Page 116 - REMOVABLE ORTHODONTIC APPLIANCES

108 Removable Orthodontic Appliances
general dental examination between the age maintain the anchorage during the premolar
of 9 and 10 years, so that interceptive extrac- and canine retraction.
tions can be considered. In a crowded lower
arch, early extraction of the deciduous canine
and first deciduous molar can be considered to Traumatic loss of anterior teeth
promote forward movement of the second
deciduous molar and lower first molar. Where The traumatic loss of a central incisor is
the congenital absence is unilateral, consider- common and if it is not possible to re-implant
ation may have to be given to a compensating the tooth, a removable space maintainer should
permanent tooth extraction on the opposite be fitted immediately. This should carry a pros-
side, possibly of the lower first premolar. In thetic tooth to maintain the space. Stainless
the absence of marked crowding unilateral steel spurs on the mesial aspects of the adjacent
loss may be acceptable with acceptance of incisors will also help to prevent these teeth
some centre-line shift, although this may mean from encroaching on the space (Figure 12.1).
that it will not be possible to obtain a satisfac- Once the space is maintained a decision can be
tory buccal intercuspation. In many cases of taken concerning the long-term management of
congenital absence of the lower second the case. Movement of the lateral incisor into
premolars the use of fixed appliances is indi- the central incisor space prior to preparing a
cated. conversion crown on the lateral incisor is unsat-
In the upper arch, congenital absence of the isfactory. It is difficult to make a crowned
upper second premolars may sometimes be lateral on one side of the arch match a natural
managed with removable appliances - the central and lateral on the opposite side of the
second deciduous molars being retained until arch.
such time as space is required. The upper Occasionally, when both central incisors are
second deciduous molars are then extracted missing or traumatized, it may be appropriate
and removable appliances used to retract the to approximate the laterals before crowning
first premolars and canines as appropriate. This them. Such movement is beyond the scope of
gives less space than the extraction of upper removable appliances and requires fixed appli-
first premolars and there is less likely to be a ance management.
satisfactory contact between the first premolar Traumatic loss of lower incisors, unless there
and first molar than there is between a canine is appropriate crowding and distal inclination
and second premolar following conventional of the lower canines, is likely to require either
first premolar extractions. Where space fixed appliances or prosthetic restoration.
requirements are large, perhaps due to a Where crowding is present, space from a lost
combination of crowding and an increased lower incisor may well close spontaneously, but
overjet, extraoral forces may be required to will probably give an unsatisfactory buccal

Figure 12.1 An appliance to hold space for
a traumatically lost central incisor. Stainless
steel spurs are placed on either side of the
missing incisor to prevent space loss.
Prosthetic replacement for |1.