PASSIVE SPACE CONTROL Dr S.E. Jabbarifar;Isfahan Dental School,Pediatric Dentistry Departement 2009.
Transcript of PASSIVE SPACE CONTROL Dr S.E. Jabbarifar;Isfahan Dental School,Pediatric Dentistry Departement 2009.
![Page 1: PASSIVE SPACE CONTROL Dr S.E. Jabbarifar;Isfahan Dental School,Pediatric Dentistry Departement 2009.](https://reader034.fdocuments.us/reader034/viewer/2022051314/55180b415503469b438b45c2/html5/thumbnails/1.jpg)
PASSIVE SPACE CONTROL
Dr S.E. Jabbarifar;Isfahan Dental School,Pediatric Dentistry Departement
2009
![Page 2: PASSIVE SPACE CONTROL Dr S.E. Jabbarifar;Isfahan Dental School,Pediatric Dentistry Departement 2009.](https://reader034.fdocuments.us/reader034/viewer/2022051314/55180b415503469b438b45c2/html5/thumbnails/2.jpg)
Prerequisite knowledge
Understand that arch length is greatest at age four years
Tooth position is maintained by balance of forces – shift vs. drift
Greatest amount of space closure – within first 6 months of premature tooth loss
Sequence & timing of exfoliation/eruption
![Page 3: PASSIVE SPACE CONTROL Dr S.E. Jabbarifar;Isfahan Dental School,Pediatric Dentistry Departement 2009.](https://reader034.fdocuments.us/reader034/viewer/2022051314/55180b415503469b438b45c2/html5/thumbnails/3.jpg)
Space control vs. space maintenance
Space control Dynamic Careful ongoing supervision
Space maintenance Utilization of appliance to preserve existing
space Not always the rule!
![Page 4: PASSIVE SPACE CONTROL Dr S.E. Jabbarifar;Isfahan Dental School,Pediatric Dentistry Departement 2009.](https://reader034.fdocuments.us/reader034/viewer/2022051314/55180b415503469b438b45c2/html5/thumbnails/4.jpg)
Variables influencing space control
Oral musculature & habitsTime elapsed since extractionDental age, eruption sequence & bony
coveringAvailable spaceInterdigitationAbsence of anomalies
![Page 5: PASSIVE SPACE CONTROL Dr S.E. Jabbarifar;Isfahan Dental School,Pediatric Dentistry Departement 2009.](https://reader034.fdocuments.us/reader034/viewer/2022051314/55180b415503469b438b45c2/html5/thumbnails/5.jpg)
Considerations in premature 1o tooth loss
Preserve the arch length!Causes:
Anterior – primarily trauma, caries Posterior – primarily caries
If space lost: Space maintenance Space regaining No treatment
![Page 6: PASSIVE SPACE CONTROL Dr S.E. Jabbarifar;Isfahan Dental School,Pediatric Dentistry Departement 2009.](https://reader034.fdocuments.us/reader034/viewer/2022051314/55180b415503469b438b45c2/html5/thumbnails/6.jpg)
Space loss in primary and mixed dentitions
Unrestored interproximal caries reduce arch circumference!
“first line of defense” = Class II & SSC restorations
Natural tooth is the best space maintainer
![Page 7: PASSIVE SPACE CONTROL Dr S.E. Jabbarifar;Isfahan Dental School,Pediatric Dentistry Departement 2009.](https://reader034.fdocuments.us/reader034/viewer/2022051314/55180b415503469b438b45c2/html5/thumbnails/7.jpg)
Planning for space maintenance
No medical contraindications
Patient must be dentally fit
Patient must be able to demonstrate good OH
![Page 8: PASSIVE SPACE CONTROL Dr S.E. Jabbarifar;Isfahan Dental School,Pediatric Dentistry Departement 2009.](https://reader034.fdocuments.us/reader034/viewer/2022051314/55180b415503469b438b45c2/html5/thumbnails/8.jpg)
Planning for space maintenance
Parents must all understand costs involved
Parents must understand importance of & be willing to attend regularly for appliance supervision/maintenance – teeth lost in primary dentition stage may cause delayed eruption of succedaneous teeth
Periodic recementation may be required
![Page 9: PASSIVE SPACE CONTROL Dr S.E. Jabbarifar;Isfahan Dental School,Pediatric Dentistry Departement 2009.](https://reader034.fdocuments.us/reader034/viewer/2022051314/55180b415503469b438b45c2/html5/thumbnails/9.jpg)
Primary Incisors
![Page 10: PASSIVE SPACE CONTROL Dr S.E. Jabbarifar;Isfahan Dental School,Pediatric Dentistry Departement 2009.](https://reader034.fdocuments.us/reader034/viewer/2022051314/55180b415503469b438b45c2/html5/thumbnails/10.jpg)
Primary Incisors
![Page 11: PASSIVE SPACE CONTROL Dr S.E. Jabbarifar;Isfahan Dental School,Pediatric Dentistry Departement 2009.](https://reader034.fdocuments.us/reader034/viewer/2022051314/55180b415503469b438b45c2/html5/thumbnails/11.jpg)
Primary Incisors
Why replace primary incisors?
Primarily for esthetic reasons
Rarely see long-term effects on speech development and function
Once 1o cuspids have erupted in occlusion the anterior arch length is established
![Page 12: PASSIVE SPACE CONTROL Dr S.E. Jabbarifar;Isfahan Dental School,Pediatric Dentistry Departement 2009.](https://reader034.fdocuments.us/reader034/viewer/2022051314/55180b415503469b438b45c2/html5/thumbnails/12.jpg)
Primary Incisors
Problems with replacement:
Appliances are weak
High maintenance – close monitoring req’d
Frequent alterations as dentition changes
Appliance may enhance caries risk
![Page 13: PASSIVE SPACE CONTROL Dr S.E. Jabbarifar;Isfahan Dental School,Pediatric Dentistry Departement 2009.](https://reader034.fdocuments.us/reader034/viewer/2022051314/55180b415503469b438b45c2/html5/thumbnails/13.jpg)
Primary Incisors
![Page 14: PASSIVE SPACE CONTROL Dr S.E. Jabbarifar;Isfahan Dental School,Pediatric Dentistry Departement 2009.](https://reader034.fdocuments.us/reader034/viewer/2022051314/55180b415503469b438b45c2/html5/thumbnails/14.jpg)
Primary Incisors
![Page 15: PASSIVE SPACE CONTROL Dr S.E. Jabbarifar;Isfahan Dental School,Pediatric Dentistry Departement 2009.](https://reader034.fdocuments.us/reader034/viewer/2022051314/55180b415503469b438b45c2/html5/thumbnails/15.jpg)
Primary Incisors
![Page 16: PASSIVE SPACE CONTROL Dr S.E. Jabbarifar;Isfahan Dental School,Pediatric Dentistry Departement 2009.](https://reader034.fdocuments.us/reader034/viewer/2022051314/55180b415503469b438b45c2/html5/thumbnails/16.jpg)
Primary Incisors
![Page 17: PASSIVE SPACE CONTROL Dr S.E. Jabbarifar;Isfahan Dental School,Pediatric Dentistry Departement 2009.](https://reader034.fdocuments.us/reader034/viewer/2022051314/55180b415503469b438b45c2/html5/thumbnails/17.jpg)
Primary Canine
Loss due to trauma or caries – rareSpace maintainer: B&L vs. RPD
Must be removed to accommodate lateral
No space maintainer: Midline shift Lingual collapse in mandible
![Page 18: PASSIVE SPACE CONTROL Dr S.E. Jabbarifar;Isfahan Dental School,Pediatric Dentistry Departement 2009.](https://reader034.fdocuments.us/reader034/viewer/2022051314/55180b415503469b438b45c2/html5/thumbnails/18.jpg)
Premature loss of primary molars
![Page 19: PASSIVE SPACE CONTROL Dr S.E. Jabbarifar;Isfahan Dental School,Pediatric Dentistry Departement 2009.](https://reader034.fdocuments.us/reader034/viewer/2022051314/55180b415503469b438b45c2/html5/thumbnails/19.jpg)
Band-loop space maintainer
Indications: Unilateral loss of the 1st primary molar before
eruption of the 1st permanent molar
Unilateral loss of the 1st or 2nd primary molar after eruption of the 1st permanent molar
Bilateral loss of the 1st primary molars before eruption of the permanent incisors and 1st permanent molars
Bilateral loss of the 2nd primary molars after eruption of the 1st permanent molar
![Page 20: PASSIVE SPACE CONTROL Dr S.E. Jabbarifar;Isfahan Dental School,Pediatric Dentistry Departement 2009.](https://reader034.fdocuments.us/reader034/viewer/2022051314/55180b415503469b438b45c2/html5/thumbnails/20.jpg)
Early loss of the 1st primary molar
![Page 21: PASSIVE SPACE CONTROL Dr S.E. Jabbarifar;Isfahan Dental School,Pediatric Dentistry Departement 2009.](https://reader034.fdocuments.us/reader034/viewer/2022051314/55180b415503469b438b45c2/html5/thumbnails/21.jpg)
Early loss of the 2nd primary molar
![Page 22: PASSIVE SPACE CONTROL Dr S.E. Jabbarifar;Isfahan Dental School,Pediatric Dentistry Departement 2009.](https://reader034.fdocuments.us/reader034/viewer/2022051314/55180b415503469b438b45c2/html5/thumbnails/22.jpg)
Other indications
Deflection of succedaneous tooth
![Page 23: PASSIVE SPACE CONTROL Dr S.E. Jabbarifar;Isfahan Dental School,Pediatric Dentistry Departement 2009.](https://reader034.fdocuments.us/reader034/viewer/2022051314/55180b415503469b438b45c2/html5/thumbnails/23.jpg)
Band-loop space maintainer
FABRICATION & DESIGN
![Page 24: PASSIVE SPACE CONTROL Dr S.E. Jabbarifar;Isfahan Dental School,Pediatric Dentistry Departement 2009.](https://reader034.fdocuments.us/reader034/viewer/2022051314/55180b415503469b438b45c2/html5/thumbnails/24.jpg)
Band-loop fabrication
Technique: Properly fitting band on abutment tooth
(pg. 389 – Pinkham) Segmental impression
(compound/alginate) Remove band from tooth & secure in
impression Create working model
![Page 25: PASSIVE SPACE CONTROL Dr S.E. Jabbarifar;Isfahan Dental School,Pediatric Dentistry Departement 2009.](https://reader034.fdocuments.us/reader034/viewer/2022051314/55180b415503469b438b45c2/html5/thumbnails/25.jpg)
Band-loop fabrication
Sectional impression tray
Green or red compound
![Page 26: PASSIVE SPACE CONTROL Dr S.E. Jabbarifar;Isfahan Dental School,Pediatric Dentistry Departement 2009.](https://reader034.fdocuments.us/reader034/viewer/2022051314/55180b415503469b438b45c2/html5/thumbnails/26.jpg)
Band-loop fabrication
![Page 27: PASSIVE SPACE CONTROL Dr S.E. Jabbarifar;Isfahan Dental School,Pediatric Dentistry Departement 2009.](https://reader034.fdocuments.us/reader034/viewer/2022051314/55180b415503469b438b45c2/html5/thumbnails/27.jpg)
Band-loop fabrication
![Page 28: PASSIVE SPACE CONTROL Dr S.E. Jabbarifar;Isfahan Dental School,Pediatric Dentistry Departement 2009.](https://reader034.fdocuments.us/reader034/viewer/2022051314/55180b415503469b438b45c2/html5/thumbnails/28.jpg)
Band-loop fabrication
![Page 29: PASSIVE SPACE CONTROL Dr S.E. Jabbarifar;Isfahan Dental School,Pediatric Dentistry Departement 2009.](https://reader034.fdocuments.us/reader034/viewer/2022051314/55180b415503469b438b45c2/html5/thumbnails/29.jpg)
Band-loop design
Loop should be wide enough bu-li to allow eruption of bicuspid (8 mm)
Loop should not restrict physiologic movement of adjacent teeth (eg. lateral movement of primary canine)
![Page 30: PASSIVE SPACE CONTROL Dr S.E. Jabbarifar;Isfahan Dental School,Pediatric Dentistry Departement 2009.](https://reader034.fdocuments.us/reader034/viewer/2022051314/55180b415503469b438b45c2/html5/thumbnails/30.jpg)
Band-loop design
Loop should not impinge on soft tissue
Loop should be in close approximation to ridge
![Page 31: PASSIVE SPACE CONTROL Dr S.E. Jabbarifar;Isfahan Dental School,Pediatric Dentistry Departement 2009.](https://reader034.fdocuments.us/reader034/viewer/2022051314/55180b415503469b438b45c2/html5/thumbnails/31.jpg)
Band-loop cementationApply floss ligatureTry-in / seat band
completelyLoop should contact
abutment below contact point
No soft tissue impingement
Cementation in properly isolated, dry field
Check/adjust occlusion
![Page 32: PASSIVE SPACE CONTROL Dr S.E. Jabbarifar;Isfahan Dental School,Pediatric Dentistry Departement 2009.](https://reader034.fdocuments.us/reader034/viewer/2022051314/55180b415503469b438b45c2/html5/thumbnails/32.jpg)
Try it in first!
![Page 33: PASSIVE SPACE CONTROL Dr S.E. Jabbarifar;Isfahan Dental School,Pediatric Dentistry Departement 2009.](https://reader034.fdocuments.us/reader034/viewer/2022051314/55180b415503469b438b45c2/html5/thumbnails/33.jpg)
Loop impingement
![Page 34: PASSIVE SPACE CONTROL Dr S.E. Jabbarifar;Isfahan Dental School,Pediatric Dentistry Departement 2009.](https://reader034.fdocuments.us/reader034/viewer/2022051314/55180b415503469b438b45c2/html5/thumbnails/34.jpg)
Loop impingement
![Page 35: PASSIVE SPACE CONTROL Dr S.E. Jabbarifar;Isfahan Dental School,Pediatric Dentistry Departement 2009.](https://reader034.fdocuments.us/reader034/viewer/2022051314/55180b415503469b438b45c2/html5/thumbnails/35.jpg)
Loop impingement
![Page 36: PASSIVE SPACE CONTROL Dr S.E. Jabbarifar;Isfahan Dental School,Pediatric Dentistry Departement 2009.](https://reader034.fdocuments.us/reader034/viewer/2022051314/55180b415503469b438b45c2/html5/thumbnails/36.jpg)
Lingual arch
![Page 37: PASSIVE SPACE CONTROL Dr S.E. Jabbarifar;Isfahan Dental School,Pediatric Dentistry Departement 2009.](https://reader034.fdocuments.us/reader034/viewer/2022051314/55180b415503469b438b45c2/html5/thumbnails/37.jpg)
Lingual arch
Indications:
Bilateral single or multiple tooth loss in mandible
Not recommended when primary incisors still present
![Page 38: PASSIVE SPACE CONTROL Dr S.E. Jabbarifar;Isfahan Dental School,Pediatric Dentistry Departement 2009.](https://reader034.fdocuments.us/reader034/viewer/2022051314/55180b415503469b438b45c2/html5/thumbnails/38.jpg)
Lingual arch
![Page 39: PASSIVE SPACE CONTROL Dr S.E. Jabbarifar;Isfahan Dental School,Pediatric Dentistry Departement 2009.](https://reader034.fdocuments.us/reader034/viewer/2022051314/55180b415503469b438b45c2/html5/thumbnails/39.jpg)
Lingual arch design
Archwire should rest on cingulae of incisors 1-1.5 mm above gingival margin
Removable vs. soldered
![Page 40: PASSIVE SPACE CONTROL Dr S.E. Jabbarifar;Isfahan Dental School,Pediatric Dentistry Departement 2009.](https://reader034.fdocuments.us/reader034/viewer/2022051314/55180b415503469b438b45c2/html5/thumbnails/40.jpg)
Lingual arch design
Solder joint should be in mid-third and parallel to band
Wilson loops
Archwire should be below plane of occlusion posteriorly
![Page 41: PASSIVE SPACE CONTROL Dr S.E. Jabbarifar;Isfahan Dental School,Pediatric Dentistry Departement 2009.](https://reader034.fdocuments.us/reader034/viewer/2022051314/55180b415503469b438b45c2/html5/thumbnails/41.jpg)
Lingual arch fabrication
Fit molar bands
Compound/alginate impression – accurate especially in lingual sulcus & lower incisor area
![Page 42: PASSIVE SPACE CONTROL Dr S.E. Jabbarifar;Isfahan Dental School,Pediatric Dentistry Departement 2009.](https://reader034.fdocuments.us/reader034/viewer/2022051314/55180b415503469b438b45c2/html5/thumbnails/42.jpg)
Lingual arch fabrication
Secure bands in impression …
…create working model
![Page 43: PASSIVE SPACE CONTROL Dr S.E. Jabbarifar;Isfahan Dental School,Pediatric Dentistry Departement 2009.](https://reader034.fdocuments.us/reader034/viewer/2022051314/55180b415503469b438b45c2/html5/thumbnails/43.jpg)
Lingual arch cementation
Check for passivity on the model and in the mouth before cementation
Archwire should be in contact with lower incisor cingulae
![Page 44: PASSIVE SPACE CONTROL Dr S.E. Jabbarifar;Isfahan Dental School,Pediatric Dentistry Departement 2009.](https://reader034.fdocuments.us/reader034/viewer/2022051314/55180b415503469b438b45c2/html5/thumbnails/44.jpg)
Lingual arch cementation
Dry field
GI or polycarboxylate cement
No soft tissue impingement
![Page 45: PASSIVE SPACE CONTROL Dr S.E. Jabbarifar;Isfahan Dental School,Pediatric Dentistry Departement 2009.](https://reader034.fdocuments.us/reader034/viewer/2022051314/55180b415503469b438b45c2/html5/thumbnails/45.jpg)
Transpalatal arch
![Page 46: PASSIVE SPACE CONTROL Dr S.E. Jabbarifar;Isfahan Dental School,Pediatric Dentistry Departement 2009.](https://reader034.fdocuments.us/reader034/viewer/2022051314/55180b415503469b438b45c2/html5/thumbnails/46.jpg)
Transpalatal arch
Rarely recommended for bilateral tooth loss in maxilla
Can prevent mesio-palatal rotation of palatal root of Mx 1st permanent molar but allows mesial tipping of molars & space loss
![Page 47: PASSIVE SPACE CONTROL Dr S.E. Jabbarifar;Isfahan Dental School,Pediatric Dentistry Departement 2009.](https://reader034.fdocuments.us/reader034/viewer/2022051314/55180b415503469b438b45c2/html5/thumbnails/47.jpg)
Transpalatal arch
May have an indication for use when one side of the arch is intact but several primary teeth are missing contralaterally
Some designs incorporate omega loop: when active can prevent bodily movement of molars
![Page 48: PASSIVE SPACE CONTROL Dr S.E. Jabbarifar;Isfahan Dental School,Pediatric Dentistry Departement 2009.](https://reader034.fdocuments.us/reader034/viewer/2022051314/55180b415503469b438b45c2/html5/thumbnails/48.jpg)
Nance arch
![Page 49: PASSIVE SPACE CONTROL Dr S.E. Jabbarifar;Isfahan Dental School,Pediatric Dentistry Departement 2009.](https://reader034.fdocuments.us/reader034/viewer/2022051314/55180b415503469b438b45c2/html5/thumbnails/49.jpg)
Nance arch
Used commonly in maxilla for bilateral tooth loss
Incorporates acrylic button in contact with palate to prevent molars from tipping
Can be very unhygenic
![Page 50: PASSIVE SPACE CONTROL Dr S.E. Jabbarifar;Isfahan Dental School,Pediatric Dentistry Departement 2009.](https://reader034.fdocuments.us/reader034/viewer/2022051314/55180b415503469b438b45c2/html5/thumbnails/50.jpg)
Nance arch
![Page 51: PASSIVE SPACE CONTROL Dr S.E. Jabbarifar;Isfahan Dental School,Pediatric Dentistry Departement 2009.](https://reader034.fdocuments.us/reader034/viewer/2022051314/55180b415503469b438b45c2/html5/thumbnails/51.jpg)
Nance arch fabrication
Bands fitted on molars
Mx impression in compound/alginate
Working model
![Page 52: PASSIVE SPACE CONTROL Dr S.E. Jabbarifar;Isfahan Dental School,Pediatric Dentistry Departement 2009.](https://reader034.fdocuments.us/reader034/viewer/2022051314/55180b415503469b438b45c2/html5/thumbnails/52.jpg)
Nance arch fabrication
Archwire will traverse the palatal vault
![Page 53: PASSIVE SPACE CONTROL Dr S.E. Jabbarifar;Isfahan Dental School,Pediatric Dentistry Departement 2009.](https://reader034.fdocuments.us/reader034/viewer/2022051314/55180b415503469b438b45c2/html5/thumbnails/53.jpg)
Nance arch fabrication
Adapted archwire is soldered to bands
Acrylic button is added to embed the wire
![Page 54: PASSIVE SPACE CONTROL Dr S.E. Jabbarifar;Isfahan Dental School,Pediatric Dentistry Departement 2009.](https://reader034.fdocuments.us/reader034/viewer/2022051314/55180b415503469b438b45c2/html5/thumbnails/54.jpg)
Nance arch fabrication
Completed arch ready for try-in and cementation
Ensure acrylic button in firm contact with palate
![Page 55: PASSIVE SPACE CONTROL Dr S.E. Jabbarifar;Isfahan Dental School,Pediatric Dentistry Departement 2009.](https://reader034.fdocuments.us/reader034/viewer/2022051314/55180b415503469b438b45c2/html5/thumbnails/55.jpg)
Crown-loop space maintainer
![Page 56: PASSIVE SPACE CONTROL Dr S.E. Jabbarifar;Isfahan Dental School,Pediatric Dentistry Departement 2009.](https://reader034.fdocuments.us/reader034/viewer/2022051314/55180b415503469b438b45c2/html5/thumbnails/56.jpg)
Crown-loop space maintainer
Indications:
As for band-loop
Abutment tooth requires full coverage SSC due to multi-surface caries or pulp treatment
![Page 57: PASSIVE SPACE CONTROL Dr S.E. Jabbarifar;Isfahan Dental School,Pediatric Dentistry Departement 2009.](https://reader034.fdocuments.us/reader034/viewer/2022051314/55180b415503469b438b45c2/html5/thumbnails/57.jpg)
Crown-loop fabrication
Abutment tooth prepared for SSCProperly contoured SSC seated, but not
cementedCompound impressionSSC placed into impressionWorking modelAnother SSC fitted and cemented with
temporary cement
![Page 58: PASSIVE SPACE CONTROL Dr S.E. Jabbarifar;Isfahan Dental School,Pediatric Dentistry Departement 2009.](https://reader034.fdocuments.us/reader034/viewer/2022051314/55180b415503469b438b45c2/html5/thumbnails/58.jpg)
Crown-loop space maintainer
![Page 59: PASSIVE SPACE CONTROL Dr S.E. Jabbarifar;Isfahan Dental School,Pediatric Dentistry Departement 2009.](https://reader034.fdocuments.us/reader034/viewer/2022051314/55180b415503469b438b45c2/html5/thumbnails/59.jpg)
Crown-loop space maintainer
![Page 60: PASSIVE SPACE CONTROL Dr S.E. Jabbarifar;Isfahan Dental School,Pediatric Dentistry Departement 2009.](https://reader034.fdocuments.us/reader034/viewer/2022051314/55180b415503469b438b45c2/html5/thumbnails/60.jpg)
Crown-loop space maintainer
![Page 61: PASSIVE SPACE CONTROL Dr S.E. Jabbarifar;Isfahan Dental School,Pediatric Dentistry Departement 2009.](https://reader034.fdocuments.us/reader034/viewer/2022051314/55180b415503469b438b45c2/html5/thumbnails/61.jpg)
Crown-loop cementation
Temporary SSC removed, under LA if necessary
Try-in crown-loop to verify loop contours
Cementation in dry field
![Page 62: PASSIVE SPACE CONTROL Dr S.E. Jabbarifar;Isfahan Dental School,Pediatric Dentistry Departement 2009.](https://reader034.fdocuments.us/reader034/viewer/2022051314/55180b415503469b438b45c2/html5/thumbnails/62.jpg)
Crown-loop space maintainer
Disadvantages:
If solder joint fails, there is no way to repair the appliance without entire re-make
Cost is higher (extra SSC)
![Page 63: PASSIVE SPACE CONTROL Dr S.E. Jabbarifar;Isfahan Dental School,Pediatric Dentistry Departement 2009.](https://reader034.fdocuments.us/reader034/viewer/2022051314/55180b415503469b438b45c2/html5/thumbnails/63.jpg)
Band-loop over SSC
Band can be fitted over SSC as alternative to crown-loop
![Page 64: PASSIVE SPACE CONTROL Dr S.E. Jabbarifar;Isfahan Dental School,Pediatric Dentistry Departement 2009.](https://reader034.fdocuments.us/reader034/viewer/2022051314/55180b415503469b438b45c2/html5/thumbnails/64.jpg)
Bonded space maintainer
Difficult to retain due to shearing forces of occlusion
Flexure in function will de-bond
Difficult to adjust
![Page 65: PASSIVE SPACE CONTROL Dr S.E. Jabbarifar;Isfahan Dental School,Pediatric Dentistry Departement 2009.](https://reader034.fdocuments.us/reader034/viewer/2022051314/55180b415503469b438b45c2/html5/thumbnails/65.jpg)
Removable appliances
Indicated for mulitple primary tooth loss when no suitable abutment teeth exist
Need to restore occlusal function over longer span
Clasping difficult for primary teeth therefore retention a problem
Compliance issues
![Page 66: PASSIVE SPACE CONTROL Dr S.E. Jabbarifar;Isfahan Dental School,Pediatric Dentistry Departement 2009.](https://reader034.fdocuments.us/reader034/viewer/2022051314/55180b415503469b438b45c2/html5/thumbnails/66.jpg)
Removable appliances
![Page 67: PASSIVE SPACE CONTROL Dr S.E. Jabbarifar;Isfahan Dental School,Pediatric Dentistry Departement 2009.](https://reader034.fdocuments.us/reader034/viewer/2022051314/55180b415503469b438b45c2/html5/thumbnails/67.jpg)
INTRA-ALVEOLAR SPACE MAINTENANCE
D362/QP362
Division of Orthodontics and Paediatric Dentistry
2004-2005
Karen M. Campbell, DDS
![Page 68: PASSIVE SPACE CONTROL Dr S.E. Jabbarifar;Isfahan Dental School,Pediatric Dentistry Departement 2009.](https://reader034.fdocuments.us/reader034/viewer/2022051314/55180b415503469b438b45c2/html5/thumbnails/68.jpg)
Premature loss of the 2nd primary molar
If the 1st permanent molar is erupted, can use conventional B & L from 6 to D
![Page 69: PASSIVE SPACE CONTROL Dr S.E. Jabbarifar;Isfahan Dental School,Pediatric Dentistry Departement 2009.](https://reader034.fdocuments.us/reader034/viewer/2022051314/55180b415503469b438b45c2/html5/thumbnails/69.jpg)
Premature loss of the 2nd primary molar
Band & loop from D to 6
Difficult to band D’s
![Page 70: PASSIVE SPACE CONTROL Dr S.E. Jabbarifar;Isfahan Dental School,Pediatric Dentistry Departement 2009.](https://reader034.fdocuments.us/reader034/viewer/2022051314/55180b415503469b438b45c2/html5/thumbnails/70.jpg)
Indications for intra-alveolar space
maintenance
Premature loss of the 2nd primary molar prior to the eruption of the 1st permanent molar
![Page 71: PASSIVE SPACE CONTROL Dr S.E. Jabbarifar;Isfahan Dental School,Pediatric Dentistry Departement 2009.](https://reader034.fdocuments.us/reader034/viewer/2022051314/55180b415503469b438b45c2/html5/thumbnails/71.jpg)
Contraindications
Medically compromised:
Cardiac patients requiring SBE prophylaxis
Immunosuppression
Chemotherapy/radiation therapy, pre-BMT
Demonstrated lack of commitment to follow-up
![Page 72: PASSIVE SPACE CONTROL Dr S.E. Jabbarifar;Isfahan Dental School,Pediatric Dentistry Departement 2009.](https://reader034.fdocuments.us/reader034/viewer/2022051314/55180b415503469b438b45c2/html5/thumbnails/72.jpg)
Distal Shoe
Provides a guiding plane for the eruption of the 1st permanent molar
![Page 73: PASSIVE SPACE CONTROL Dr S.E. Jabbarifar;Isfahan Dental School,Pediatric Dentistry Departement 2009.](https://reader034.fdocuments.us/reader034/viewer/2022051314/55180b415503469b438b45c2/html5/thumbnails/73.jpg)
Dentist’s responsibility
Mark on the working model the distal terminus of the appliance
![Page 74: PASSIVE SPACE CONTROL Dr S.E. Jabbarifar;Isfahan Dental School,Pediatric Dentistry Departement 2009.](https://reader034.fdocuments.us/reader034/viewer/2022051314/55180b415503469b438b45c2/html5/thumbnails/74.jpg)
Dentist’s responsibility
Provide measurement from radiograph
Mark depth of shoe with cut on model
Shoe should be 1 mm below mes marginal ridge of the 1st permanent molar
![Page 75: PASSIVE SPACE CONTROL Dr S.E. Jabbarifar;Isfahan Dental School,Pediatric Dentistry Departement 2009.](https://reader034.fdocuments.us/reader034/viewer/2022051314/55180b415503469b438b45c2/html5/thumbnails/75.jpg)
Completed appliance
![Page 76: PASSIVE SPACE CONTROL Dr S.E. Jabbarifar;Isfahan Dental School,Pediatric Dentistry Departement 2009.](https://reader034.fdocuments.us/reader034/viewer/2022051314/55180b415503469b438b45c2/html5/thumbnails/76.jpg)
Immediate insertion
Follows extraction – can better visualize placement of shoe
Area already anesthetized
eliminates potential for 1st permanent molar drift
![Page 77: PASSIVE SPACE CONTROL Dr S.E. Jabbarifar;Isfahan Dental School,Pediatric Dentistry Departement 2009.](https://reader034.fdocuments.us/reader034/viewer/2022051314/55180b415503469b438b45c2/html5/thumbnails/77.jpg)
Cemented appliance
![Page 78: PASSIVE SPACE CONTROL Dr S.E. Jabbarifar;Isfahan Dental School,Pediatric Dentistry Departement 2009.](https://reader034.fdocuments.us/reader034/viewer/2022051314/55180b415503469b438b45c2/html5/thumbnails/78.jpg)
Crown with distal shoe
D prepared for SSC; E to be extracted at later appt
![Page 79: PASSIVE SPACE CONTROL Dr S.E. Jabbarifar;Isfahan Dental School,Pediatric Dentistry Departement 2009.](https://reader034.fdocuments.us/reader034/viewer/2022051314/55180b415503469b438b45c2/html5/thumbnails/79.jpg)
Crown with distal shoe
Segmental impression with crown inserted
![Page 80: PASSIVE SPACE CONTROL Dr S.E. Jabbarifar;Isfahan Dental School,Pediatric Dentistry Departement 2009.](https://reader034.fdocuments.us/reader034/viewer/2022051314/55180b415503469b438b45c2/html5/thumbnails/80.jpg)
Crown with distal shoe
Tooth temporized with SSC
![Page 81: PASSIVE SPACE CONTROL Dr S.E. Jabbarifar;Isfahan Dental School,Pediatric Dentistry Departement 2009.](https://reader034.fdocuments.us/reader034/viewer/2022051314/55180b415503469b438b45c2/html5/thumbnails/81.jpg)
Crown with distal shoe
![Page 82: PASSIVE SPACE CONTROL Dr S.E. Jabbarifar;Isfahan Dental School,Pediatric Dentistry Departement 2009.](https://reader034.fdocuments.us/reader034/viewer/2022051314/55180b415503469b438b45c2/html5/thumbnails/82.jpg)
Crown with distal shoe
Extraction of the E and preparation for cementation
![Page 83: PASSIVE SPACE CONTROL Dr S.E. Jabbarifar;Isfahan Dental School,Pediatric Dentistry Departement 2009.](https://reader034.fdocuments.us/reader034/viewer/2022051314/55180b415503469b438b45c2/html5/thumbnails/83.jpg)
Crown with distal shoe
Cementation Confirmation by radiograph
![Page 84: PASSIVE SPACE CONTROL Dr S.E. Jabbarifar;Isfahan Dental School,Pediatric Dentistry Departement 2009.](https://reader034.fdocuments.us/reader034/viewer/2022051314/55180b415503469b438b45c2/html5/thumbnails/84.jpg)
![Page 85: PASSIVE SPACE CONTROL Dr S.E. Jabbarifar;Isfahan Dental School,Pediatric Dentistry Departement 2009.](https://reader034.fdocuments.us/reader034/viewer/2022051314/55180b415503469b438b45c2/html5/thumbnails/85.jpg)
Following eruption of the 1st permanent molar
Distal shoe no longer appropriate – 1st permanent molar may tip mesially above shoe
Parents must be aware of need for second appliance from the beginning
Conventional B & L or lingual arch may be required
![Page 86: PASSIVE SPACE CONTROL Dr S.E. Jabbarifar;Isfahan Dental School,Pediatric Dentistry Departement 2009.](https://reader034.fdocuments.us/reader034/viewer/2022051314/55180b415503469b438b45c2/html5/thumbnails/86.jpg)
Drawbacks of the appliance
Can only replace a single tooth due to its cantilever design
Inherent lack of strengthCannot restore occlusal functionD’s are very difficult to fit bandsEpithelium perforated in area of distal
shoe