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Dr started the lecture explaining the course and the distribution
of marks on both semesters; you can find all the information on
the syllabus
Let's start our lecture..
This lecture will be divided into 4 parts:
Before we go into the details about space management we
have to understand and remember few basic things:
Slide #1:
Dental occlusion undergoes significant changes starting from
birth until Adulthood.
We start from edentulous phase >> then primary dentition
phase >> then we go into mixed dentition phase >> then the
permanent dentition
Primary dentition: phase start at 6 month of age and end at
usually 2.5 to 3 years of age, in this age all of primary teeth will
be erupting.
Mixed dentition: Starts at 6 years of age, the 1
st
tooth that's
going to exfoliate is the lower central incisor. The 1
st
tooth to
erupt is the upper 1
st
molar and the central incisor, usually at
the same time, but in some cases the permanent molar erupts
before the incisor and in the other cases the opposite.
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These stages that we talked about will occur in a timely and
orderly fashion if any changes happened on the timing or the
order in which the eruption of teeth occur the consequences
will be a disruption of the spaces that exists and eventually we
will have a space loss. Some teeth will grow out of the arches
and the permanent teeth will not have a proper space to erupt.
Slide #2:
There are normally existing spaces in the dental arches.
Primate Space: This is the space that is mesial to the canine on
the upper arch and distal to the canine on the lower arch.
Leeway Space: Is the difference in size between the primary C,
D and E, and the permanents 3, 4 and 5.
*Which one is bigger?
The primary C, D and E.
(The Mesiodistal dimension of C, D and E is bigger than the
permanents, and thats why they create a little bit space to
accommodate the erupting permanents teeth)
Incisor liability is: (At the age of 7 -8 the eruption of lower
incisor age the lower Incisor of permanents are usually bigger
than primary (the mesiodistal of primary are smaller)
So we reach a stage during eruption in which there is no space
for permanents teeth to erupt and it looks like that the
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permanent erupting in a slightly crowding position. This mild to
moderate crowding which occur between 7 8 ages is called
incisor liability.

This mild to moderate -around 2 mm crowding- is relieved by
itself "dont need treatment" due to many factors:
One of these factors is that the permanent teeth erupt in a
more protruded position than the primary teeth, so this
will give about 1-2 mm extra space.
The other factor is the primate space which is "distal to
the canine", this space will be utilized when there is
eruption of central and the lateral by the distal drifting of
the canine.
Another factor is the growth of mesiodistal width of the
arch (intercanine width ) increased about 1-2 mm
Those factors together compensate the change between the
size of permanents and primary teeth so it resolves mild to
moderate crowding by itself with no treatment needed.
** If there is more crowding (moderate to severe ) the
crowding won't be resolved by itself, it won't be resolved by the
growth of the arch because the intercanine growth will stop at
9 years of age, so the patient's going to have crowding teeth.

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Primary Molar Relationship:
Mesial step.
Distal step.
Flush.
Class 1, 2 and 3 in angles relationship for permanents molar
The Importance of knowing the primary molar relationship is
that the relation will tell us how the permanent molars will
erupt, so if I have a mesial step then most probably the molars
will erupt either be a class 1 or end to end .
If they erupt end to end after the loss of primary molars then it
will be class 1, how?
By the late mesial shift of the permanent first molar.
Slide 4:
Now sometimes there will be arch length deficiencies;
There will be a crowding and it happens for 2 general reasons:
1- Arch length is too small to accommodate the size of the
teeth, or
2- We have an adequate arch length but some
environmental factors occur, like the loss of primary teeth
at early stage so we end up having deficiencies of the arch.
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And how the arch deficiencies or discrepancy can be
diagnosed?
Slide #5:
(Signs of arch deficiencies)
1- If we have an early exfoliation of primary canine while the
erupting of lower lateral incisor, so we dont have enough
space for incisor to erupt in proper position and thats
why the lateral will cause the exfoliation of primary
canine.
2- If the incisor is totally blocked out of the arch either labial
or lingual; because of this blocking, there will be gingival
recession specially when the blocking of the arch is labial;
thus, there will not be enough support from gingival
tissues and we end up having gingival recession in that
area.

3- Some researches says that the lack of interdental
spaces in primary dentition is found to be a sign of
deficiency on the arch of side of crowding.
But this is unreliable sign since Baume stated that 9 out of
16 individuals with no interdental spaces in the primary
dentition did not have any crowding in the permanent
dentition, so this is not a reliable sign even though some
authors said that the lack of interdental spaces means the
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teeth will be crowded and doesnt have adequate space
for permanents teeth to erupt.

Slide #6:
Why do we get space loss?
The causes of space loss are different between anterior
and posterior teeth.
It might sometimes- be an environmental factors that
reduce the mesiodistal width of primary dentition, some
of these factors are:
Interproximal caries.
Poor restoration.
Natural wearing of the teeth.

Premature loss of primary teeth due to:

The loss of primary anterior teeth is usually
attributed to trauma rather than tooth decay.
But on posterior teeth the majority of teeth loss due
to decay rather than trauma.
Loss of primary teeth early due to ectopic eruption of
permanents tooth.
Maybe due to congenital disorder that will cause
premature exfoliation of teeth.
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Or maybe premature re-sorption due to arch length
deficiency, like early exfoliation of the canine during
the eruption of the lateral.
Now...
In order to understand if we want to use space maintainer or
not, or to understand either we're going to have space loss or
not, we have to understand how the development of
malocclusion occurs;
The tooth is hold in its position due to different forces in
different directions, and those factors are:
Occlusion from opposing tooth.
Periodontal ligament holding the tooth.
The adjacent teeth.

If the one of these forces is lost, there will be imbalance and
will either over-erupt if there is no opposing tooth or tilt misally
or distally according to the side of the force.

The general factor that influence the development of
malocclusion when the tooth is extracted prematurely
Depends on:
The presence of abnormal oral musculature.
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The presence of oral habits.
Existing malocclusion.
And stages of dental development.
Now ..
If, for instance, we have a child with a thumb sucking
habit, in thumb sucking habit the force will be protrusion
on the upper teeth and retro clination on the lower teeth.
If we lost D in the above case, with this type of force (of
thumb sucking ) the lower incisors will even retrocline
more.
So (distal movement to the canine and incisors) into the
extraction space, so this child who have habit and losing
tooth on lower arch he will lose the space quicker;
because the force (thumb) will cause the teeth to move
(extra force) towards the extraction side>> so will lead to
increase the retroclination of lower teeth and distal
movement for the canine into the extraction space.
*If the patient has crowded teeth, for example, and we
remove the tooth.
Do you think that the teeth will try to get a better position
by drifting into the extraction space? Yes.
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So the space loss increase when the patient already have
a malocclusion or crowding, but when the patient spaced
originally so will not have a space loss for the area
because there is no forces causing the tooth to go into or
to drift or move into the extraction space.
The abnormal musculature.
They said that the patient who have a High tongue
posture coupled with a strong mentalis muscle may
damage the occlusion after the loss of a mandibular
primary molar because the collapse of the lower dental
arch and distal drifting of the anterior segment.
One example is when we have oral habit, this habit will
increase the collapse of the anterior segment and drifting
of the teeth more distally into the extraction side.
The existing malocclusion.
*the patient who have Class II, division 1 and there
is loss of the tooth prematurely, the class 2 div 1 will
be more severe that because of in class 2 div 1 the
upper incisor is proclined and the lower incisor in
most cases is either in normal inclination or
retrocline.
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If we lose a primary tooth we will have drifting of
the lower segment so the severity of class 2 will be
increased.
*Class III molar relation increased in patients with
premature loss of mandibular second primary molar.
*The class 2 div 2 malocclusion will have greater lip
forces that maintain the retroclination of the upper
incisors and, thus, lip forces may contribute to
increased space loss should a primary molar loss
occur.
So the class 2 and 3 will increased in there severity
if we have premature loss of primary tooth
The stages of dental development.
In general we will have more space loss if there is active
eruption of the permanent molars.
*On the x-ray in the slide.
We have an early loss of E if this loss before the 4 years of
age , we will not have a space loss in this up to age 4.
But from age 5 -6 when we have an active eruption of the
permanent 1
st
molar there is no tooth to guide its
eruption so it will drift more misally, which means during
the active eruption we will lose a lot of space if we dont
have a space maintainer.
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So during the active eruption of adjacent teeth more
space is lost.

*Miyamoto, Chung and Yee (1976) studied 255 children
aged 11 years and older to observe the effects of the early
loss of the primary canines and first and second molars on
malocclusion of the permanent dentition.
They found that:
Children who had a premature loss of one or more
canines or molars more commonly received orthodontic
treatment for the permanent dentition. This Orthodontic
treatment need was increased with the number of
prematurely teeth that were lost, the frequency of
orthodontic treatment in children who had lost one or
more primary teeth was three times greater than the
control group.
As a conclusion, if you loss primary teeth prematurely you will
end up having more problems later on and orthodontic
treatments will be needed, and, the number of teeth lost will
increase the severity .
The reference of this lecture is from slides and MacDonalds
book
DONE BY:
Sara Al Omari