be needed to guide the teeth into a desirable position .
Presentation of problems to parents: Take sufficient time to explain existing conditions & discuss the possibility of the development of a future malocclusion if steps are not taken to maintain the space or to guide the development of the occlusion. Also explain that the space-maintaining appliance will not correct an existing malocclusion but will only prevent an undesirable condition from becoming worse or more complicated.
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