Success rates and failures of fixed and removable space maintainers after the premature loss of primary molars.

OBJECTIVE: The evidence base for the use of space maintainers is relatively sparce despite being used for decades after the premature loss of primary molars. This study aims to increase the dental evidence base via investigating retrospectively the success rates of prefabricated fixed and removable space maintainers inserted from 2019 to 2021 and followed up until February 2023 at a specialized university clinic and to identify reasons for any reported minor and major failure. The authors hypothesized that there is no significant difference in failure rates between fixed and removable space maintainers inserted after the premature loss of a single primary molar per quadrant. METHOD AND MATERIALS: Patients' digital records were searched yielding 645 space maintainers. After the application of inclusion criteria, 157 (67%) fixed prefabricated space maintainers in 112 children and 77 (33%) removable space maintainers in 61 children were analyzed for an average of 18.4 ± 9.5 months. RESULTS: Kaplan-Meier survival analysis with Mantel-Cox statistics showed an overall cumulative survival time of 31.6 months (SE = 1.15, 95% CI = 29.4 to 33.9). Major failure occurred significantly more in removable maintainers (n = 40/67, 59.7%), mostly due to loss of the appliance, compared to fixed space maintainers (n = 27/67, 40.3%; P < .001). The present study indicates that space maintainers were mainly placed in young children with high caries experience, where treatment was mostly possible using advanced behavior management. CONCLUSIONS: Fixed space maintainers had a significantly lower failure rate than their removable counterpart. However, both require continual repairs, preservation, or even replacement till the eruption of the permanent tooth.

Arm design of band and loop space maintainer affects its longevity: a patient-specific finite element study.

Fixed space maintainers (FSMs) are commonly utilized in pediatric dentistry to prevent space loss following premature tooth extraction. Although previous studies have examined the survival rates and causes of FSM failure, the impact of arm design on failure has not been investigated. This study aimed to investigate the tensile and compressive stresses related to FSMs with different arm designs and evaluate the effect of arm designs on FSM failure. Cone beam computed tomography images of a child who experienced premature loss of a primary mandibular left second molar tooth were retrieved from our database, then processed and simulated using the Rhinoceros software. Finite element analysis was performed to evaluate the stresses on four distinct FSM arm designs under simulated chewing forces. The results showed that the straight-arm FSM design exhibited the highest von Mises principal stress, while FSMs with curved arms and surrounding primary mandibular left first molar in the mesial area demonstrated the lowest von Mises stress accumulation. Intense stress accumulation on the distal surface of tooth 74 was observed in the test models due to the transmitted forces by the FSM. The maximum principal stresses accumulated at the base of the alveolar socket of the mesial root of tooth 36, while the minimum principal stresses were identified at the mesio-marginal area of the alveolar crest. The arm design played a crucial role in enabling the appliance to effectively withstand the stresses accumulating on the Space maintainer (SM) and orthodontic band. Bending the SM arms to match the surrounding profile with curvature increased the stress absorption capacity by increasing the arm length.

Effects of Fixed and Removable Space Maintainers on Dental Plaque and DMFT/dft Values / Efecto de los mantenedores de espacio fijos y removibles en la placa dental y en los valores de los índices DMFT/dft

ABSTRACT: Purpose: Space maintainers are important for the health and placement of children's primary and permanent teeth. However, plaque and caries levels can be negatively affected when a dental appliance is in the mouth. This study aims to evaluate the oral health of pediatric patients that have space maintainers applied as a result of early tooth loss. Methods: This study included 100 systemically healthy patients between the ages of 4-15 years that were treated with space maintainers due to early loss of teeth. Decayed, missing, filled tooth index values and dental plaque status of the participants were recorded. Controls were performed in the 6th and 12th month. The index results were compared and evaluated statistically using ANOVA and paired-t-tests. Results: A total of 116 space maintainers, including 36 band and loops, 16 lingual arches, 21 palatal arches, 43 removable appliances, were evaluated in the study. Statistically significant differences were found between the pre-treatment and post-treatment index values (p<0.001). In the group of band and loops and removable space maintainers; the increases in DMFT/dft values of 6th month and 12th month according to initial DMFT/dft values were statistically significant (p<0.05). For plaque index, the increase in 12th month of all types of appliances were found statistically significant (p<0.001). The greatest increase in plaque index level was seen in the teeth of patients that had been treated with a lingual arch. Conclusions: Incompatible space maintainers can lead to caries, increased plaque accumulation, demineralized areas, and periodontal problems. The accumulation of plaque and difficulty of cleaning the teeth, especially in the fixed space maintainers, negatively affects the health of teeth. For this reason, good oral hygiene should be provided to patients and controls should be regularly performed.

RESUMEN: Los mantenedores de espacio son importantes para la salud y la colocación de la dentición primaria y permanente de los niños. Sin embargo, los niveles de placa y caries pueden verse afectados negativamente cuando se coloca un aparato dental en la boca. Este estudio tiene como objetivo evaluar la salud bucal de pacientes pediátricos a los que se les aplicó mantenedores de espacio como resultado de la pérdida temprana de los dientes. Métodos: Este estudio incluyó a 100 pacientes sistémicamente sanos entre las edades de 4 a 15 años que fueron tratados con mantenedores de espacio debido a la pérdida temprana de dientes. Se anotaron los valores del índice de dientes cariados, faltantes y el estado de la placa dental. Los controles se realizaron en el 6° y 12° mes. Los resultados del índice se compararon y evaluaron estadísticamente mediante ANOVA y pruebas t pareadas. Resultados: Un total de 116 mantenedores de espacio, incluyendo 36 bandas y bucles, 16 arcos linguales, 21 arcos palatinos, 43 dispositivos removibles, fueron evaluados en el estudio. Se encontraron diferencias estadísticamente significativas entre los valores de los índices en el pretratamiento y postratamiento (p<0.001). En el grupo de bandas, bucles y mantenedores de espacio removibles los aumentos en los valores de DMFT/ dft en el sexto mes y el 12º mes fueron estadísticamente significativos (p<0.05). Para el índice de placa, el aumento en el 12º mes de todos los tipos de aparatos se encontró estadísticamente significativo (p<0,001). El mayor aumento en el nivel del índice de placa se observó en los pacientes que habían sido tratados con un arco lingual. Conclusiones: los mantenedores de espacio pueden provocar caries, aumento de la acumulación de placa, áreas desmineralizadas y problemas periodontales. La acumulación de placa y la dificultad de limpiar los dientes, especialmente en los mantenedores de espacio fijos, afecta negativamente la salud dental. Por esta razón, se debe proporcionar una buena higiene bucal a los pacientes y se deben realizar controles regularmente.

The effect of fiber-reinforced composite versus band and loop space maintainers on oral Lactobacillus acidophilus and Streptococcus mutans levels in saliva.

BACKGROUND: Orthodontic bands have been shown to alter oral microbial flora that lead to convert caries-free patients to moderate or high caries risk individuals. AIM: This study aimed to evaluate the effect of conventional band and loop space maintainers versus fiber-reinforced composite (FRC) resin space maintainer on the salivary cariogenic microflora (Lactobacillus and Streptococcus mutans) in children over a period of 6 months. MATERIALS AND METHODS: The study sample was divided equally into two groups: Group A: 25 patients received FRC (INFIBRA®: Reinforcing ribbon, Bioloren, Italy) space maintainer and Group B: 25 patients received band and loop space maintainers. The saliva samples were collected from the patients before the insertion of the space maintainer and at 2 weeks, 3 months, and 6 months postinsertion. RESULTS AND CONCLUSION: The Lactobacillus acidophilus isolated was 1.7 colony-forming unit (CFU) (×106) and 1.8 CFU (×106) in Group A and Group B, respectively, prior to the insertion of space maintainers. There was no significant increase in L. acidophilus over the follow-up of 6 months in both the groups (P > 0.05). However, the Streptococcus mutans isolated before insertion in both Group A and Group B was 2.6 CFU (×106), which over a period of 6 months showed significant increase to 3.13 CFU (×106) in Group B (P < 0.05) and no increase was seen in Group A. S. mutans level increased considerably in patients with band and loop space maintainer over the follow-up of 6 months. No significant increase in the L. acidophilus count was observed over the same period in both the groups.

Methods of space maintenance for premature loss of a primary molar: a review.

AIM: This critical appraisal attempts to answer the question: What is the best method of space maintenance (SM) following premature loss of a primary molar in children under 12 years old? METHODS: A search to identify studies relevant to the PICO was conducted. Single case reports and studies prior to 1986 were excluded. The principles of GRADE were followed to appraise the evidence. RESULTS: 20 studies were identified, which evaluated 2265 space maintainers (SMs). Two studies were graded high quality, four moderate, eight low, and six very low. All studies reported on longevity outcomes and most on adverse effects. CONCLUSIONS: There was no strong evidence favouring a particular SM, the following recommendations were made: (a) strong recommendations: In cases where rubber dam cannot be used clinicians should not use Glass Fibre Reinforced Composite Resin (GFRCR) SMs. (b) Weak recommendations: Crown and Loop SMs are recommended for loss of primary first molars; GFRCR SMs (placed under rubber dam) are recommended for loss of primary second molars. Bilateral SMs may have questionable efficacy and their use where there is loss of multiple molars in the same quadrant should be weighed against the risk of unwanted tooth movements, loss of a removable SM or no space maintenance at all.

Space maintainers in the primary and mixed dentition - a clinical guide.

This paper describes different types of space maintainers and the clinical situations where they may be useful, for example, when primary teeth have been lost prematurely. It serves as a clinical guide for practitioners on the best types of space maintainers to use and on the clinical uses of space maintainers in preventing undesirable tooth movements and resulting loss of arch length.

Evaluation of Skeletal and Dental Effects of Lower Lingual Arches.

OBJECTIVE: A lower lingual arch is usually recommended as a holding device to maintain arch length and to prevent mesial migration of the mandibular first molars. Despite its widespread use, comparatively little is known about the effects of a lower lingual holding arch on preservation of lower arch dimensions and tooth position and the impact of the device on mandibular growth. The aim of this study is to evaluate the skeletal and dental effects of the lower lingual holding arch with regard to arch dimension, positions of mandibular molars and incisors, and usual mandibular growth. STUDY DESIGN: Thirty-four children (18 males and 16 females) who needed space maintainers were included in the present study. The patients were divided into two groups according to whether they were missing second primary molars on one or both sides. Group I comprised 16 children (8 males and 8 females, average age 8.8 ± 0.9 years) with a missing second primary molar on one side; Group II comprised 18 children (10 males and 8 females, average age 8 ± 0.7 years) with extractions on both sides. Lateral cephalograms, dental pantomograms, and study casts of the patients were taken at the beginning and the end of the study period. Average treatment time was 20.4 ± 4 months. RESULTS: Lower incisors moved forward and Incisor Mandibular Plane Angle (IMPA°) increased in both treatment groups. Statistically significant differences between the groups were found when comparing pre-treatment and post-treatment arch dimension and position of mandibular molars. Results were better for lingual arches with extraction on one side than with extraction on both sides Conclusions: A lingual arch seems to be an effective tool for maintaining arch length, and was not found to impair mandibular growth.

Relative positional change of a dental implant in the esthetic zone after 12 years: a case report.

Although the biological process of osseointegration is similar in adults and adolescents, implant placement is contraindicated in young patients until bone growth is complete. However, even in adults, significant craniofacial changes may occur over an individual's lifetime, as a result of discrete and continuous dental eruption, vertical soft tissue augmentation, or facial bone growth. After such changes, implants may be in infraocclusion. The present case report describes the long-term follow-up of a dental implant located in the esthetic zone. The implant, placed when the patient was 20 years old, demonstrated a relative positional change 12 years postinsertion. The possible reasons for the movement and the long-term clinical implications of this type of case are discussed.

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

BACKGROUND: 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. AIM: 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. MATERIALS AND METHODS: 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. STATISTICAL ANALYSIS: 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. RESULT: 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. CONCLUSION: At different time intervals, the total numbers of bacterial count of Streptococcus mutans were comparatively higher, followed by Lactobacillus sp. and Candida albicans.

The Hawlix: a simple and aesthetic prosthetic- orthodontic retainer.

This report introduces the Hawlix, a hybrid thermoformed and cold-cured retainer. It was developed to overcome the limitations that modified Hawley retainers possess when used in patients with bounded saddles, attributable to dental trauma or hypodontia. The Hawlix can be used as an intermediate retainer while a patient is waiting to receive restorative treatment. Some of the advantages of the Hawlix over the modified Hawley retainer include: superior aesthetics, cost-effectiveness, ease of manufacture, adequate resistance to fracture, preservation of a residual ridge, and precise space maintenance.

A Modified Nance Palatal Arch for the Treatment of Ectopically Erupting Permanent First Molars.

Permanent teeth that remain impacted could lead to the early loss of primary teeth and cause space problems in dental arches. We present two cases of ectopic eruption of the permanent maxillary first molars treated with soft distal movements using a modified Nance palatal arch (NPAm). The wire was soldered to the band and positioned distally to serve as support for the elastic chain, which was attached to a bonded button on the occlusal surface. After a few months, the ectopic eruption was corrected, preserving the adjacent primary teeth and restoring the occlusion. An NPAm is a viable option for distalization and space recovery in the maxillary arch.

Prótesis fija con sistema tubo-barra en odontopediatría: reporte de un caso clínico de 12 meses de seguimiento / Fixed prosthesis with tube-bar system in pediatric dentistry: a case report over 12 months of follow-up

Introducción: La pérdida prematura de incisivos primarios puede producir alteraciones estéticas, funcionales y psicológicas. La rehabilitación protésica permite reemplazar los dientes faltantes y evitar las secuelas que ello puede acarrear. Objetivo Describir la técnica y evolución clínica de una prótesis fija anterior tipo Denari durante 12 meses de seguimiento. Descripción del caso Paciente de sexo femenino de 3 años de edad que acude en busca de atención profesional posterior a la avulsión de los incisivos centrales superiores. Con la finalidad de devolver la estética del sector anterosuperior, recuperar la función oral e interferir con el hábito de interposición lingual se decidió realizar una terapia basada en prótesis parcial fija tipo Denari. Durante el año de seguimiento la prótesis fue muy bien tolerada por la paciente y sin alteración de los tejidos blandos adyacentes, destacando un aumento en el espacio interincisal, lo que demuestra el crecimiento transversal. Conclusión La prótesis dental en niños es una tarea exigente, marcada por la necesidad de adaptación a los cambios continuos que conllevan los procesos de crecimiento y maduración de complejo maxilofacial. En este contexto es que la prótesis tipo Denari con sistema tubo-barra es una excelente y estética alternativa en pacientes de corta edad en donde la prótesis va a permanecer en la boca por un largo período de tiempo, sin interferir en el crecimiento, desarrollo y función del sistema estomatognático.

Introduction: Premature loss of primary incisors may result in aesthetic, functional and psychologic problems. Prosthetic restoration allows replacing missing teeth, avoiding the unwanted consequences that their absence may carry. Objective The aim of this clinical case is to describe the technique and clinical evolution of a Denari fixed anterior prosthesis over 12 months of follow-up. Case description 3 year-old female patient sought professional attention after the avulsion of the upper central incisors. In order to restore the natural appearance of the anterior superior area, recover oral function and intervene in the habit of tongue interposition, the treatment decided upon was a partially fixed Denari prosthesis. During the follow-up year the prosthesis was very well tolerated by the patient and without altering any adjacent soft tissues. We highlight an increase in the interincisal space, which demonstrates transversal growth. Conclusion A dental prosthesis in a child is a demanding task marked by the need to adapt to the continuous changes brought about by maxillofacial growth and maturation. It is in this context that the Denari prosthesis with its tube-bar system is an excellent and esthetic alternative in young patients where the prosthesis is going to remain in place for a prolonged period without interfering in the growth, development and function of the stomatognatic system.

Follow-up problems with fixed appliances in pediatric dentistry.

Fixed appliances are commonly used in managing early orthodontic problems. Despite their widespread use, they have the potential to impinge on the soft tissues, interfere with the eruption of adjacent teeth and become dislodged or broken. These two case reports present the poor outcomes of fixed appliance treatments if the patient fails to attend follow-up appointments. A successful outcome of treatment with fixed appliances depends upon proper patient selection and the communication skills of the dentist to help patients/parents understand the importance of regular checkups.

[Evaluation of clinical efficiency of various space maintainers in premature loss of deciduous molars].

The paper presents the results of two years observation of clinical application of three variants of space maintainers in early primary molars loss. Sixty-five children aged 6-12 years were included in the study. The most common problems when using fixed space maintainers is a deformation of intermediate part seen in 58.3% of children when applying crown (ring) with bracer. Support elements debonding at stabilizing devise fixed directly to tooth enamel is registered in 49.6% of children. Cementation releasing of support elements is observed by the application of crown (ring) with bracer at 45.8% of children.

Clinical success and longevity of band and loop compared to crown and loop space maintainers.

AIM: To prospectively evaluate the success and survival rates of band and loop (B&L) compared to crown and loop (C&L) space maintainers. METHODS: Thirty-six children were divided into two groups (18 B&Ls and 18 C&Ls) matched for gender, age and the extracted tooth. For the study group, all clinical procedures were performed by the same paediatric dentist. Regular follow-up appointments were scheduled at 4-6 months. Comparisons in survival time and variables which might have affected the mean survival time were tested using Log rank and Chi-square tests. RESULTS: A total of 16 girls and 20 boys (3.4-6.3 years old) were included. The overall failure rate was 53 %. For B&Ls, the failure rate was 83 % compared to 22 % for C&Ls. The main reason for failure of B&Ls was decementation (87 %), while for C&Ls, it was solder breakage (75 %). The mean survival time for B&Ls was 18.8 months, and for C&L, it was 40.4 months (p < 0.001). CONCLUSIONS: The failure rate and mean survival time for C&Ls were clinically and statistically significantly better than those for B&Ls. Depending on the clinical presentation of the abutment tooth and the intended life expectancy of the space maintainer among other factors, it is recommended that, where a space maintainer is indicated in the primary dentition, preference is given to C&L over B&L space maintainers.

Caries recurrence after treatment under general anaesthesia for early childhood caries: a retrospective cohort study.

AIM: To evaluate rates of caries relapse and explore factors affecting relapse rates after comprehensive dental treatment under general anaesthesia (GA). METHODS: A retrospective cohort study of children ≤6 years of age at the time of reference GA (RGA) who were in an anaesthetic low risk category [American Society of Anesthesiologists (ASA) classification 1 or 2], and had completed 36 months follow-up period was conducted. Patients' demographics and dental records were collected. Associations between relapse rate and different factors affecting relapse rates were evaluated. RESULTS: A total of 278 children with mean age of 47 ± 14 months were included. Over 8 % of children had more than one GA, 88 % attended their post-operative follow-up appointment and 45 % returned for all recall appointments over 3 years. During the 3-year follow-up, the relapse rate was 22 %. ASA-2 children and those with less than full primary dentition present at the RGA were more than twice as likely to experience caries relapse as compared to ASA-1 children (OR = 2.46, 95 % CI 1.33-4.56) and those with mixed dentition present at the RGA (OR = 2.74, 95 % CI 1.27-5.91). CONCLUSION: ASA-2 health status and having less than a full primary dentition were major predictors of caries relapse after dental treatment under GA.

Multiple Radiolucencies of the Jaws in a 6 Year Old.

Radiolucencies of the jaws are a common finding. Mostly, they are isolated findings associated with inflammatory processes and consistent with inflammatory periapical disease, such as periapical cysts and periapical granulomas. If associated with the crowns of unerupted teeth, they may represent dentigerous cysts. However, occasionally, larger lytic/radiolucent lesions are identified; even more infrequently, these radiographic findings may be multiple and concurrent. The purpose of this report is to present the case of a 6-year-old female patient with no known concomitant syndrome who presented with multiple intraoral swellings and to discuss the treatment of multiple, bilateral mandibular and maxillary radiolucencies.