Transcript فایل 2
In The name of God
Space management in pediatric dentistry
Dr.Saeid Baghi Pedodontist
یکف سوق یاضف تلالاتخا اب ییانشآ
یریش یاهنادند متسیس رد کیتندوترا یاه نامرد نژولکا لام داجیا دعتسم ار کدوک هک یدراوم رد هلخادم دنک یم یمیاد یاهنادند رد • د وش نامرد هدنیآرد لکش نیرتهب هب هک یدراوم رد هلخادم ) دوش ماجنا رت تحار هدنیآ رد نامرد ( • ت لاکشم دیاب کشزپنادند فادها نیا ندرک هدروآرب یارب دهد زیامت ینادند تلاکشم زا ار یتلکسا •
یاهنادند متسیس رد یتلکسا یاهنژولکا لام نامرد دتفا یم ریخات هب لیلد 3 هب بلغا یریش تس ا راوشد نینس نیا رد یتلکسا نژولکا لام صیخشت یلو تسا دشر لاح رد هلحرم نیا رد کدوک هچ رگا دراو کدوک هکینامز رد هدنام یقاب تروص دشر نازیم حیحصت هب کمک یارب دوش یم mix dent هلحرم تسا یفاک یتلکسا یاهنژولکا لام بلغا هرود هب زاین دوش زاغآ نارود نیا رد هک ینامرد ره هب لیامت نامرد عطق اب اریز دراد ینلاوط یرادهگن دراد دوجو هیلوا دشر یوگلا ددجم یرارقرب .1
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سوق لوط تلاکشم
Premature loss of teeth Ankylosis Missing Impaction Transposition Ectopic eruption .1
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سوق لوط تلاکشم
زا دوز : یریش یاهنادند سوق لوط رد لکشم نیرتمهم یریش نادند نداد تسد • یفلخ و یمادق هیحان : یریش یاهنادند نداد تسد زا دوز : یریش یاهنادند نداد تسد زا دوز للع یگدیسوپ دعب ،امورت لوا : یمادق هیحان • • ) تردن هب ( امورت دعب، یگدیسوپ لوا : یفلخ هیحان
4 هب لاومعم هتفر تسد زا یریش یاهروزیسنا دوش یم نیزگیاج لیلد اضف ظفح ندیوج ملکت ) لیلد نیرتمهم ( ییابیز .1
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یریش یاهنادند متسیس رد اضف ظفح
یریش یاهرلوم ینیزگیاج هب طوبرم اتدمع زا ه ب رجنم دناوت یم زولیکنا ، نادند ندیشک ، یگدیسوپ دوش اضف نتفر تسد ?
: رادهگن اضف نیرتهب • • •
یریش یاهنادند سوق
اهنادند نیب اضف دوجو : کیژولویزیف primate space سامت دوجو و اهنادند نیب اضف دوجو مدع : Type I Type II یلامیزگورپ
• •
Primate Space
B و C نیب : Maxilla
•
D و C نیب : Mandible
•
Primary Dentition Terminus
)
یریش مود رلوم نادند یاهتنا هحفص
(
یریش یاهنادند متسیس نژولکا فیرعت کلام
•
تسا هدمآ تسدب یریش نادند
20
نژولکا یگلاس
3
رد
•
)
Flush Terminal Plan
(
FTP یاهرلوم نیمود لاتسید حوطس یفلخ یمادق تیعقوم تسا یدومع هحفص کی رد مه لباقم یریش
زا ر
)
Mesial Step
(
MS
ت یلایزم نییاپ یریش مودرلوم یاهتنا هحفص تسلااب یریش مود رلوم یاهتنا هحفص
رت یل
)
Distal Step
(
DS
اتسید نییاپ یریش مودرلوم یاهتنا هحفص تسلااب یریش مود رلوم یاهتنا هحفص زا
سامت رد لباقم یمیاد یاهرلوم نیلوا هطبار
)
یگلاس
6 (
هیلوا
لوا رلوم یلاکاب رایش رد لااب یمئاد لوا رلوم رد نییاپ و لااب یمئاد لوا یاهرلوم MB پساک : Cl I نییاپ یمئاد MB یاهپساک : End – on مه لباقم MB پساک زا رت یمادق لااب یمئاد لوا رلوم MB پساک : Cl II نییاپ یمئاد لوا رلوم رایش زارت یلاتسید لااب یمئاد لوا رلوم MB پساک : Cl III نییاپ یمئاد لوارلوم یلاکاب • • • •
ییاهن نژولکا ینیب شیپ
دع ب اهکف یوگلا – دوش یم لماک اهکف هطبار یگلاس
3
ات دنک یمن یدایز رییغت نآ زا
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یمئاد یاهنادند CI I Cl III CI II Primary هرود فیفخ دیدش MS
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MS DS
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Mixed هرود رد
یمئاد یاهنادند یمئاد یاهنادند Cl I هیلوا سامت رد Cl II هیلوا سامت رد Cl I Cl II یمئاد یاهنادند : End – on Cl I دراوم مراهچ هس Cl II دراوم مراهچ کی Cl III هیلوا سامت رد Cl III • • • • یور ر ب ...
ای اهیگدیسوپ ای یریش نادند نداتفا دوز لثم یطیحم لماوع دراذگ یم رثا لماکت لاح رد نژولکا
Management of Space in Pediatric Dentistry
Etiology of Early Primary Tooth Loss
• Extraction or destruction: – extensive caries or traumatic injury • Premature exfoliation: – abnormal root resorption (e.g. ectopic eruption) – systemic disorders or hereditary syndromes Hypophosphatasia Rickets Acrodynia Histiocytosis X triad Leukemia Cherubism Juvenile Periodontitis Cyclic neutropenia Dentinal dysplasia Papillon-Lefevre syndrome
Functions of a Space Maintainer
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2.
3.
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5.
6.
7.
Maintain space Prevent movement adjacent teeth Provide masticatory function Prevent overeruption of opposing teeth Improve esthetics Assist in speech (anterior segments) Aid in control of deleterious oral habits
Note: appliance must neither inhibit nor deflect normal growth changes
Ideal Prerequisites of a Space Maintainer
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2.
3.
4.
5.
Simple to construct and maintain Durable , strong, stable Passive Easily cleanable and not enhance dental caries or soft tissue pathology Readily adjustable for flexible application
Factors to consider when planning a space maintainer:
• Question:
“When should a space maintainer be placed?”
• General Rule: “Whenever the clinical situation will allow space loss to
encroach on the arch length
unerupted permanent teeth.
needed for the
Factors to consider when planning a space maintainer:
1.
2.
3.
4.
5.
6.
7.
8.
Dental and periodontal condition Arch length Presence/absence of permanent successor Time elapsed since loss of primary tooth Status of first permanent molar eruption Status of permanent successor’s development and eruption potential Cooperation level of child and parents Which tooth is lost, in which arch, at what time?
A space maintainer may not be required if there is: 1. Existence of cuspal interference .
2. Widely spaced primary dentition.
3. If succeeding tooth within 6 months.
is expected to erupt 4. If present space is not adequate for the succeeding tooth.
5. The possibility of future 6. Where the opposing 6's are locked into a desirable and stable orthodontic relationship work.
Suggested that succeeding tooth will most likely erupt within 6 months if: 1. 75% of the root is present on the succeeding tooth.
2. Less than 1 mm of alveolar bone is covering succeeding tooth.
3. Destruction of the alveolar bone occurred when the primary tooth was lost.
4. Mixed-dentition is in its later stages.
Adverse Effects
1.
2.
3.
4.
Dislodged, broken, and lost appliances Plaque accumulation Caries Interference with successor eruption 5.
6.
7.
8.
Undesirable tooth movement Inhibition of alveolar growth Soft tissue impingement Pain
parents should be informed that: 1. Space maintainer requires monitoring.
2. Patient must maintain adequate OH.
3. Appliance may break, requiring repair or replacement.
4. Broken appliances are hazardous to the child and will be ineffective.
It is necessary to obtain parental awareness and understanding related to space maintenance.
Before Placing a Space Maintainer
• • • Evaluate Arch Length – Has the space already been lost?
– Is there excess space?
Appropriate Radiographs – Succedaneous tooth?
– Time to Eruption?
Patient/Family Compliance
Premature loss of anterior teeth?
•
1
Incisors:
– no decrease in intracanine dimensions if loss after eruption of canines – Need SM?: Not necessary •
1
Canines:
– common loss due to ectopic eruption of permanent lateral incisors – Need SM?: consider LLHA with spur or elective extraction of canine
Premature loss of posterior teeth?
•
Comprehensive evaluation:
determine if space maint. is indicated for: a) First primary molar b) Second primary molar c) Multiple tooth loss •
Priority:
2 nd M > 1 st M > Canine > Incisor
Classification and Types of Space Maintainer Appliances •
Unilateral fixed:
– Band & loop / Crown & loop – Distal shoe •
Bilateral fixed
– Lower lingual holding arch – Transpalatal arch – Nance appliance •
Removable
– Modifications of Hawley retainer design
Band/Crown and Loop
• • • • MAXILLARY or
MANDIBULAR
Unilateral most typical Can be bilateral if permanent teeth are not present Single tooth span
SM: Band and Loop Advantages 1. Easy to construct.
2. Inexpensive.
3.
Easily adjusted.
4. Allows eruption of permanent tooth.
5. Non invasive.
6. Painless.
SM: Band and Loop Disadvantages
1.
Masticatory function.
Not restored
2.
Extrusion of opposing dentition.
Not prevented
3.
Normal distal movement of primary canine during eruption of permanent lateral incisor
Not allowed if placed for the early loss of mandibular 1st primary molar
SM: Band and Loop Construction • Band: stainless steel material 0.005 inches in thickness • Crib: portion of the wire spanning the edentulous space • Loop: portion of the wire contacting the abutting tooth 0.032 inches in diameter
Crown and Loop
• • Stronger than band and loop Cementation failure or loss less likely • Excellent choice if tooth needs a restoration
Revers Band and Loop
• • • When second primary molar extracted When first permanent molar not fully erupted Band on first primary molar
Lower Lingual Holding Arch
• • •
MANDIBULAR ONLY
Bands on first permanent molars Anterior Stop = Cinguli of #23-#26
SM: Lingual Arch Indications 1.
Premature loss of primary posterior teeth.
2.
Base for aesthetic restoration in loss of anterior teeth.
3 . Used as a base for habit appliance.
SM: Lingual Arch
contraindication:
• Before the eruption of permanent incisors because of : 1- lingual eruption of permanent incisors 2-primary incisors does not sufficient anchorage to prevent significant loss of arch length
SM: Lingual Arch Advantages Disadvantages 1. Maintains arch form.
2. Allows eruption of perm teeth w/o interference.
3. Not easily displaced.
1 . Does not prevent extrusion of opposing teeth.
2. Not advisable to band teeth which are: • Hypoplastic • • Hypocalcified Highly prone to caries.
3. Can promote decay in non compliant patients.
4. Ease of cleaning for proper OH.
5. Patient comfort.
SM: Fixed Lingual Arch Construction • Band: Stainless steel material 0.005 inches in thickness (ortho bands) •
Lingual arch wire:
Stainless steel round wire 0.036 inches in thickness
LLHA Omega Loops
• • Omega Loops in area of premolars allow slight adjustment to fit appliance Should not be used to activate appliance
Appliance Activation Features
• Can be added by attaching light wire features • This is beyond routine space maintenance
What About Removable Appliances?
• • • Yes, they are possible High failure rate due to breakage and loss Parent and patient compliance must be exceptional
Removable Acrylic Space Maintainer
Distal Shoe
• MAXILLARY or
MANDIBULAR
• Used when second primary molar requires extraction and first permanent molar has not erupted
Distal Shoe
• Should be evaluated with radiograph prior to cementation – Length – Position • Will be replaced with another space maintainer when permanent teeth erupt.
Nance Appliance
•
MAXILLARY ONLY
• Bands on first permanent molars
SM: Nance Appliance
Maxillary arch: multiple tooth loss Indications: The same as for fixed lingual arch Construction:
Bands: Stainless steel material 0.005 inches in thickness Palatal wire: Stainless steel round wire 0.036 inches in thickness
Transpalatal Holding Arch (TPA) • Can be used like a Nance.
• • Advantage – Lack of acrylic button so less tissue irritation and more cleansible Disadvantage – Lack of anterior stop = possible tooth shift (?)
Space regaining
Regaining Arch Circumference Mixed Dentition Appliances used:
Amount to be gained Mandible Maxilla 0-2 mm helical spring helical spring loop lingual arch headgear split saddle jackscrew 2-4 mm sling shot split saddle split saddle headgear lip bumper jackscrew
Head Gear
Jackscrew Appliance
Jackscrew Appliance
Helical Spring Appliance
Helical Spring Appliance
Thanks for your attention