1. What are the most important things of space maintenance
    • 1. Provider's understanding that they can influence expectations of the patient doctor relationship
    • 2. Provider's understanding that patient's background can influence expectations of the patient/doctor relationship
  2. What is the leeway space?
    The difference between the size of the primary molars and permanent premolars
  3. What is the definition of arch discrepancy?
    Space available-space required= arch discrepancy
  4. What are the potential solutions for crowding?
    • 1. Change space available
    • 2. Change space required
  5. What are the ways that we can change available space?
    • 1. Distalize molars
    • 2. Procline incisors
    • 3. Expand Palate
    • 4. Upright posterior teeth
  6. How can we change space required?
    • 1. Interproximal reduction
    • 2. Extract teeth (single tooth, 4 premolars)
  7. Which primary teeth will we extract to guide the succeeding tooth?
    • Primary canines (C's)
    • 6 months later extract primary first molar
    • Permanent 4 will then be extracted later CD4
  8. How does early loss of incisors usually occur?
    caries or trauma
  9. Which problems occur when incisors are lost early?
    • Minimal arch length loss (except very early loss, no spacing)
    • Minimal impact on masticatory function
    • Potential impact on speech sounds (S,Z, Th)
  10. What usually causes loss of canines?
    Due to ectopic eruption of incisors
  11. What problems are associated with early canine loss
    • No relationship with posterior alignment
    • Accompanied by lateral shift of incisors and midline shift
    • If bilateral, may accompany lingual tipping
  12. How are primary first molars usually lost?
    Usually due to caries
  13. What are some problems with primary first molar loss?
    • Canine and incisor dislocation toward the extraction site
    • Mesial movement of primary second molar
    • mesial eruption of maxillary first premolars
    • No large loss in arch width, length, perimeter
  14. When is space loss reduced after the early loss of the primary first molar?
    • When the permanent first molars erupt
    • Intercuspation reduces space loss
  15. What are the causes of primary second molar loss?
    • Caries
    • sometimes ectopic eruption of permanent first molar
  16. What are some consequences of primary second molar loss?
    • Arch length reduction
    • Blocked out 2nd premolar
  17. When does space loss occur with primary second molars?
    • Space loss often occurs before extraction
    • Greatest loss 4-8 months after extraction
  18. What is the impact of early tooth loss on occlusion?
    • Mandibular effects are worse than maxillary
    • 2nd primary molar has worse effects than 1st
    • Early extraction is worse than later
    • Extraction in crowded arches is worse than in spaced
  19. How does early tooth loss affect alignment and occlusion?
    • Increased likelihood of orthodontic treatment
    • Premature primary incisor and canine loss doesn't affect posterior occlusion
    • Premature loss of primary canines may affect anterior alignment
    • Premature loss of primary molars may affect posterior occlusion
  20. Band and Loop
    • Band cemented around an abutment tooth
    • Fixed unilateral space maintainer
  21. Distal shoe
    • Subgingival extension to keep 1st molar in place
    • fixed unilateral appliance
  22. Lower lingual holding arch
    • Bands cemented around primary second molars or permanent first
    • Wire arch connects molars and contacts mandibular incisors
    • Fixed bilateral space maintainer
  23. Transpalatal arch
    • Bands cemented around primary second molars or permanent first
    • Wire arch connects molars
    • Fixed bilateral space maintainer
  24. Nance holding arch
    • Wire arch connecting molars with acrylic button contacting hard palate
    • Fixed bilateral space maintainer
  25. Groper appliance
    • Mesh bonding base soldered to lingual arch
    • Plastic denture tooth adapted and bonded to mesh base
    • fixed bilateral space maintainer
  26. Removable space maintainers
    • No single classic appliance
    • Need creativity
    • Acrylic holds occlusion and fills the space
Card Set
GDA lecture 10