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Space management in the developing dentition and dental arches

Space management in the developing dentition and dental arches

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  • In orthodontics, preserving the space available in the dental arches for the eruption of the permanent teeth is essential during the development of the dentition in order to minimize eruption problems and ensure that teeth erupt in the best possible position.
  • The space available in the dental arches is affected by the difference in width of the temporary teeth compared to the width of the permanent teeth. It is all in space! To know more.

Adequate supervision and follow-up by the orthodontist through clinical examination supplemented with radiographs will allow early detection of developmental anomalies and eruption problems. When indicated, certain interventions may be recommended to minimize the possible impact of these problems.

A procedure frequently used in orthodontics to help the eruption of the permanent teeth when space is deficient is to extract certain deciduous (temporary) teeth (serial extractions). Sometimes, it is also indicated to use appliances that maintain space in the preventive and interceptive stages of orthodontic supervision. The space maintainer is an appliance that:

Will a space maintainer “prevent having braces”?

It is important to mention again that the orthodontic supervision while a space maintainer is worn must be considered as a preliminary step aimed at facilitating the eruption of the teeth. This intervention does not move or correct teeth to improve their position or alignment.

Lower space maintainer

Serial extractions and the use of a lower space maintainer have helped the permanent teeth erupt in a better position without losing space.

Serial extractions and the use of a lower space maintainer have helped the permanent teeth erupt in a better position without losing space.

 

Removable upper space maintainer

  • The most commonly used upper maintainer is made of acrylic and metallic wires and can be removed by the patient (removable appliance);
  • To be efficient, it must be worn at all times except for eating and tooth brushing;
  • Must be removed to eat and can be removed for certain sports or for a special occasion, such as playing a wind instrument, swimming in a lake, etc.;
  • Adaptation to upper or lower space maintainers is quite fast. After a short period, speech and phonetics are practically normal and no real discomfort is experienced in wearing them if they are adequately adapted to the dentition.

Removable upper space maintainer orthodontic dental appliance

Using a removable upper space maintainer allowed better eruption of the permanent teeth.

Fixed upper space maintainer

Sometimes, it may be indicated to use a fixed maintainer rather than a removable one in the maxillary arch. This may be the case when:

Lingual fixed space maintainer orthodontic appliance

The fixed upper space maintainer is similar to the one used in the mandibular arch. (A) A 8-year-old girl presenting severe space deficiency. (B) Fixed space maintainer in the mouth at 10.5 years of age; no space was lost, but there is still a lot missing to lodge the canines that have not yet erupted. The situation would have been worse without using a maintainer. The maintainer does not create space… it only preserves what is available. (C) Another example of a fixed maintainer where the teeth have erupted properly in the space that was preserved by using the appliance. The patient is now ready for the corrective phase.

Useful advice if you wear a space maintainer

Broken orthodontic retention or contention dental applianceCare and cleaning

“Loose” appliance

Repair and replacement of lost or broken appliances

The “Bite Plane”: a space maintainer with a variation

Even if the main purpose of space maintainers is not to correct malocclusions, certain variations of these appliances may allow for some tooth movement and contribute to improving certain aspects of a malocclusion.This appliance, called a “bite plane”:

  • Has an anterior ramp or biting plane preventing any contact between opposing teeth;
  • Is used when there is excessive overbite (lower anterior teeth biting into the palate). See image on the opposite side;
  • Wearing such an appliance for several months may allow to obtain vertical changes in the way the teeth close together by allowing the eruption of the posterior teeth. The anterior teeth of both arches will become separated from one another.

The appliance also:

  • Acts as a regular space maintainer by preserving space and preventing tooth movements during eruption;
  • Prevents the lower anterior teeth from biting into the palate and damaging the gingiva;
  • Allows the posterior teeth to continue their normal eruption path and thus provide better support to the dentition.
Bite plane to make room for teeth in orthodontics
Bite plane allowing disclusion during orthodontic corrections

(A) The bite plane is used when excessive overbite exists between the anterior teeth (blue circle). (B) Adding the bite plane (pink) allows the lower incisors to bite on the plane rather than near the palate or in the palatal mucous membrane. This slightly moves the mandible downward when opening the mouth (arrows). (C) If the appliance is worn continuously, after several months, the posterior teeth will start migrating upward (eruption) in an attempt to re-establish contact with the opposing teeth (arrows). (D) After some time, the posterior teeth will touch and if the appliance is removed, we will notice that the lower incisors are now apart from the upper incisors.

 

Excessive overbite (vertical overlap) of the front teeth (A). With a

(A) Excessive overbite (vertical overlap) of the front teeth. (B) With a “bite plane” in place, the posterior teeth do not touch and the lower anterior teeth do not bite into the palate. (C) After a few months, the anterior teeth do not overlap as much when the appliance is removed and the posterior teeth touch.

Use of a "bite plane" also acting as a space maintainer allowed the lower teeth to become more visible while decreasing the overbite.

Use of a bite plane also acting as a space maintainer allowed the lower anterior teeth to become more visible while decreasing the overbite as the posterior teeth erupted more easily. Photos: (A) Before the intervention: excessive overbite, lower anterior teeth completely hidden by the upper teeth. (B) Bite plane inserted in the mouth. (C) After 6 to 8 months, the lower anterior teeth are now visible when the appliance is removed.

ex 2

Another example of the use of a bite plane to help decrease the excessive anterior overbite.

Bite plane for dental disclusion in orthodontics

(A) Malocclusion with excessive overbite. (B) The use of a bite plane to decrease the overbite and allow the eruption of the posterior teeth.

Use a bite plane in orthodontics to open the occlusion.

(A) 10-year-old young girl with excessive overbite of the anterior teeth; the lower teeth bite into the palate. (B) Inserting the bite plane. The arrows indicate the dental movements that will occur while the appliance is worn simply by separating the teeth in both arches. (C) After 8 months, still with the appliance in the mouth, we notice that the posterior teeth got closer to one another and touch. (D) This relationship is maintained once the appliance is removed. The dotted line allows the comparison between the position of teeth from the beginning to the end.

➡ To learn more about this case.

Other information or use of a bite plane

Guided plane used at the beginning of treatment with elastics

Bite plane used at the beginning of treatment with elastics

The bite plane can also be used during orthodontic corrections to make teeth that present an overbite more visible and facilitate the corrections.

(A) Dentition where the upper teeth excessively cover the lower teeth. (B) Bite plane that separates the lower teeth.

The guiding planes can also be sued during orthodontic corrections. It helps the teeth to become more visible during alignment. (A) Severe dental malocclusion (adult, 37 years of age) with excessive overbite of the anterior teeth. (B) With the appliance in the mouth. (C)" During the orthodontic corrections. (D) Final result; the teeth are well separated.

(A) Severe dental malocclusion (adult, 37 years of age) with excessive overbite of the anterior teeth. (B) With the appliance (bite plane) in the mouth at the beginning of treatment. (C) During the orthodontic corrections toward the end of treatment. (C) Final result; the teeth are well separated and more functional. The gum problem present at the beginning is stable.

Examples of eruption problems where space management was inadequate.

Permanent upper right canine that erupts above a temporary tooth that has not fallen off (arrow). It is sometimes indicated to extract temporary teeth to facilitate the eruption of permanent teeth.

Permanent upper right canine that erupts above a temporary tooth that has not fallen off (arrow). It is sometimes indicated to extract temporary teeth to facilitate the eruption of permanent teeth.

An X-ray allows us to detect in this 12-year-old girl a serious eruption problem; both upper canines are impacted and are heading toward the palate. Examination of the dentition without X-rays makes this diagnosis difficult to make.

An X-ray allows us to detect in this 12-year-old girl a serious eruption problem; both upper canines are impacted and are heading toward the palate. Examination of the dentition without X-rays makes this diagnosis difficult to make.

Examples of bad space management during the eruption of permanent teeth. The available space was not preserved, teeth migrated, space was lost and the eruption of some teeth occurred outside the dental arch. This kind of problems can usually be avoided with good supervision during the eruption of teeth.

Examples of bad space management during the eruption of permanent teeth. The available space was not preserved, teeth migrated, space was lost and the eruption of some teeth occurred outside the dental arch. This kind of problems can usually be avoided with good supervision during the eruption of teeth.

Tooth migration, space loss and eruption problems of two upper premolars that are completely blocked and cannot erupt properly following inadequate supervision during dental development.

Tooth migration and space loss leading to eruption problems. Two upper premolars are completely blocked and cannot erupt properly following inadequate supervision during dental development. Proper space maintenance during the eruption of teeth could have avoided these problems.

A space maintainer could have avoided this eruption problem and the need for orthodontic corrections.

Inadequate supervision in the mandibular arch. (A) The forward migration of the molars creates space deficiency that prevents the eruption of the lower second premolars. Using a space maintainer could have prevented this problem or minimized it. (B) The orthodontic corrections repositioned the teeth where they should have been maintained by a maintainer when they were erupting.

To see other examples of eruption problems and how X-rays can help detect them.

Radiographs are a crystal ball that predict the future of dental eruption.

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