Fixed Space Maintainer Research Articles

Assessment of Periodontal Parameters Following the Use of Fixed and Removable Space Maintainers in 6-12-year Olds.

ABSTRACTAimPlacement of fixed space maintainer (FSM) and removable space maintainer (RSM) may increase the risk of gingivitis in children. This study aimed to assess the effect of using FSMs and RSMs on periodontal parameters in 6–12-year olds.Materials and methodsThis interventional prospective study was conducted on systemically healthy 6–12-year olds (mean age of 8 years) presenting at the Department of Pediatrics, Tehran University requiring space maintainers. The probing pocket depth (PPD), bleeding on probing (BOP), and gingival index (GI) were recorded at the baseline and 6 months after using space maintainers in the abutment teeth in patients with fixed space maintainers and in the tooth with the Adams clasp in children with removable space maintainers as well as the same teeth in the opposing jaw/quadrant as controls.ResultsA significant increase in PPD was noted in distolingual and mesiolingual sites at 6 months after placement of FSM (p < 0.05). This increase was not significant for RSM at any site. A significant increase in GI and BOP was also noted at 6 months after placement of FSM and RSM (p < 0.05). Caries index did not show a significant change in FSM but caries index significantly increased following the use of RSM.ConclusionBOP and GI increase following placement of FSM and RSM, and PPD increases in distolingual and mesiolingual areas of the banded tooth.How to cite this articleHosseinipour ZS, Poorzandpoush K, Heidari A, et al. Assessment of Periodontal Parameters Following the Use of Fixed and Removable Space Maintainers in 6–12-year Olds. Int J Clin Pediatr Dent 2019;12(5):405–409.

Case report: A novel, fixed chairside space maintainer

Introduction: To prevent the dental arch deficiency after untimely loss of primary teeth, a space maintainer is employed. Space maintainers currently in use like band and loop are considered a non-aesthetic appliance. Light Cured Acrylic Resins LCAR are commonly utilized in dental practice. They provide the essential mechanical and physical properties with the necessary characteristics to be used in diverse functions in dentistry. Aim: To provide an aesthetic alternative space maintainer after premature extraction of second primary molar. Case Description: An eight-year-old healthy boy reported with a recently missing lower left second primary molar. A pink color sheet of LCAR Triad® VLC (Custom Tray) product was used to construct a space maintainer. After complete examination, full arch isolation was performed using rubber dam and suction. Both the abutment teeth were cleaned with pumice slurry and then etched with 35% orthophosphoric acid for 30 seconds for primary first molar and 20 seconds for the permanent first molar. The teeth were rinsed, air-dried, and wetted with an adhesive that was light-cured for 20 seconds. A thin layer of flowable composite was applied to the buccal surfaces of the abutment teeth without light-curing it. The cut length of LCAR was placed over the flowable composite extending from the buccal aspect of permanent first molar to buccal aspect of the primary second molar. The ends of the LCAR were adapted to the teeth surfaces with a plastic instrument. The composite and LCAR was light-cured for 2 minutes. for each end of LCAR.Conclusion: This case report showed that the Light Cure Acrylic Resin space maintainers can be a new alternative to the traditionally fixed space maintainers used in pediatric dentistry.

Assessment of salivary microbial parameters with two types of fixed space maintainers in children

Purpose: The originality of the present study was to evaluate caries risk factors with salivary microbial parameters in a population of children with two types of fixed space maintainers. Methods: The study sample was divided equally into two groups; group A: twelve child received EZ space maintainer; group B: twelve child received band and loop space maintainers. The samples were collected before the insertion of the space maintainer and 2 weeks after its insertion. Results: There was no statistically significant difference between (EZ/Lacto) (0.36 × 103 ± 0.68× 103) and (Band & Loop /Lacto) (4.38× 103± 7.78× 103) where (p=0.165). There was no statistically significant difference between (EZ / Strept) (1.38 × 103 ± 3.22× 103) and (Band & Loop Strept) (5.42× 103± 12.75× 103) where (p=0.488). There was no statistically significant difference between (EZ) (0.87×103 ± 1.80× 103) and (Band & Loop) (4.90× 103± 7.17× 103) where (p=0.112). Conclusions: Both EZ space maintainer and band and loop space maintainer increase bacteria count insignificantly. EZ space maintainer can be used as alternative to conventional band and loop space maintainer.

The Longevity of Band and Loop and Pontic–Crown Fixed Space Maintainers in Children Aged 4 to 7 Years: A Randomized Controlled Trial

Introduction: The best way to prevent malocclusion and reduce the length of the arch in cases of early loss of primary teeth is placement of space maintainer. The aim of the present study was to compare the longevity of band and loop space maintainer with that of pontic–crown space maintainer. Materials and Methods: In this randomized control trial, 40 children aged 4 to 7 years, admitted to Isfahan School of Dentistry, were studied using convenient sampling method. They were randomly assigned into intervention and control groups. In the control group, the stainless steel crown (SSC) was fitted to the second primary molar tooth (E), and after laboratory stages, band and loop were cemented on the SSC. In the intervention group, a suitable SSC was fitted to the second primary molar tooth, and the molding was performed with alginate. After the laboratory procedure, the crown–pontic complex was cemented on the tooth. Both groups were followed-up every 6 months and the longevity of both space maintainers was examined for 18 months. Data were analyzed by Chi-square test, Kaplan–Meier survival analysis, and rank logarithm test. Results: Within 18 months, four cases of decementation were seen in the band and loop group: two cases in the first 6 months (P = 0.487), one case in the second 6 months (P = 0.474), and one case in the third 6 months (P = 0.472); no loss due to decementation was observed in the crown–pontic group. There was only one treatment failure due to loss of solder that happened in the crown–pontic group during the second 6 months (P = 1). Four failures in the band and loop group and one failure in the crown–pontic group showed no significant difference between two groups in terms of frequency of failure (P = 0.152, Kaplan–Meier survival analysis). Conclusion: Pontic–crown space maintainer is a suitable alternative for band and loop space maintainer in treating the early loss of primary molars.

Effects of fixed and removable space maintainers on halitosis.

BackgroundThe current study evaluated the effects of fixed and removable space-maintainers on halitosis and oral health of children.MethodsForty-three patients randomly selected between the ages 4–10 whom fixed or removable space maintainers were indicated in Gazi University, Faculty of Dentistry, Department of Pedodontics. The inclusing criteria were: caries-free (with/without restorations), with absence of periodontal diseases, without systematic disease, no mouth breathing and no use of antibiotics the 2-months period before the study. The patients were subdivided into two groups: the group treated with fixed space maintainers (group 1, n = 27), the group treated with removable space maintainers (group 2, n = 16). The the plaque index (PI), gingival index (GI), periodontal screening index (PSI), tongue coating index (TCI) records and the halitosis measurements were obtained at three time periods (T1: immediately after application, T2: 1 week after application, T3: 5 weeks after application). The measurement values of T1 served as control.ResultsNo statistically significant difference was found in the PI, GI, PSI, TCI and halitosis measurements between T1–T2, T2–T3 and T1–T3 in both appliance groups and between the groups (p > 0.05).ConclusionsThe fixed and removable space maintainers did not affect oral health status and halitosis significantly.

Shear Bond Strength of Intraoral Laser Welding and its Effect on Intrapulpal Temperature Rise in Primary Teeth: An in Vitro Study.

This study compared the shear bond strength (SBS) of conventional welding (CW) and intraoral laser welding (LW) on fixed space maintainers (SMs), and investigated the intrapulpal temperature change (ITC) during LW. Lasers have been used for intraoral welding. The SBS test used 26 molar bands divided into two groups, CW and LW. Stainless steel wires were welded to the middle of the buccal and lingual aspects of all the bands, using an Nd:YAG laser for the LW group and silver solder and flux soldering media for the CW group. The samples, fixed to acrylic resin blocks, were subjected to shear testing. In the ITC test, 25 exfoliated primary second molar teeth were used to adapt molar bands. J-type thermocouple wire was positioned in the pulp chamber. ITCs were determined during Nd:YAG laser welding of stainless steel wires to the bands. Mann-Whitney U test was used to determine differences in SBS between the groups. ITCs were analyzed by paired t test. The SBS between groups showed significant differences (LW: 489.47 ± 135.70; CW: 49.71 ± 17.76; p < 0.001). The mean ITC during LW was 3.64 ± 0.79 (min: 2.4; max: 5.10). None of the samples' ITCs exceeded the critical threshold value (5.5 °C). LW obtained a higher-strength joint than CW. ITCs during LW do not present a thermal risk to primary teeth. The intraoral use of LW for SMs in primary teeth is recommended in terms of strength and ITCs.

Modified willet's distal shoe pressure appliance

Prematurely missing primary molars lead to various problems, and space loss is one of them. When primary second molar is lost before the eruption of first permanent molar, it can cause space loss due to mesial drifting. Various distal shoe space maintainers are available, but in bilaterally lost primary second molars it is difficult. Willet's appliance is usually used as a fixed space maintainer, and when the molars are in the soft tissue it is advocated to use pressure appliance to guide the permanent molar in its functional position. In this article fixed pressure appliance, that is, modified Willet's appliance was used successfully in prematurely lost primary mandibular second molars, with 1-year follow-up.

Effect of fixed space maintainers and removable appliances on oral microflora in children: An in vivo study.

Oral habits and caries if left untreated may result in crowding and arch length discrepancy in developing dentition. Therefore, appliances are used to maintain the arch length and for proper relationship between dental arches. However, its insertion may cause an increase in bacterial concentration. This study aimed to evaluate the growth of Streptococcus mutans, Lactobacillus sp., and Candida albicans in saliva during the first 6 months of orthodontic therapy. Twenty children in the age group of 6-15 years were selected with regard to indication of orthodontic treatment, and subsequently grouped as patients to be treated with fixed space maintainers or removable appliances. Unstimulated saliva was collected in a sterile container at baseline and at 1-month, 3-month, and 6-month recalls for every selected child. Samples collected were processed for bacterial culture in different culture media at different time intervals. SPSS (Statistical Package for Social Sciences) Version 15.0 statistical software was carried for bacterial counts. Chi-square test and t-test were performed to know the effects of each variable and to reveal the statistical significance. Bacterial counts of Streptococcus mutans, Lactobacillus sp., and Candida albicans were found to be statistically significant (P 0≤ 0.001), (P < 0.05), and (P < 0.001), respectively in both the groups at all intervals. At different time intervals, the total numbers of bacterial count of Streptococcus mutans were comparatively higher, followed by Lactobacillus sp. and Candida albicans.

Modified Distal Shoe Appliance for Multiple Loss of First and Second Primary Molars.

A 4.5-year-old boy reported to the Department of Pedodontics and Preventive Dentistry complaining of pain and recurrent swelling in lower right back region of the jaw since five days. The patient was well oriented and did not have any contributory medical history. No abnormality was detected in the general and extra-oral examinations. Intra-oral examination revealed that both the mandibular first and second primary molars on the right side (FDI teeth No. 84,85) and the mandibular second primary molar on the left side (FDI tooth No. 75) had deep carious lesions and were judged to be non-restorable. The teeth were tender to palpation. The mandibular first primary molar on the left side (FDI tooth No. 74) had a multi-surface carious lesion not involving the pulp [Table/Fig-1]. The gingival tissue surrounding the first and second primary molars on the right side (FDI teeth No. 84,85) was inflamed and the buccal vestibule slightly obliterated. Radiographic examination revealed a radiolucency involving the furcation of both the mandibular first and second primary molars of the right side (84,85) and the mandibular second primary molar of the left side (75) along with external root resorption. A multi-surface carious lesion, not approaching pulp, was seen on mandibular left primary first molar (74). The mandibular first permanent molars on both sides showed Nolla’s Stage V of tooth development [Table/Fig-2]. In addition, smooth surface caries were seen on upper and lower anteriors. Based on clinical and radiographic examination a diagnosis of apical periodontitis was made and extraction of mandibular left second molar (75) and mandibular right first and second molar (84,85) followed by fabrication of a space maintainer was planned. Parental consent for the same was taken. Study models were obtained and a space analysis (using Huckaba’s method) revealed approximately 2mm of space available per side. The mandibular left primary first molar (74) was restored using a pre-formed stainless steel crown. A 125X0.04mm band was adapted around the mandibular right primary canine. Impressions were made in alginate and models obtained along with the crown and the band on the respective teeth. A 1mm (19 G) Hard Round Stainless Steel (HRSS) wire was used for fabrication of the appliance. The extension of the horizontal and vertical arms was determined using radiographs (after adjusting for the radiographic error). A vertical slit of the desired depth was made on the model and the wire was adapted accordingly. Following adaptation, the wire was soldered to the crown and the band respectively. The mandibular molars indicated for extraction were extracted under local anaesthesia and the appliance was seated in place. Radiographs were taken to check the horizontal and vertical extension of the appliance [Table/Fig-3] and the appliance was then cemented using Type I Glass Ionomer Cement on the same appointment following haemostasis [Table/Fig-4]. The patient was recalled after three days to assess wound repair and stability of appliance. Subsequently the patient was placed on a monthly recall. The recall after 10 months showed erupted permanent first molars [Table/Fig-5,​,6];6]; the space maintainer was well accepted by the child and we were satisfied and optimistic about the future of his dentition. This appliance would be eventually replaced with a bilateral fixed space maintainer like lingual arch following complete eruption of the permanent first molars and incisors.

Mechanical properties of different types of space maintainers

Currently, inside the oral cavity, the dental space maintainers are subjected to forces exerted on them when performing various functions; therefore, it is important to know how each of these mechanisms behave and respond to forces that are applied directly to them. The mechanical properties of the materials used in dentistry are defined by a set of characteristics representing the behaviour of their particular working conditions and it is qualitatively expressed by a number of parameters.The study aimed to determine the pressing force that can be taken by four 4 types of space maintainers frequently used in practice - fixed and removable, applied on four samples realized with human teeth extracted for orthodontic purposes. Static tests were carried out on a machine type short WDW-5 EC with a maximum force of 5 kN and a loading speed of 5 mm/min by a special testing machine, with an innovative appliance; data recording was automatically performed, using a computer with a special program that present the specific diagrams. Experimental determinations included the following aspects: to determine the maximum force that can be supported by each sample, and to observe the deformations. The values obtained indicate that the best option in terms of behavior under the conditions specified is the removable appliance, and the less functional version is the fixed space maintainer using brackets. According to tests conducted, the fracture strength was found to be more important for fixed space maintainers (band and loop, for example) so, in practice is using more frequent these types of space maintainers.

Effects of Fixed and Removable Space Maintainers on Plaque Accumulation, Periodontal Health, Candidal and Enterococcus Faecalis Carriage

Objective: To evaluate the effects of space maintainers on plaque accumulation, periodontal health and oral microflora. Subjects and Methods: The study participants comprised 38 patients aged 4-10 years requiring either fixed or removable space maintainers. Plaque index, gingival index, bleeding on probing index, candidal colonization and Enterococcus faecalis were recorded just before the application of space maintainers (T0) and during treatment at the 1st (T1), 3rd (T2) and 6th (T3) month. Results: The gingival and bleeding on probing index scores increased significantly (gingival index from 0.20 ± 0254 to 0.54 ± 0417 and bleeding on probing index from 7.18 ± 9.946 to 18.07 ± 14.074) in the regions with fixed space maintainers at T3 (p < 0.01). The mean Candida counts also increased (for removable appliances from 1.90 ± 3.638 to 1.98 ± 3.318, p < 0.05, and for fixed appliances from 4.25 ± 4.587 to 4.52 ± 4.431, p < 0.001). The salivary E. faecalis counts at T3 also increased significantly with the use of fixed and removable appliances (for removable appliances from 5.93 ± 2.65 to 85.53 ± 34.1 and for fixed appliances from 4.95 ± 2.94 to 123.59 ± 29.51, p < 0.001). A positive correlation was found between the plaque (r = 0.67), gingival (r = 0.76) and bleeding on probing index scores (r = 0.76) and the candidal colonization for the fixed space maintainers (p < 0.01, p < 0.001). Conclusions: In this study, both fixed and removable space maintainers led to an increase in the number of microorganisms in the oral cavity as well as to increases in the periodontal index scores. Patients should be informed that space maintainers may serve as a source of infection and that special attention must be given to their oral hygiene.

In vitro bond strength and fatigue stress test evaluation of different adhesive cements used for fixed space maintainer cementation.

Objective:The purposes of this research were to (1) compare the shear-peel bond strength (SPBS) of a band of a fixed space maintainer (SM) cemented with five different adhesive cements; and (2) compare the survival time of bands of SM with each cement type after simulating mechanical fatigue stress.Materials and Methods:Seventy-five teeth were used to assess retentive strength and another 50 teeth were used to assess the fatigue survival time. SPBS was determined with a universal testing machine. Fatigue testing was conducted in a ball mill device.Results:The mean survival time of bands cemented with R & D series Nova Glass-LC (6.2 h), Transbond Plus (6.7 h), and R & D series Nova Resin (6.8 h) was significantly longer than for bands cemented with Ketac-Cem (5.4 h) and GC Equia (5.2 h) (P < 0.05).Conclusion:Although traditional glass ionomer cement (GIC) cement presented higher retentive strength than resin-based cements (resin, resin modified GIC, and compomer cement), resin based cements, especially dual cure resin cement (nova resin cement) and compomer (Transbond Plus), can be expected to have lower failure rates for band cementation than GIC (Ketac-Cem) in the light of the results of the ball mill test.

Fixed functional space maintainer: A weight gainer: A case report

Restoration of primary maxillary incisors severely damaged by caries or trauma is a clinical challenge for pedodontist. In the past, the only treatment option would have been to extract the affected teeth and replace them with prosthetic substitutes. Various therapeutic modalities from removable partial dentures to fixed space maintainer can be used for replacement of such lost teeth. The purpose of this paper was to describe the rehabilitation of primary anterior and posterior teeth in a 5-year-old child using fixed functional space maintainer. It constituted a design, whereby the maxillary primary second molars were used to support the appliance through bands and a wire that contained an acrylic flange bearing trimmed acrylic teeth, both anteriorly and posteriorly. The appliance was both functional and aesthetical.

The Nance Obturator, a New Fixed Obturator for Patients with Cleft Palate and Fistula

In patients with fistulas that impair function (e.g., feeding, resonance, intelligibility), obturators are used to improve feeding and reduce nasal air emission by occluding the abnormal opening between the oral and nasal cavities. This report describes a novel method for occluding an anterior palatal fistula in patients with cleft palates. The new design for a fixed obturator is based on the Nance appliance, which was originally used as a space maintainer, but has been redesigned for closing an anterior palatal fistula in a patient with cleft lip and palate. The Nance obturator may be used when the surgical closure of the fistula is not feasible and a removable device is not successful. As it is a fixed device, it does not require remaking with maxillary growth. The new design may also function as a fixed space maintainer to preserve molar anchorage and maxillary transverse width.

Fiber reinforced composite loop space maintainer: An alternative to the conventional band and loop

The stainless steel band and loop appliance is the most commonly used fixed space maintainer in pediatric dentistry. But there are several disadvantages with this appliance such as the need for a cast or a working model, decalcification of the abutment tooth, loosening because of breakage or dissolution of the luting agent, tendency to get embedded in the soft tissue and the possibility of metal allergy. The purpose of this article is to present a simple, laboratory design of a “Fiber Reinforced Composite” (FRC) loop space maintainer and discuss the advantages over the traditional band and loop space maintainers.

Intrusive luxation in primary teeth – Review of literature and report of a case

Luxation injuries such as intrusion are commonly seen in the primary dentition. Intrusion drives the tooth deeper into the alveolar socket, which results in damage to the pulp and peridontium. Difficulty in gaining compliance from a very young child and the risk of damaging the permanent tooth germ makes the management of these injuries challenging. Careful clinical and radiographic examination along with regular follow-up is essential. A case of intrusive luxation to the maxillary central incisor in a 3-year-old patient is reported. Spontaneous reeruption was noted 4months after injury, but the tooth had developed an abscess and external root resorption. Hence, extraction of the tooth was done and an anterior esthetic fixed space maintainer was placed. Traumatic injuries to the primary dentition should not be ignored by the parents or by the dentist. The paper also includes a literature review of intrusive luxation in the primary dentition.

Management of premature loss of primary first molar case with simple fixed space maintainer

Early loss of primary molars may cause a space problem for the arch development.Several techniques have been used to treat this problem. One of the therapies thatcould be used is space maintainer therapy. This paper will explain the management ofpremature loss of mandible primary first molar by using a simple fixed spacemaintainer combined with molar band and resin composite.

SIMPLE FIXED SPACE MAINTAINER BONDED WITH FLOWABLE RESIN COMPOSITE IN PREMATURE LOSS OF MAXILLARY FIRST PRIMARY MOLAR

The premature loss of primary teeth will make the adjacent tooth drift due to the mesial force of the erupting posterior teeth in the growing child. To overcome this problem a space maintainer is needed. But, space maintainer needs to undergo a laboratorial process, which means needing more time and money. This paper reported a case with premature loss of maxillary first primary molar using space maintainer which can be used immediately, easy to do, and need low cost, a simple fixed space maintainer bonded with flowable resin composite.

Periodontal Conditions Associated with Space Maintainers Following Two Different Dental Health Education Techniques

The aim was to investigate the effect of fixed and removable space maintainers on periodontal status of children and to compare the efficiency of verbal and written dental health education. 52 healthy children aged between 7-10 years who will be treated with fixed or removable appliances were divided into two subgroups to whom were given verbal and written dental education. Plaque index, bleeding index and mean pocket depth scores of the teeth were recorded at baseline and 3, 6 and 9 months after application. Plaque, bleeding index and mean pocket depth scores showed significant difference in the appliance groups in the follow-ups. Plaque index scores displayed a positive correlation with the duration of both appliances. The difference between pocket depth scores were found to be significant in the follow-ups in both appliance groups while it was insignificant between education groups and significant increase in bleeding index scores was observed in both appliance groups and education techniques given. It is concluded that both removable and fixed space maintainers can result in inflammation on periodontal tissues of the children.

Fixed Space Maintainers Combined with Open-Face Stainless Steel Crowns

This study investigates the clinical performance of fixed space maintainers placed on seriously damaged abutment teeth. Crowns were placed on damaged abutment primary teeth. Fixed space maintainers were prepared by using rectangular wire between the window in the facial surface of the crowns and other abutment teeth and were subsequently bonded with a flowable resin composite. This procedure was introduced clinically, and the cases were observed over a period of twelve months. Twenty-seven fixed space maintainers (25 on lower jaw, two on upper jaw) were included in this study. No clinical failure was recorded in any of the cases in the observation time, and the rate of clinical performance was 100%. The study shows the effectiveness of fixed space maintainers combined with stainless steel crowns ("open-face fixed space maintainers") which were placed on primary molar teeth used as abutments in cases with extensive caries and loss of occlusogingival dimension.