Part 6: Space Maintenance

Primary Incisor Loss

-loss of primary incisor doesnt cause loss of overall arch length but may cause localized space loss
-replacement of lost primary incisor generally done for esthetic and speech, but not for space maintenance
-options: a) partial denture (if pt over 3 yrs old)
b) fixed prosthesis (ortho bands placed on 2 nd molars and ortho wire w/ tooth fixed to wire runs along arch
-used on pts under 3 yrs old or lack cooperation
-if there is LINGUAL ectopic eruption of permt incisors, giving double row of teeth, you can let primary incisors
exfoliate if mobile or else you should extract them
-the permt incisors will move labially once this is done
-there can be LATERAL ectopic eruption where central incisors erupt into lateral incisor position, causing early
exfoliation of a primary lateral
-this can result in midline deviation so other primary lateral should be extracted
Permanent Incisor Loss
-space loss can occur very quickly after losing permt incisor
-an appliance should be constructed and inserted as soon as possible
Primary Canine Loss
-canine loss causes:
a) lingual collapse of permt incisors
b) loss of arch length
c) increased overbite and overjet
d) midline deviation to side of lost canine (if unilateral)
-if canine loss is unilateral, should extract contralateral primary canine
-appliances:
1) Lower lingual holding arch
Primary First Molar Loss
1) Lost in primary dentition
a) Unilateral: band-loop space maintainer
b) Bilateral: band-loop space maintainer on both sides
DO NOT USE LLHA UNTIL PERMANENT INCISORS ARE ERUPTED. PERMANENT
INCISORS COMMONLY ERUPT LINGUALLY AND CAN BE TRAPPED BY THE APPLIANCE.
2) Lost in mixed dentition
a) Unilateral: band-loop space maintainer
b) Bilateral: lower lingual holding arch (mandible)/palatal holding arch (max.) or Nance appliance
Primary Second Molar Loss
1) Lost in primary dentition
a) Unilateral: distal shoe or acrylic partial denture
b) Bilateral: lower lingual holding arch/palatal holding arch, Nance appliance, or removable appliance
2) Lost in mixed dentition
a) Unilateral: bilateral holding arch
b) Bilateral: lower lingual holding arch/palatal holding arch, Nance appliance, or removable appliance