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PubMed2006

Free-end space maintainers: design, utilization and advantages.

Primary molars are a determining factor in the development of occlusion. Given their importance, when restorative treatment is notfeasible and a primary molar must be extracted, the practitioner should keep in mind the risk of losing space, and the consequent malocclusion. Preservation of the space can eliminate or reduce the needforprolonged orthodontic treatment. For that reason, there are various kinds of space maintainers and the pediatric dentist must decide which one to utilize, on the basis of general and local factors related to the child In the selection of a treatment option for space maintenance, the greatest complications occur when the first permanent molar has not yet erupted A large variety of appliances have been devised to deal with this situation. This article proposes the use of a removable space maintainer that is open on one end and can be employed to guide the first permanent molar, maintaining the integrity of the mucous membrane and serving as a prosthetic appliance, preventing the complications and contraindications often caused by sub-gingival maintainers.

Child↗

PubMedDate not supplied

Success of reinforced fiber material space maintainers.

PURPOSE: Various space maintainers are used in pediatric dentistry. However, their construction requires time-consuming laboratory procedures. Recently, fiber-reinforced composites (FRC) have been introduced and used in different branches of dentistry. The objective of this study was to assess long-term results for a newly developed space maintainer as an alternative procedure for practitioners. METHODS: This study used Splint-it (Jeneric/Pentron, Wallingford, Conn), a FRC, to prepare a newly developed space maintainer chairside in 1 appointment. A total of 40 space maintainers were applied to 29 children (14 girls, 15 boys) between 7 to 14 years old (mean +/- SD = 10 years, 1 month +/- 1 year, 11 months) to protect the space of their early extracted first and second primary molar teeth. For 4 children, space maintainers were prepared with artificial teeth to restore the anterior teeth loss, which occurred due to trauma. To protect the space until the fixed partial dentures were constructed, 5 space maintainers were applied to 3 children who had 2 permanent first molar teeth extracted. Appliances were observed for up to 2 years. RESULTS: Twenty-nine (73%) space maintainers were dislodged at the end of the sixth month. The space maintainers placed on primary teeth (1 or both abutments) showed the highest failure rate (94%). CONCLUSIONS: This study suggested that Splint-it space maintainers can be accepted as successful appliances only for short periods. Prolonged use of this material for space maintenance in children must be further evaluated.

Adolescent↗

PubMedDate not supplied

[Hawley appliance and its clinical use].

The authors presented considerations on the Hawley appliance, describing its main characteristics and modifications. It is also showed the advantages of its use, as well as its main indications: a) slight tooth inclinations and rotations; b) extrusion of posterior teeth; c) space maintener and d) as retention after orthodontic treatment.

Child↗

PubMed1998

Lingual arch appliance fabrication in the dental office.

Lingual arch is a mandibular fixed bilateral space maintaining appliance. It prevents the first permanent molar from drifting forward and preserves the available space, especially the leeway space in mixed dentition cases. The purpose of the present article is to present a simplified way of lingual arch appliance fabrication in the dental office, which will result in effective space maintenance and time savings for both the patient and the dentist.

Dental Arch↗

PubMed1991

Traumatic avulsion of the mandibular right primary lateral incisor and cuspid.

Premature loss of the primary mandibular cuspid has been considered rare. When this occurs, however, space maintenance should be considered to prevent distal drifting of the lateral incisor. The purpose of this case report was to document traumatic avulsion of the mandibular right lateral and cuspid. A lingual arch appliance with a spur was fabricated to maintain space and prevent movement of the mandibular incisors. Sequelae of premature loss of primary teeth is presented.

Child, Preschool↗

PubMed1999

Ectopic eruption of maxillary canine and premolars: case report.

This article presents a case of ectopic eruption of permanent teeth in the maxilla in the late mixed dentition. The authors advocate early diagnosis of ectopic eruption with a closer follow-up during the transition from primary to permanent dentition and space maintenance, as a way to avoid active orthodontic treatment for alignment ectopic erupted teeth.

Bicuspid↗

PubMed1989

[Long-term observation of patients with trauma of the lower anterior primary teeth].

Three patients who had had trauma of the lower primary central incisors at the age of 1.5 years or less were observed with regard to the IIIB and/or IVA after eruption of the permanent dentition, and the findings were discussed from the viewpoint of space control. Patient 1 suffered shedding and loss of A perpendicular A following a fall downstairs at the age of 1.5 years. Measurement of the distance between B perpendicular B teeth revealed a tendency toward space closure and decrease until the age of 4 years and 6 months. At the age of 5 years and 11 months, the space was greater than that at the age of 4.5 years. The patient was also found to have brownish, partially parenchymatous defects of the permanent dentition, which were considered to be a sequela. Patient 2 suffered dislocation of A perpendicular A and root exposure at the age of 1 year and 1 month, and received treatment involving restoration and fixation for a 10-day period using a resin splint. Because of a fistula at the apical region of A and a discolored brown with internal resorption revealed by roentgenography, which were observed at the age of 4 years and 10 months, tooth extraction was performed and the course was observed with local space maintenance. When the patient was 6 years and 4 months old, eruption of 1 perpendicular 1 and hypoplasia of the labial surface were recognized. Since it proved possible to preserve A perpendicular A until the patient was 4 years old, the course was observed without any decrease in space until permanent dentition was accomplished. Patient 3 suffered shedding and loss of A perpendicular A at the age of 8 months. When the patient was 1 year and 3 months old, eruption of B perpendicular B occurred with mesial inclination. At the ages of 2 years and 7 months and 6 years and 4 months the patient underwent treatment with a space retainer and eruption of 1 perpendicular 1, respectively, without association of abnormal findings on the labial surface, probably because crown formation of 1 perpendicular 1 had not yet occurred due to the trauma suffered by the patient.(ABSTRACT TRUNCATED AT 400 WORDS)

Humans↗

PubMed2005

Preventive and interceptive orthodontic treatment needs of an inner-city group of 6- and 9-year-old Canadian children.

OBJECTIVE: Early recognition of developing malocclusions and the potential for uncomplicated orthodontic treatment procedures can minimize or eliminate future costly treatment. This study was designed to assess the potential for this approach in children living in a limited-income environment. A modified index for preventive and interceptive orthodontic needs (IPION) was used to determine the need for such treatment in schoolchildren aged 6 and 9 years. METHODS: Two calibrated examiners examined each child independently and assessed several components of his or her occlusion, including molar relationship, crossbite, open bite, overbite and overjet. Dental variables such as presence of caries and early loss of teeth were also noted. Informed consent was obtained and all children present at school on the day of the field study were included. A total of 395 children were divided into 2 groups, aged 6 and 9 years. RESULTS: A high prevalence of caries in the deciduous dentition (30.4% for 6 year olds; 20.6% for 9 year olds) and early loss of primary teeth (11.9% for 6 year olds; 29.4% for 9 year olds) was observed. A large percentage of children had crossbite in the anterior or posterior segments, or both. Open bites were also a common finding. Future orthodontic problems were identified in 28% of this population by using the modified IPION. No statistically significant differences (p > 0.05) were found between sexes or age groups using the chi2 test. CONCLUSIONS: Most of the developing malocclusions identified in this study would be amenable to interceptive orthodontics, consisting of space maintenance, crossbite correction and arch expansion.

Child↗

PubMedDate not supplied

Radiographic success of ferric sulfate and formocresol pulpotomies in relation to early exfoliation.

PURPOSE: The purpose of this retrospective study was to evaluate the radiographic findings with formocresol and ferric sulfate pulpotomies in relation to early tooth loss. METHODS: Vital pulpotomies with either ferric sulfate or formocresol, performed by faculty members between 1992 and 2002 at The University of Iowa, were evaluated retrospectively. Radiographic criteria were established to assess success or failure of the treated tooth. This was then correlated with time of tooth loss and space management. RESULTS: Eighty-five molars, followed between 6 to 61 months, met the inclusion criteria. Of these, 15 (43%) teeth treated with ferric sulfate, 23 (56%) treated with formocresol, and 5 (55%) treated with a combination of ferric sulfate and formocresol remained free of any radiographic pathology. Overall, 13% of the pulpotomized teeth were prematurely lost due to abscess formation and in need of space management. Regardless of the treatment type, internal root resorption was the most common cause of premature exfoliation. CONCLUSIONS: Both ferric sulfate and formocresol pulpotomies can lead to premature exfoliation of primary teeth, with the subsequent need for orthodontic space maintenance. Therefore, radiographic criteria should be taken into consideration when evaluating pulpotomized teeth at recall visits.

Alveolar Bone Loss↗

PubMed1983

Influence of tooth-to-denture-base discrepancy on space closure following premature loss of deciduous teeth.

Influence of tooth-to-denture-base discrepancy on so-called physiologic migration of the first molar was studied on serial dental casts of 116 boys and girls, obtained through a dental health program for school children in an area in which there was no dentist. The alteration of spaces following premature loss of deciduous molars was examined comparing the anterior to posterior discrepancies between tooth and denture base. Modes of space alteration showed positive correlation with the size of the discrepancy, especially in the mandibular dental arches. The space deficiency in the posterior region seemed to have a positive effect on the mesial migration of the first molar. Mesial migration of the first molar seems to be pathologic rather than physiologic and is strongly affected by tooth-to-denture-base discrepancies. Space maintenance does not seem to be useful, because it is not necessary in minimum discrepancy cases and is not effective in severe discrepancy cases.

Adolescent↗

PubMed2001

Stainless steel crown bridge replacing permanent molar in the adolescent patient: a case report.

The loss of a permanent molar in young adolescent patient creates a need for early space maintenance and restoration of function. To establish function and esthetics short-term treatments include interim restorative approaches. This paper describes a functional, cost-effective stainless steel crown bridge as an interim restoration after the loss of permanent first molar in an early adolescent dentition.

Acrylic Resins↗

PubMedDate not supplied

An alternative restorative method for regional odontodysplasia: case report.

A 5-year-old Caucasian male presented with early loss of multiple deciduous teeth. All the characteristics were consistent with the diagnosis of regional odontodysplasia (ROD). Significant initial findings included premature loss of multiple primary mandibular teeth and some malformed permanent teeth. The affected teeth showed hypoplastic enamel and dentin, short roots, and wide pulp chambers, and were localized in the mandibular dentition. Treatment objectives for this patient were to provide improved esthetics, restored chewing function, and space maintenance by the construction of a temporary prosthetic restoration. However, with limited tooth support and an unusual occlusal pattern, it is difficult to obtain satisfactory retention and esthetics with traditional prosthetic techniques. In this article we introduce an alternative method for fabricating a custom removable denture and discuss the prognosis of the malformed permanent dentition and further treatment plan.

Child, Preschool↗

PubMed2006

Loss of space and changes in the dental arch after premature loss of the lower primary molar: a longitudinal study.

The purpose of the study was to evaluate the space changes, dental arch width, arch length and arch perimeter, after the unilateral extraction of lower first primary molar in the mixed dentition period. A longitudinal study was conducted among forty children in the age group of 6-9 years, who reported for extraction of lower first primary molar in the department of Pedodontics, Govt. Dental College, Trivandrum. Study models were made from alginate impression taken before extraction and after extraction at the periodical intervals of two months, four months, six months and eight months. The mesiodistal width of lower first primary molar of the non-extracted side was taken as the control. The results of the study showed statistically significant space loss in the extraction side ( P value < 0.01) and no significant space loss in the control side (P value > 0.05). The rate of loss was greatest in the first four months. The arch width, arch length and arch perimeter had no significant change from initial to eight months follow up. The present study challenges the use of a space maintenance under the circumstances of premature loss of mandibular primary molar for preventing space loss.

Cephalometry↗

PubMed2003

Periodontal repair in dogs: gingival tissue occlusion, a critical requirement for GTR?

BACKGROUND: Design criteria for guided tissue regeneration (GTR) devices include biocompatibility, cell occlusion, space maintenance, tissue integration, and ease of use. Previous studies have established the importance of wound stabilization and space provision during the early healing sequel for successful GTR outcomes as well as evaluated biocompatibility, tissue integration, and clinical manageability of various biomaterials. The importance of cell or tissue occlusion has yet to be established. The objective of this study was to evaluate the role of tissue occlusion as a critical determinant for GTR outcomes. METHODS: Routine, critical size, 5-6 mm, supra-alveolar, periodontal defects were created around the mandibular premolar teeth in six young adult Beagle dogs. Space-providing expanded polytetrafluoroethylene (ePTFE) membranes, with (macroporous) or without (occlusive) 300- microm laser-drilled pores, 0.8 mm apart, were implanted to provide for GTR. Treatments were randomly assigned to left and right jaw quadrants in subsequent animals. The gingival flaps were advanced to cover the membranes and sutured. The animals were euthanized at 8 weeks postsurgery for histologic and histometric analysis. RESULTS: Three animals experienced wound failure within 2-3 weeks postsurgery resulting in exposure and removal of the occlusive ePTFE membranes. All defect sites, irrespective of membrane configuration or history of membrane exposure and removal, exhibited substantial evidence of periodontal regeneration including a functionally oriented periodontal ligament. To evaluate the biologic potential of GTR devices, only animals without wound failure and membrane removal were included. Alveolar bone regeneration for animals receiving occlusive and macroporous ePTFE membranes averaged (+/-sd) 3.2+/-1.1 versus 2.0+/-0.4 mm (p=0.3113). Cementum regeneration was enhanced in defect sites receiving the occlusive ePTFE membrane compared to the macroporous membrane (4.7+/-0.4 versus 2.3+/-0.2 mm; p=0.0167). Ankylosis was observed in one animal. Limited root resorption was observed in a second animal. CONCLUSION: Tissue occlusion does not appear to be a critical determinant for GTR. However, tissue occlusion may be a requirement for optimal GTR. Moreover, macroporous space-providing devices may increase the predictability of clinical GTR therapy.

Alveolar Bone Loss↗

PubMed1998

Sodium space and intravascular volume: dietary sodium effects in cystic fibrosis and healthy adolescent subjects.

OBJECTIVE: To assess the physiologic response to salt depletion in subjects with cystic fibrosis (CF) and control male adolescents for sodium balance, sodium space, and stimulation of the renin-angiotensin-aldosterone axis. DESIGN: Seven subjects with CF and six controls received a salt-replete (150 or 290 mmol NaCl per day) diet and then a salt-deplete (10 mmol NaCl per day) diet while in a clinical research center. RESULTS: Space maintenance: CF subjects responded to salt depletion with a greater weight loss than did controls (1.9 vs 0.8 kg) and a decrease in 24Na+ space, whereas controls maintained 24Na+ space. Paired (Na-deplete/Na-replete) blood volumes decreased in subjects with CF, but not in controls. Renin-angiotensin-aldosterone axis stimulation: During salt repletion, subjects with CF had significantly higher aldosterone values than did controls in the afternoon, but not at 7:00 AM. During salt depletion, plasma renin activity and aldosterone increased significantly more in subjects with CF than in controls (renin, 35 vs 13 ng/mL/hour [9.7 vs 3.6 ng.L-1 s-1]; aldosterone: 181 vs 101 ng/dL [5021 vs 2802 pmol/L]). Furthermore, the angiotensin antagonist saralasin increased renin much more in subjects with CF (154 vs 36 ng/mL per hour [43 vs 10 ng.L-1 s-1]). Vasomotor functions: Mean arterial pressure was decreased in subjects with CF on both diets and decreased significantly more with low salt only in subjects with CF. During salt depletion, subjects with CF showed enhanced orthostatic tolerance (less heart rate increase with standing) compared with controls, thus obscuring their volume loss. The blood pressure response to an acute infusion of saralasin suggested that in salt-replete subjects with CF, but not in controls, angiotensin receptors were functional in maintaining vascular tone. During salt depletion, angiotensin was more important for maintenance of blood pressure in subjects with CF than in controls, because the saralasin-induced drop in blood pressure was 20%, ie, close to shock levels, in subjects with CF, and only 6% in controls. CONCLUSION: The data suggest that patients with CF are so successful in compensating for volume depletion by vigorous activation of the renin-angiotensin system that salt depletion/dehydration cannot be recognized easily by routine clinical measurements, eg, capillary refill, serum sodium levels, or tachycardia.

Adolescent↗

PubMed2002

Histological assessment of augmented jaw bone utilizing a new collagen barrier membrane compared to a standard barrier membrane to protect a granular bone substitute material.

Successful bone augmentation requires predictable space maintenance and adequate exclusion of those cells that lack osteogenetic potential from the defect area. Natural bone mineral is considered to be osteoconductive and is used as space maker in combination with membrane barrier techniques. The aim of this study was to compare qualitative histological results achieved by using deproteinized bovine bone mineral (DBBM) as a space maintainer and a new collagen barrier (Ossix, test group) vs. the same bone substitute and the standard e-PTFE membrane (Gore-Tex), control group). Twenty-eight patients were randomly assigned to the test or the control group. Seven months after augmentation procedures, biopsies were obtained at reentry and were analysed histomorphometrically. In all, 14 specimens of group I (test group, Ossix) and 13 specimens of group II (controls, PTFE-membranes) showed close qualitative similarity of their histologies. Histomorphometrically, total mineralized bone area was 42% +/- 18% in group I vs. 39% +/- 15% in group II. The unmineralized tissue area was 44% +/- 15% vs. 46% +/- 12% and the area of DBBM remnants 14% +/- 9% and 15% +/- 12%, respectively. The differences were statistically nonsignificant (Mann-Whitney test). The occurrence of barrier exposure did not interfere with the histological outcome either in the test or in the control group. The new collagen barrier combined with the DBBM provided qualitative bone regeneration comparable to the standard e-PTFE material combined with the same mineral.

Absorbable Implants↗

PubMed1985

Maintaining the quality of laboratory services in a cost-containment environment.

Cutting costs while maintaining quality requires a very complete understanding of laboratory medicine and laboratory management. The pathologist must take the lead in maximizing the usefulness of laboratory information, while minimizing costs of labor, reagents, send-outs, equipment, maintenance, space, and overhead. Consideration is given to evaluation of alternative laboratory arrangements, streamlining of quality control, and monitoring and optimizing laboratory utilization, in cooperation with the clinician.

Cost Control↗

PubMed2006

Orthodontic treatment provided by general dentists who have achieved master's level in the Academy of General Dentistry.

INTRODUCTION: The purposes of this study were to document orthodontic treatment currently provided by general dentists for comparison with past and future studies and to ascertain variables that influence practitioners' orthodontic treatment patterns. METHODS: A 21-item survey was mailed to 750 master's level members of the Academy of General Dentistry. Surveys returned within 8 weeks were included for statistical analysis. RESULTS: The response rate was 62%. Most practitioners spent less than 10% of their practice time providing orthodontic treatment and reported that this would not change in the future. Many provided orthodontic treatment in the permanent dentition, and the most common conditions or malocclusions treated were space maintenance, anterior crossbite, rotation, habits, molar uprighting, and posterior crossbite. The most common orthodontic appliances used were removable Hawley appliances with finger springs, straight wire orthodontic therapy, rapid palatal expanders, and functional appliances. CONCLUSIONS: The number of general dentists providing comprehensive orthodontic treatment has not changed since previous surveys; practitioners also do not expect a change in the next 5 years. Factors that influenced the orthodontic treatment provided included the primary source of orthodontic training, the number of orthodontic continuing education hours earned per year, the practitioner's location, and the proximity to the nearest orthodontist.

Adult↗