Clinical Evaluation for Space Maintainer after Unilateral Loss of Primary First Molar in the Early Mixed Dentition Stage

Background and Objectives: Controversy exists regarding the need for a space maintainer after early unilateral loss of a primary first molar. This study aimed to assess the need for a space maintainer after unilateral loss of a primary first molar in the early mixed dentition period. Materials and Methods. In this cross-sectional study, fifty children between 6 and 8 years who had lost a primary first molar unilaterally later than 6 months ago were randomly selected. Midline deviation, molar and canine relationships at both sides, facial growth pattern, and the amount of space loss were all assessed. Data were analyzed using SPSS version 25 via the one-sample t-test, paired t-test, and linear regression (alpha = 0.05). Results. The mean amount of space loss was 1.36 ± 0.78 mm (1.32 mm in the maxilla and 1.40 mm in the mandible). Time since tooth extraction and facial pattern had significant correlations with space loss P < 0.05 . Conclusion. In this particular age group, it is imperative to precisely assess the related factors such as the facial pattern and time since tooth extraction to decide about the placement of a space maintainer for a prematurely lost primary first molar.

Can Fixed Space Maintainers Have Adverse Effect on the Teeth and Periodontium?

BACKGROUND Space maintenance after premature loss of primary teeth is of importance in preventing space loss and potential crowding in future. Fixed space maintainers are used to prevent space loss but the presence of such fixed appliances near the tooth and its supporting structures may have some adverse effects. The purpose of this study was to evaluate the potential adverse effects of fixed space maintainers on the teeth and periodontium. METHODS Twenty young children in mixed dentition period (between 8 – 11y 7m years old) who were considered for space maintainer treatment were selected. Each patient had bilateral first molars that went under the band for fixed space maintainer. The patients were examined for decayed, missed and filled teeth (DMFT), bleeding on probing, clinical attachment level, gingival index and periodontal pocket depth at the beginning (T0), one month (T1), three months (T2) and six months (T3) later. Repeated measures ANOVA then Post - hoc LSD (Friedman test for gingival index) tests were used to interpret the data. RESULTS As compared to the beginning of the study, at the end of the 6 months follow-up period DMFT of the involved first molars did not change significantly (P = 0.163). But bleeding on probing, clinical attachment level, gingival index and periodontal pocket depths changed significantly at the same time frame (P < 0.001). CONCLUSIONS The fixed space maintainers might have some adverse effects on the periodontal structures of the banded teeth, so the clinicians should insist more on oral hygiene instructions and the patients must be under intense oral hygiene control. KEY WORDS Space Maintainers, DMFT, Bleeding on Probing, Clinical Attachment Level, Periodontal Pocket Depth

Fiber Reinforced Composite Space Maintainers Versus Band and Loop Space Maintainers – A Systematic Review

BACKGROUND Premature loss of primary teeth requires orthodontic intervention to prevent the occurrence of malocclusions in the future. The most preferred way to maintain this space is by using space maintainers. Band and loop maintainers are the most commonly used fixed space maintainers. Despite being the most effective, it has several disadvantages. Hence, the objective of this review was to compare the efficiency between fiber reinforced composite (FRC) space maintainer and the conventional band & loop space maintainer. METHODS A systematic review was performed. Electronic and hand search retrieved 260 records, 246 were screened. The intervention and outcomes were assessed in the study included for systematic review. RESULTS Seven studies were included in this systematic review. These studies compared the fiber reinforced composite and the conventional band & loop and provided results about their clinical efficacy and patient satisfaction. CONCLUSIONS Despite being one of the gold standard appliances for space maintenance, the conventional band and loop space maintainers have multiple disadvantages. The major disadvantages included failure of the appliance due to cement loss and bending of the wire. Out of the 7 articles included in this study, 6 of the articles concluded that the FRC space maintainers are as effective as the conventional band and loop. FRC space maintainers proved to be time effective, more aesthetic, has better patient acceptance and is easier to fabricate. Hence, fiber reinforced composite space maintainers can be used as a more aesthetic and effective alternative to the conventional band and loop space maintainers if proper technique and protocol is followed. KEY WORDS Space Maintainers, Band and Loop Space Maintainer, Fiber Reinforced Space Maintainer, Interceptive Orthodontics, Orthodontics

3D Printed Band and Loop Space Maintainer: A Digital Game Changer in Preventive Orthodontics

Premature loss of primary molars often leads to loss of arch circumference in the primary and mixed dentition. It can lead to malpositioning and even impaction of permanent tooth, if not prevented. Space maintainers in preventive orthodontics, are imperative in maintaining arch integrity. Band and loop space maintainers are indicated whenever there is premature loss of primary molar. The conventional band and loop space maintainer is most routinely fabricated, but poses certain limitations. Three-dimensional (3D) printing in digital dentistry is one of the major developments in dentistry. It replicates the dental cast in the most accurate forms. This allows for supreme precision and minimal human errors. Besides decreasing the laboratory procedures, it has the least chance of failure or breakage. The current case report discusses 3D printing technology for the fabrication of band and loop space maintainer, which can revolutionize preventive orthodontics for children.

Conservative Approach of a Dentigerous Cyst

Dentigerous cysts (DC) are the most common odontogenic cystic lesions of inflammatory origin occurring in children. These lesions can be treated by enucleation with or without related impacted teeth or marsupialization/decompression. The latter procedures have been used successfully for many years, but decompression is increasingly recommended in children because of its good outcomes and the preservation of the developing tooth. This conservative surgical technic allows simultaneously the normal eruption of the involved permanent teeth and the ossification of the bony defect. The present report describes an 8-year-old female patient with an inflammatory DC associated with an endodontically treated primary molar accidentally discovered on panoramic radiograph. Decompression of the cyst was performed, by means of a removable space maintainer acting as an acrylic obturator after removal of teeth 83 and 84. Ten months after the decompression procedure, a complete resolution and regression of the cystic lesion with full spontaneous eruption of the premolar were observed.

Space maintainer ‘Y model’ as a preventive orthodontic treatment for paediatric patients: a case report

Background: Caries is one of the most common oral diseases that occur among children. Caries and dental trauma in children may cause early tooth loss, also known as premature loss, and result in occlusion abnormalities caused by the dental arch narrowing. A space maintainer is a preventive orthodontic appliance designed to maintain a narrow arch to prevent premature loss. Purpose: This study aims to describe the treatment of a case of space management in a patient with premature loss by using the space maintainer ‘Y model’. Case: An eight-year-old boy was accompanied by his mother, complaining that the lower posterior right tooth had been extracted. The mother was worried that the new tooth would have an overlapping growth. Case Management: The diagnosis was mandibular primary molar loss. The study cast was analysed based on Moyers 2.62 cm, Huckaba 2.24 mm, and curve determination 2.40 mm. The mandibular removable space maintainer treatment was performed on the patient and was followed by nine control visits every week. The outcome was a successful treatment from the use of the space maintainer ‘Y model’. Conclusion: The space maintainer treatment with the Y model in the paediatric patient showed a good result, evidenced by the tube opening of 1.2 mm, showing that the appliance followed lateral jaw growth.