hey it's Dr Amanda with Street smile Solutions Street smile solutions.com and
today we're going to answer this question that came in today I call this an ask Dr a question
um talking to a doctor he sent me a case we were discussing it it was like an eight-year-old she
just had generalized constricted arches class one no issues with vertical nice over jet nice
overbite the only issue this patient had nice profile was that she just had generally crowding
constricted arches just probably maybe due to habits maybe just due to a soft diet when she
was little maybe she wasn't breastfed maybe she was bottle fed I don't know the reason but you
know she had maybe six days and eight millimeters of crowding per Arch constricted arches anyways
so the doctor said this is a really great doctor who knows a lot about Ortho but doctor said well
why can't we just put in space maintainers and I was like what's that going to do so let's talk
about that what is a space maintainer so there's lots of reasons that you use space maintainers
in pediatric dentistry and also in Orthodontics obviously a pediatric dentistry people put them
in when you have early loss of a tooth you don't have to pull it out Duty Decay or something like
that and you don't want the other teeth to slide around I mean to me I only put them in
in situations where there's a loss of an e so an e is or if it's like crazy early and
we had a loss of a d or a c oh D um like really really young patient like a two-year-old um but
um an e is your your a your J your K and your T um or your upper one of your any of your primary
second baby molars the two-year-old molars that's an e so that's when I put those in and that would
make sense in that but the problem is and you know there's abandoned Loops there's lingual arches
there's nances there's tpas those are probably the most common types of space maintainers
unilateral bilateral but there's also that's fixed there's also removable space maintainers
um obviously in Ortho we don't use band and Loops because it has something to do with ortho
um but so for this patient I was you know trying to get him to think a little bit about this okay
what would happen I mean first of all what type of space maintain are you talking about because
there's no teeth missing you know no abnormal teeth missing that should be there it's not like
we had an early loss of a tooth so why would we put in a space maintainer I mean sometimes I'll
put in space maintainers and mixed dentition kids if we already have proper width of the
Jaws they're developed transversely to this width I want because if I put something in like a TPA a
nance or a lingual Arch it it has has a transverse component so it's going to maintain the transverse
well naturally the tongue if it's positioned properly should be expanding The Arches we want
the tongue to expand the Arches naturally and if we put something in that braces The Arches it's
not going to expand naturally which is actually bad it's actually worse so we don't want to do
that only other reason if I had a patient like I mentioned that had the proper width already
whether we didn't expand our first or just patient came with a proper width is I'd put it in if there
was a missing tooth a missing e like I mentioned your AJ KRT hopefully I got those right um baby
second molar two-year-old molar if the transverse was right I will not put them in if the transverse
is not right you've got to correct the transverse first and that is the number one thing that I see
pediatric dentists do wrong wrong they just you know their place in space maintainers you know not
abandon Loops fine but I'm talking about bilateral space maintainers that protect the transverse
um only other way to do it is let's say we had a patient that was slight Class 2 or slate class
three and I'm talking like slight like we don't need growth modification we're looking at the
staff and the profile and it'll need to grow a lower jaw I don't need to grow an upper jaw I
don't I don't retract upper jaws I don't believe in that I don't believe in anything retraction
only forward or though Pro you know protrusiveness Pro moving things forward when needed
um so in that situation in a slight like class two patient that didn't need growth of the mandible
but just maybe had some slippage Class 2 Dental of the upper molars forward into an e-space or
Class 2 patient that maybe was two millimeters class two or Edge even up to edge to edge edge to
edge class two end and end on class two you know I might put in a nance on top because the nice thing
about that is it maintains the e space it'll brace if the transverse was already corrected
and perfect right not if the jaw was narrow not if we had crowding if the Arches were developed
properly I could put in an ants or a TPA and it'll brace and hold those sixes or 3 and 14 so
that they don't slip forward when you lose a and j or upper E's so that you maintain that class one
um because the lower ones when you lose the lower ease those will move forward a little
bit and then in an end on case in a flush terminal case it will actually turn into class one if you
brace the top ones and we do the opposite with the class three with the class three we'll put
in a lingual Arch on the lower um if the patient is like edged Edge or slight class three and if
the patient did not need a protraction face mask we looked at the ceph we got the ceph
numbers we looked at the profile we didn't feel like we need um to protract the maxilla we ran
the numbers the airway is good we already have the right transverse I mean it's a little less
of an issue on the lower than it is on the upper so the lower tends to follow the upper when you
expand the upper the lower often rolls out but so I don't want to trap a lower Arch if the molars
are rolled in I would want to Upright those molars first and then put in that lingual Arch so anyways
to answer his question the answer was no we don't want to put in a space maintainer in this case we
want to develop the Arches that's the only option you know um and then you know if you wanted to
put space maintainers in for kicks and Giggles I'd probably not going to do much but you know
if the patient was class one I don't see the point but be my guest all right thanks so much