Space maintainers

Definition
Space maintenance can be defined as the
provision of an appliance (active or passive )which
is concerned only with the control of space loss
without taking into consideration measures to
supervise the development of dentition.
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 Space maintainers are appliances used to maintain
space or regain minor amounts of space lost, so as
to guide the unerupted tooth into a proper
position in the arch.(ASDC-J.D. Child 2001)
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Important functions of sound
primary teeth:
 Efficient mastication of food.
 Maintenance of a normal facial appearance
 Formulation of clear speech.
 Maintenance of a proper diet (missing / decayed teeth
– rejection of food – difficulty in eating )
 Maintenance of space and arch continuity for the
emergence of permanent teeth.
 Flared root configuration of molars resists mesial
migration and space loss.
 A most important space maintaining appliance indeed
is a properly restored primary teeth.
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Causes of premature loss of
primary teeth
 Caries
 Trauma
 Ectopic eruption
 Abnormal root resorption
 Systemic disorders or hereditary syndromes
Eg.Hypophosphatasia, Rickets, Acrodynia ,
Histocytosis X, Leukaemia, Cherubism, Juvenile
Periodontitis, Dentinal Dysplasia, Cyclic Neutropenia,
Papillon –Lefevre Syndrome
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 Premature loss of primary teeth may lead to
undesireable tooth movements of primary and or
permanent teeth including loss of arch length.
 Arch length deficiency can produce or increase the
severity of malocclusions with crowding, rotations,
crossbite, excessive overjet &overbite ,unfavorable
molar relationship & occlusal plane discrepancies
 Teeth try to retain contact, and when, adjacent
contact is missing they usually drift and opposing
tooth supraerupts.
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 Altered tooth position may include symptomatic
space deficiency with loss of arch length and
circumference, blocked or deflected eruption of
permanent teeth, unattractive appearance, food
impaction areas, increase caries &periodontal
disease.
 Altered occlusal relationship may evidence traumatic
interferences & untoward jaw relationships
 Thus, corrective measures such as passive space
maintainers, active tooth guidance with space
regaining or combination of both may be needed to
optimize the normal process of occlusal development
after premature loss of primary tooth11/27/2016 7

SPACE CLOSURE AFTER PREMATURE
LOSS OF PRIMARY TEETH
 Rate of closure:
 Seipel, Breakspear and Seward found that maxillary
space closure is fairly constant, with a slight tendency
for the closure rate to slow after first year.
MAXILLA MANDIBLE
Sepiel (1946) D: 1.3mm/yr D: 1mm/yr
Breakspear (1951) D: 0.8mm/yr
E: 2mm/yr
D: 0.9mm/yr
E: 1.6mm/yr
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Rate of closure
 Richardson (1965), maxilla and mandible combined
 AMOUNT OF CLOSURE
 Maxillary spaces close more rapidly than mandibular
spaces.(Davey 1967)
First 6 months : 1.35 mm
Second 6 months : 0.86mm
Third 6 months : 0.77mm
Fourth 6 months : 0.59 mm
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DIRECTION OF CLOSURE
 David G. Owen (1967) in a literature survey noted that
there is complete agreement among clinical
investigators that early maxillary extraction spaces
close predominantly by mesial movement of teeth
posterior to the extraction space. On the other hand
mandibular spaces close predominantly by distal
movement of the teeth anterior to the extraction
space.
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Factors influencing the development of
malocclusion after premature loss of
primary molar
 Abnormality of oral musculature
 Presence of oral habits
 Existence of malocclusion
 Stage of developing dentition
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Treatment considerations
The following considerations are important to the
dentist when space maintenance is considered
after the untimely loss of primary teeth-
a) Time elapsed since loss-
If space closure occurs, it usually
takes place during the first 6 months after the
extraction. When a primary tooth is removed & all
factors indicate the need for space maintenance, it
is best to insert an appliance as soon as possible
after the extraction.
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b) Dental age of the patient-
The chronologic age of the patient is
not so important as the developmental age. Gron
studied the emergence of permanent teeth based
on the amount of root development, as viewed on
radiographs, at the time of emergence. She found
that teeth erupt when three-fourths of the root is
developed, regardless of the child’s chronologic
age.
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c) Amount of bone covering the unerupted tooth-
If there is bone covering the crowns, it can be readily
predicted that eruption will not occur for many months, a
space-maintaining appliance is indicated. If due to
infection bone is destroyed then regardless of root
formation status tooth eruption is accelerated.
d) Sequence of eruption of teeth-
The dentist should observe the relationship of
developing & erupting teeth adjacent to the space created
by the untimely loss of a tooth. More space is lost if teeth
adjacent to area left by extraction are actively erupting
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 Eruption of mandibular second molars before eruption
of second premolars tend to decrease space available
for second premolars and may lead to its partially
blocking out of the arch.
 Eruption of maxillary canine at the same time of
maxillry first premolars tend to dicsplace canine
labially
In these conditions intervention is needed in form of
space maintainer.
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E) Delayed eruption of the permanent tooth-
In case of impacted permanent tooth, it is necessary to
extract the primary tooth, construct a space maintainer &
allow the permanent tooth to erupt at its normal position.
If the permanent teeth in the same area of the opposing
dentition have erupted, it is advisable to incorporate an
occlusal stop in the appliance to prevent supraaeruption in
the opposing arch.
f) Congenital absence of the permanent tooth
g) Amount of space closure
maxillary 2nd molar> mandibular 2nd
molar>maxillary 1st molar> mandibular 1st molar
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h) Abnormal oral musculature - Strong mentalis
muscle patterns may have a pronounced –ve effect
after loss of 1°ry molar or canines with collapse of
arch and distal drifting of anterior Segment.
i) Patient’s overall health
J) Oral hygiene status
K) Patient’s cooperative ability
l) Eruption
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Space maintainer may not be
required if there is
1. Existence of cuspal interference.
2. Widely spaced primary dentition.
3. If succeeding tooth is expected to erupt
within 6 months.
4. If present space is not adequate for the
succeeding tooth.
5. The possibility of future orthodontic work.
6. Where the opposing first molars are locked
into a desirable and stable relationship
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Adverse Effects
1. Dislodged, broken, and lost appliances
2. Plaque accumulation
3. Caries
4. Interference with successor eruption
5. Undesirable tooth movement
6. Inhibition of alveolar growth
7. Soft tissue impingement
8. Pain
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Ideal Prerequisites of a Space
Maintainer
 It should maintain the entire mesio-distal
space created by a lost tooth.
 It must restore the function as far as possible
& prevent over-eruption of opposing teeth.
 It should be simple in construction.
 It should be strong enough to withstand the
functional forces.
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 It should not exert excessive stress on
adjoining teeth.
 It must permit maintenance of oral hygiene.
 It must not restrict normal growth &
development and natural adjustments which
take place during the transition from
deciduous to permanent dentition.
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Premature loss of anterior
teeth
 1 Incisors:
 no decrease in intracanine dimensions if loss after
eruption of canines
 Need SM?: Not necessary
 Extraction of antimere is suggested to prevent midline
shift.
 1 Canines:
 common loss due to ectopic eruption of permanent
lateral incisors
 Need SM?: consider LLHA with spur or elective
extraction of antimere canine
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
Premature loss of posterior teeth?
 Comprehensive evaluation:
determine if space maintainer is indicated for:
a) First primary molar
b) Second primary molar
c) Multiple tooth loss
 Priority: 2nd M > 1st M > Canine > Incisor
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CLASSIFICATION OF SPACE
MAINTAINERS
1) Acc. To Hitchcock(1973)-
Removable or fixed or semi-fixed.
With bands or without bands.
Functional or non-functional.
Active or passive.
Certain combinations of the above
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2) Acc. To Raymond C.Thurow (1978)-
Removable
Complete arch
Lingual arch
Extra-oral anchorage
Individual tooth
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3) Acc. To Hinrichsen (1962)-
 Fixed space maintainers-
CLASS I (a) Non-functional types-
i. Bar type.
ii. Loop type.
(b) Functional types-
i. Pontic type.
ii. Lingual arch type.
CLASS II Cantilever type (distal shoe, band &
loop.)
 Removable space maintainers-
Acrylic partial dentures
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Fixed space maintainers
Space maintainers which are fixed or fitted onto the
teeth are called fixed space maintainers.
ADVANTAGES:
1. Bands and crowns are used which require minimum
or no tooth preparation.
2. They do not interfere with passive eruption of
abutment teeth.
3. Jaw growth is not hampered.
4. The Succedaneous permanent teeth are free to erupt
into the oral cavity.
5. They can be used in un-co-operative patients.
6. Masticatory functions is restored if pontics are
placed.
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Fixed space maintainers
DISADVANTAGES:
1. Elaborate instrumentation with expert skill is
needed.
2. They may result in decalcification of tooth material
under the bands.
3. Supra eruption of opposing teeth can take place if
pontics are not used.
4. If pontics are used it can interfere with vertical
eruption of the abutment tooth & may prevent
eruption of replacing permanent teeth if patient fails
to report.
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Band and loop appliances
Indications (Methewson):
 In case of premature loss of any primary molar in
primary dentition or primary maxillary molar in
transitional dentition with permanent successor not
erupting clinically for the next 2 years and its root
length is less than one third mature.
 Premature loss of a primary second molar as the
permanent first molar is erupted clinically.
 Bilateral loss of single primary molar before eruption
of permanent incisors.
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Band and loop appliances
CONTRAINDICATIONS
 An occlusion that is extremely
crowded or already exhibits
marked space loss.
 High dental caries activity
 Replacement of primary anterior teeth.
 Replacement of primary second molars in transitional
dentition with the permanent molar not erupted.
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Band and Loop Disadvantages
1. Masticatory function.
Not restored
2. Extrusion of opposing
dentition.
Not prevented
3. Normal distal movement of primary cuspids during
eruption of permanent lateral incisor
Not allowed if placed for the early loss of mand 1st primary molar
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Band and Loop Construction
 Band: stainless steel
material 0.180×0.005
inches in thickness
 Crib: portion of the wire
spanning the edentulous
space
 Loop: portion of the wire
contacting the abutting
tooth 0.036 inches in
diameter.
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Band and loop
 . The loop should be parallel to the edentulous ridge
1mm off the gingival tissue and should rest against the
adjacent tooth at the contact area. The faciolingual
dimension of the loop should be approximately 8mm.
 The distal free end of the loop should lie on both sides
and in the middle of band. This allows occlusal
clearance and adequate strength of the soldered joints.
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Bilateral fixed space maintainers
FIXED LINGUAL ARCH
 The lingual arch is the most effective appliance for
space maintenance and minor tooth movement in the
lower arch.
 The classical mandibular arch wire consists of two
bands cemented to the first permanent molars or
sometimes 2nd deciduous molars, which are joined by a
stainless steel wire butting against four incisors.
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LINGUAL ARCH INDICATIONS
1. Maintainence of arch perimeter , because of premature
loss of 1°ry teeth after permanent incisor eruption
2. Maintainence or prevention of mandibular changes in
arch length, overjet &overbite from incisor repositioning
in transitional dentition.
3. Retention of position of mandibular incisors after tooth
movement to prevent relapse in mand. Ant. Crowding
and changes in bite depth.
4. Base for aesthetic restoration in loss of anterior
teeth(hollywood appliance) and as a base for habit
appliance.
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LLHA CONTRAINDICATIONS
1. Anything that require frequent adjustments, eg
tooth movement or space regaining
2. Rampant dental caries, high plaque scores and
poor patient co-operation
3. Ant. Or posterior crossbite
4. Extreme mand. Ant. Crowding or lingually
erupting succedenaous teeth
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Lingual Arch
Advantages Disadvantages
1. Maintains established
arch form.
2. Allows eruption of perm
teeth w/o interference.
3. Not easily displaced.
4. Ease of cleaning for
proper oral hygiene.
5. Can be modified easily
to serve in many
situations.
6. Patient comfort.
1. Does not prevent extrusion
of opposing teeth.
2. Not advisable to band teeth
which are:
• Hypoplastic
• Hypocalcified
• Highly prone to caries.
3. Can promote decay in non-
compliant patients.
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Fixed Lingual Arch Construction
 Band: Stainless steel
material 0.005 inches
in thickness (ortho
bands)
 Lingual arch wire:
Stainless steel round
wire 0.036 inches in
thickness
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 . The arch wire should contact the erupted permanent
incisors at the cingulum.
PASSIVATION-
The lingual arch wire should be completely passive.
This is done by heating the wire to a dull brownish
appearance, while keeping the wire gently in place on the
cingula with an old instrument.
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Nance Appliance
 The Nance arch is simply a maxillary lingual arch that
does not contact the anterior teeth, but approximates
the anterior palate.
 The palatal portion approximates an acrylic button
that contacts the palatal tissue, which theoretically
provides resistance to the anterior movement of
posterior teeth.
Indications:
The same as for fixed lingual arch
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Construction:
Bands: Stainless steel material
0.005 inches in thickness
 Palatal wire: Stainless steel
round wire 0.036 inches in
thickness.
 At the rugae area, a small U-shaped bend should be
incorporated in the wire, which is approximately 1-2 mm
away from the soft tissue.
 The acrylic button is placed usually on the descending
portion of the palatal vault. The button is about 0.5 inch
in diameter, rests against the palatal tissues.
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Transpalatal arch
 The construction of transpalatal arch was described
by Hill et al (1975) and Tsamtsouries and George E.
White (1977). The transpalatal arch runs directly
across the palatal vault avoiding contact with the soft
tissue.
 When permanent maxillary molars move anteriorly ,
they rotate mesiolingually around the large palatal
root.transpalatal arch reduces ant. Molar movement
by preventing this rotation.
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INDICATIONS:
 The best indication for transpalatal arch is when one
side of the arch is intact, and several primary teeth on
the other side are missing.
 When primary molars are lost bilaterally , it cannot be
used as both permanent molars may tip anteriorly
despite the transpalatal arch, and in these cases a
conventional lingual arch or Nance palatal holding
arch is preferred.
ADVANTAGE
 Lack of acrylic button so less tissue irritation and more
cleansable.
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DISADVANTAGE:
 Failure of the appliance to remain passive.
 If appliance is not passive , unexpected vertical &
transverse movement of the permanent molars can
occur.
CONSTRUCTION:
 0.036 inch standard round wire is bent to confirm to
the palatal contour and extending toward the palatal
surface of the bands. As it approaches the mesial part
of the palatal site of the band, the wire should be bent
to the distal part of the band to assure a better joint.
After soldering the wire should be heat treated in
order to make it passive.
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Various Changing Trends In Use Of
Space Maintainers
 Glass Fibre Reinforced composite resins as space
maintainers.
FABRICATION
 1 After Extractions & impression: diagnostic casts are
made. The amount of ribbond to be placed is
measured with Vernier calliper
 2 Placement of Ribbond:
 The abutments on which Ribbond is to be placed is
cleaned with pumice.
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11/27/2016 47
The area is isolated with rubber dam acid etched with
37% orthophosphoric acid ,washed with water and
then dried. The bonding agent is applied and cured
for 10 seconds according to manufacturers
instructions.
A thin layer of flowable composite is applied on distal
surface of the mesial tooth and on the mesial surface
of the distal tooth of the created space without light
curing where Ribbond is intended to be placed.

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Ribbond is placed on the abutment teeth. After
preliminary curing on both the teeth,
additional restorative composite is further
placed & cured for 40 seconds to completely
bond the space maintainer with the abutment.

 The space maintainer is checked for any occlusal and
gingival interferences.
 Finishing is done with composite finishing burs.
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INTRA ALVEOLAR (DISTAL SHOE)
APPLIANCE
o Used to maintain the space of a primary second
molar that has been lost before the eruption of the
permanent first molar.
o An unerupted permanent first molar drifts
mesially within the alveolar bone if the primary
second molar is lost prematurely. The result of the
mesial drifts is loss of arch length & possible
impaction of the second premolar.
o Introduced by willets (1932) with bar type gingival
extension and modified by Roche (1942) with a V
shaped gingival extension.
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APPLIANCE DESIGN
 This appliance consists of a metal or plastic
guide plane along which the permanent
molar erupts.
 The guide plane is attached to a fixed or
removable retaining device
 When fixed, the distal shoe is usually retained with a band
instead of a stainless steel crown so that it can be replaced by
another type of space maintainer after the permanent first molar
erupts.
 To be effective, the guide plane must extend into the alveolar
process so that it contacts the permanent first molar
approximately 1 mm below the mesial marginal ridge, at or
before its emergence from the bone.
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APPLIANCE DESIGN
 If primary first and second molars
are missing, the appliance must be
removable because of the length of
the edentulous span and the guide
plane is incorporated in a partial
denture.
 This type of appliance can provide
some occlusal function.
 Careful measurement and positioning are necessary to
ensure that the blade will ultimately guide the permanent
molar.
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DISTAL SHOE
DISADVANTAGE
 Unfortunately, this design limits the strength of the
appliance and provides no functional replacement for
the missing tooth
 CONTRAINDICATIONS
1. Hopelessly damaged abutment
2. Patients who are at risk for subacute bacterial
endocarditis or who are immunocompromised,
because complete epithelialization around the intra-
alveolar portion has not been demonstrated.
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DISADVANTAGES
 Fabrication and placement can be quite complicated
especially as patients in need of such appliances are usually
very young and often uncooperative.
 Radiographs are needed to determine the position of the
distal intragingival extension in relation to the tooth bud
of the permanent first molar,
 multiple impressions may be required (study and working
models), at placement local analgesia is needed in order to
force the sharpened distal extension through the ridge
(unless it is placed at the time of extraction).
 Due to its cantilever design and its cementation on the
occlusally convergent crown of the first permanent primary
molar, the appliance is somewhat fragile.
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DISADVANTAGES
 Inflammation of the soft tissue surrounding the extension
may occur, a metallic tattoo may result, and a chronic
inflammatory response may be expected thus making this
appliance contraindicated in any patients who may be at
greater risk and are medically compromised
 Blood dyscrasias,
 Congenital heart defects,
 A history of rheumatic fever,
 Diabetes or generalized debilitation [hicks, 1973].
 Another contraindication is multiple loss of the first and
second primary molars. The distal shoe appliance can
replace only one tooth.
 Healthy patients with poor oral hygiene are also
contraindications.
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 A simplified chair side-fabricated
distal shoe appliance [Brill, 2002]
has been described as being an
efficient and cost effective appliance
with success rates approximately
equal to those of other space maintainers.
 The only treatment alternative to the distal shoe space
maintainer is a removable appliance. Carrol and Jones
[1982] included in their appliance design acrylic pressure
ridges, created by making 2mm deep x 2mm wide
grooves in the plaster model in the area of the unerupted
first permanent molar. They also adapted lead foil
around the distal end of the appliance so that it could be
viewed radiographically.
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 An acrylic partial denture with a distal extension to
guide first permanent molars into position may be
used .The teeth to be extracted are cut away from the
stone cast and a depression is cut into the stone model
to allow the fabrication of the acrylic extension.
 The acrylic will extend into the alveolus after removal
of the primary teeth. The extension may be removed
after eruption of the permanent tooth.
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C, The primary teeth have been
extracted
in preparation for the placement of the
partial denture. D, The acrylic distal
shoe extension. E, Lead foil has
been placed over the tissue extension
to determine, with the aid of a
radiograph, whether the acrylic is
positioned properly to guide the
eruption of the first permanent molar.
C D
E

DISTAL SHOE
Should be evaluated with
radiograph prior to
cementation
Length
Position
Will be replaced with
another space maintainer
when permanent teeth
erupt.
FAULTY POSITIONING IS THE MOST COMMON
PROBLEM WITH THIS APPLIANCE11/27/2016 59

11/27/2016 60
A modified distal shoe “pressure”
appliance to provide bilateral
space maintenance and eruption
guidance for the first permanent
molars.

Decalcification beneath bands
 Poor band fit or defective cement may serve as a locus for
debris accumulation and subsequent decalcification.
 Steps to prevent this include :
 Adapting a band that contours tightly to the tooth surface
and extends beneath the gingival margins.
 Providing a thorough prophylaxis before cementation.
 Keeping the tooth thoroughly dry during cementation.
 Using glass ionomer cements.
 Teaching the child and parent proper oral hygiene practices
to include the use of fluoride rinses.
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Removable space maintainers
 They are space maintainers which can be removed and
reinserted into the oral cavity by patient
 The partial denture is most useful for bilateral
posterior space maintenance when more than one
tooth has been lost per segment and the permanent
incisors have not yet erupted.
 TYPES;
1. Functional
2. Non functional
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ADVANTAGES
1. Easy to clean and permit maintainance of proper
oral hygiene.
2. Maintain or restore the vertical dimension.
3. Can be worn part time allowing circulation of
the blood to the soft tissues.
4. Room can be made for permanent teeth to erupt
without changing the appliance.
5. Stimulate eruption of permanent teeth.
6. Help in preventing development of tongue
thrust habit into the extraction space.
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DISADVANTAGES:
1. May be lost or broken by the patient.
2. Un-co-operative patients may not wear the appliance.
3. Lateral jaw growth may be restricted, if clasps are
incorporated.
4. May cause irritation of the undrelying soft tissues.
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INDICATIONS:
1.When aesthetics is of importance.
2.In case the abutment teeth cannot support a fixed
appliance.
3.In cleft palate patients who require obturation of the palatal
defect.
4.In case the radiograph reveals that the unerupted
permanent tooth is not going to erupt in less than five
months time.
5.If the permanent teeth have not fully erupted it may be
difficult to adapt bands.
6.Multiple loss of deciduous teeth which may require
functional replacement in the form of either partial or
complete dentures.
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CONTRAINDICATIONS-
1.Lack of patient co-operation.
2.patients who are allergic to acrylic material.
3.Epileptic patients.
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A, Primary teeth
with rampant
gross caries and
pulpal
involvement.
B, Complete
dentures in place
after the
extraction of all
primary teeth.

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C, Modification of the dentures after eruption of
upper first permanent molars and
lower permanent incisors.

Localized Space Loss (3 mm or
Less):Space Regaining
 Space is easier to regain in the maxillary arch than in
the mandibular arch because of the increased
anchorage for removable appliances afforded by the
palatal vault and the possibility for use of extraoral
force (headgear).
MAXILLARY SPACE REGAINING.
 Permanent maxillary first molars can be tipped distally
to regain space with either a fixed or removable
appliance, but bodily movement requires a fixed
appliance.
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 For tipping one molar , a removable appliance retained
with Adams' clasps and incorporating a helical finger
spring adjacent to the tooth to be moved is very
effective. One posterior tooth can be moved up to 3
mm distally during 3 to 4 months of fulltime appliance
wear. The spring is activated approximately 2mm to
produce 1 mm of movement per month.
 The molar generally will derotate spontaneously as it
is tipped distally.
 If bodily movement of one or both permanent
maxillary first molars is necessary in regaining space,
it sometimes can be accomplished by using headgear
or an arch wire with excellent anchorage
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A removable appliance with a fingerspring is used to regain space by tipping a
permanent first molar distally.
A, The appliance incorporates multiple Adams' clasps and a 28
mil helical spring that is activated 1 to 2 mm per month.
B, Premature loss of the primary second molar has led to mesial drift and rotation of
the permanent first molar.
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

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 After space is regained, fixed space maintainer is
recommended, rather than trying to maintain the space
with the removable appliance that was used for space
regaining.
A removable appliance with a fingerspring is used to regain space by tipping a
permanent first molar distally.
A, The appliance incorporates multiple Adams' clasps and a 28
mil helical spring that is activated 1 to 2 mm per month.
B, post operative space is regained . After space regaining, the space should be
maintained with a band and loop or lingual Arch if the permanent incisors have
erupted.


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A, A fixed appliance also can be used to regain space in the
maxillary posterior regions, with a coil spring generating
the distalizing force.
B , Palatal anchorage was gained using a Nance arch and
the erupted teeth.

Mandibular Space Regaining.
 If space has been lost on one side of the mandibular arch,
the appliance of choice is a removable lingual arch
incorporating a loop that can be opened to provide the
necessary distal force.
 It is important to activate the lingual arch so that the molar
is tipped up and back, while the reaction force is expressed
largely downward on the cingulum area of the lower
incisors.
DISAVDANTAGE:
 Incisors may tip forward.
 An alternative for unilateral mandibular space regaining is
a fixed appliance and an arch wire, which provide excellent
anchorage
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Space regaining in a child with space loss in the upper and lower arches.
A, Casts demonstrating loss of space as a result of caries and early loss of a primary
molar.
B, Bitewing radiograph shows space loss caused by mesial tipping of upper and
lower permanent first molars.
C, An active lingual arch, inserted from the distal in this case, was used for
mandibular space regaining.
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D, When an active lingual arch is inserted from the mesial, the welded
attachment on the band should be tipped up on the mesial to allow easy
placement and removal.
E, Note that when the lingual arch is fully seated, the dimple on the distal of
the sheath into which it inserts serves as a lock to retain the arch wire.
F, Casts of this patient after treatment with a mandibular lingual arch and
maxillary headgear, showing the space regaining that was achieved.
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Bilateral space loss in mandibular
arch
 Lip bumper: it is a labial appliance fitted to the tubes on
molar teeth
 It creates distal force to tip the molars distally.
DISADVANTAGE
 Lip bumper also alters the
equilibrium of forces against the
incisors, removing any restraint
from the lip on these teeth.
The result is forward movement
of the incisors
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 Moving molar distally in mandibular Arch is quite
challenging and requires support from a number of
teeth. Using a lingual arch, to incorporate anchorage
from the permanent and primary molars as well as the
incisors and force from a coil spring can be effective.
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Jackscrew Appliance
It is designed to regain space without
tipping or rotating the teeth.
Reciprocal movement of the molar
distally and the bicuspid mesially will
be effected by the proximity of the
adjacent teeth
Ectopic Spring Distalizer
Designed in principle to function the same as
the Elastic Halterman, this appliance features
a recurved wire spring to achieve the distal
movement of the six-year molar that is caught
under the distal edge of a primary second
molar

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Looped Coil Space Regainer
This appliance is used to gain
space for an un-erupted
bicuspid, but it can move
more than one tooth or move
a molar distally
Elastic Halterman Appliance
This design is indicated when the erupting first
permanent molar is caught under the distal
edge of a primary second molar. A mushroom-
shaped button is bonded to the occlusal surface
of the erupting molar. A band with a hook that
extents distal to the molar is cemented to the
primary second molar. Chain elastic is used
between the hook and the button to provide
the distal force needed to move the first
permanent molar

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Sliding Distal Shoe
This expanding distal shoe engages a
mesially erupting six-year molar and
guides it distally when the primary second
molar has been lost prematurely. Light
coil springs over the loop wire provide the
needed pressure for distalization.
Removable space regainer with expansion
screw

Space maintainers

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