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Ani Subekti

The Use of Crown (SSC) and Loop as Space


Maintainer in Premature Loss of Mandibular
Second Primary Molar on Children Aged 5 Years
(Case Report)
Ani Subekti1; Sri Kuswandari2
1) Dental Nurshing Department of Polytechnic Health Semarang; 2) Departement of
Pedodontia Gadjah Mada University

Abstract
The effect of primary tooth premature loss is space closure. Space maintainer is used to prevent the
space closure. There are various types modification of fixed space maintainer, for example modification
of crown and loop. Modification of crown and loop can be used as an alternative instead conventional
space maintainer. Crown and loop is commonly used for primary teeth with large cavities which needed
crown restoration. The purpose of this case report was reporting the treatment of premature loss of
mandibular second primary molar in a boy aged 5 years using crown and loop space maintainer. It was
reported that there was a boy aged 5 years with premature lost of mandible primary second molar. The
child was taken care for premature loss using removable space maintainer for 1 month, but the
removable space maintainer was not convenient and rarely used. There was extending caries of the
primary mandible first molar. Space for 35 narrowed 9.8 mm to 5.3 mm. Space regainer was should
used. But tooth analysis 74 and 36 as the anchorage was not possible because of the resorbtion tooth 74
and 36 is apically open. Finally fixed space maintainer with modification crown and loop was used to
maintain the space. Evaluation for 1 year, the appliance is still attached and the space is not narrowing.
Tooth bud of 35 is still far from the eruption.
Keywords: premature loss of mandibular second primary molar, crown and loop space maintaner,
children aged 5 years

Introduction

A space maintainer is an intra-oral appliance used to preserve arch length following the
premature loss of primary teeth/tooth. This allows the permanent teeth to erupt unhindered
into proper alignment and occlusion. A space maintainer is recommended after the premature
loss of primary teeth [1].
Basic concept is space closure occurs during the first 6 months after extraction. It is best to
insert the appliance as soon as possible following the extraction. Loss of space occurs primarily
due to a tipping movement of teeth (mesially or distally). In the maxillary molar region, space
loss occurs due to rotation (mesial-in) in conjunction with mesial tipping [2].
Kinds of space maintainer based on use was removable space maintainer, semifixed space
maintainer and fixed space maintainer (SM). Different kinds of appliances can be used for
space maintenance depending on the childs stage of dental development, dental arch,
involved missing teeth, occlusion, patients age, ability to cooperate and to tolerate a
removable appliance [3]. Many different types of space maintainers can be used for primary
teeth loss. These are (a) Several kinds of band and loop and crowns with welded tube and
loop, b) Fixed wire composite resin space maintainers, (c) Distal shoe retainers, (d) Mandibular

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The Indonesian Journal of Dental Research


Proceeding of The International
Symposium on Oral and Dental Sciences

 

Ani Subekti

lingual arch, (d) Nance appliance and transpalatal arch, as well as (f) several kinds of removable
appliances as removable partial dentures [4].
Crown and Loop type is commonly used in cases: (1) tooth abutment posterior was caries and
require extensive restoration crown, (2) tooth abutment never get pulp treatment which the
crown needs to be protected in case thoroughly [5].

Case Presentation

An 5-year-old boy with rampant caries reported to the Department of Pedodontics Faculty of
Dentistry, University Gadjah Mada, Yogyakarta, Indonesia. In intra oral examination of the
teeth are experiencing tooth 75 apical fenestration, tooth 74 had large caries dentin. The
parents wanted to extract tooth 75. The space between tooth 74 and tooth 36 was 9.8 mm
(Figure 2). We decided to give a removable space maintainer, i.e. removable partial denture
(RPD) to prevent the mesial drifting of 36 (Figure 4). Both the child and the parents were
pleased with the new look of the child. Orthopantomograph confirmed that bud tooth 35 had
still far from the eruption.
On one month follow-up the patient was unable to attend because of sick. On November 18,
2011, the patient came back with a condition space maintainer couldnt be used again.
Patients do not seek treatment immediately. In February 2012, the patient came again. Result
of examination was space between 74 and 36 was 5,3 mm. The child's mother wanted him to
used fixed space maintainer. There was caries dentin which indicated crown treatment.
Therefore we used fixed space maintainer with modification crown/SSC with loop.
Evaluation for 1 year, the appliance is still attached and the space is not narrowing. Tooth bud
35 is still far from the eruption.

Figure 1 & 2. View from the front and left side

Figure 3. View orthopantomograph before use SM

The Indonesian Journal of Dental Research


Proceeding of The International
Symposium on Oral and Dental Sciences

189

Ani Subekti

Figure 4. Insertion removable SM on June 9, 2011

Figure 5. Loose space 35 because mesial drifting 36 on February 29, 2012

Figure 6. Insertion crown and loop SM on March 8, 2012

th

Figure 7. View from left side on 1 year after insertion

Discussion

After 75 extraction, the patient used removable space maintainer because removable space
maintainer is easier without having a tooth preparation procedures. However, patient used it
for 1 month. Although removable space maintainers have certain advantages, such as being
easier to clean and allow better maintenance of oral hygiene, they can be removed and worn

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The Indonesian Journal of Dental Research


Proceeding of The International
Symposium on Oral and Dental Sciences

Ani Subekti

by the patient himself and may be broken or lost easily. If its happen, removable space
maintainer will not be effective [2].
Patient came 6 months later in February 2012. Examination of the space between the teeth 36
and 74 which was 9,8 mm to 5,3 mm, we decided to made a crown and loop space maintainer,
not space regainer. Due consideration based on the analysis of the tooth 74 and tooth 36 as an
anchorage is not possible. There is extensive dental caries of 74 and root resorption. The
apical root of 36 is still open. The space maintainer most commonly used for premature loss of
a single posterior tooth with modification the band-and-loop or crown-and-loop space
maintainer [5].
The following considerations are important to the dentist when space maintainer is used after
the premature 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 had been
removed and 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, is to make an
appliance before the extraction and deliver it at the extraction appointment.
It needs sufficient time explaining and discussing this condition to his parent, that there is the
possibility of the development of a future malocclusion if steps are not taken. It has to
maintain the space or guide the development of the occlusion. The fact is space maintaining
appliance will not correct an existing malocclusion but will only prevent an undesirable
condition from becoming worst or more complicated. Also, the importance of the right start
using space maintainer in order to prevent the mesial or distal drift of adjacent teeth [6].

Conclusion

Observations in the next year, crown and loop space maintainer is still attached. There is
mesial drift, but space regainer is not always used, depends on the condition of the abutment
teeth and the age of the patient.
Clinical follow-up and radiographic examination has taken periodically. It is interesting to prove
how early and individualized diagnosis can minimize treatment needs and prevent
complications.

References

[1] Terlaje RD, Donly. 2001. Treatment planning for space maintenance in the primary and
mixed dentition. J Den Child, 68: 109-114
[2] Kargul B, Caglar E, Kabalay U. 2003. Glass fiber reinforced composite resin space
maintainer: Case reports. J Dent Child, 70: 258-61
[3] Qudeimat MA, Fayle SA. 1998. The longevity of space maintainers: a retrospective study.
Pediatr Dent, 20: 267-272
[4] Kirzioglu Z, Erturk SO. 2004. Success of reinforced fiber material space maintainer. J Den
Child, 71: 158-162
[5] Simsek S, Yilmaz Y, Gurbuz T. 2004. Clinical evaluation of simple fixed space maintainers
bonded with flow composite resin. J Dent Child, 71: 163-8
[6] Christensen J, Fields H. 1998. Treatment planning and treatment of orthodontic problems.
In, Pediatric Dentistry: Infancy Through Adolescence. Jimmay R. Pinkham, Senior editor.
W.b. Saunders Company. Phaladelphia . p. 419-447

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Symposium on Oral and Dental Sciences

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