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July's Tip: Simple Techniques for Maintenance of Inter-dental Space after Extraction or Up-righting of Posterior Teeth

By: Dr. Adrian Palencar

After extraction or up-righting of posterior teeth there is commonly a lag time before the patient decides to proceed with a final prosthetic replacement.  There are multiple reasons for the delay; finances, apprehension and personal concerns are just a few.

The author will present two protocols for simple space maintenance. One is a case where a fixed prosthesis (bridge) is pre-planned and the second is a situation where an implant-supported crown will replace the missing tooth.

Case one – a fixed prosthesis is pre-planned

In this case the MX left first molar was missing and the patient was not quite certain when she would be ready to replace the missing tooth with a fixed prosthesis (bridge), (Figure 1).  Therefore, a simple space maintainer was proposed, which will survive many years if required.

A section of a .040 SS wire was pre-measured, cut and sandblasted. It was then bonded with composite resin into the small DO and MO cavity prepared in juxtaposition to the extraction site (Figure 2, 3 & 4).  The rest of the cavity was filled with a composite material. It is paramount to bond this wire in slight infra-occlusion.  The radiogram reveals void free restorations and good root parallelism (Figure 5).  The final restoration illustrating a three unit fixed prosthesis is shown (Figure 6).

Case two – an implant-supported crown is pre-planned

 The MN left first molar was missing for several decades, which precipitated mesial tipping of the second molar (Figure 7, 8).  After the up-righting of the MN left second molar with the assistance of a TAD, a specially designed temporary space maintainer was cemented.   This space maintainer was constructed in such fashion that it did not have to be removed during the implant surgery.

The author suggests a SS band on the second molar and a bonded sandblasted pad on the second bicuspid. The connector is a .032 SS wire bent out bucally to the height of the maximum coronal convexity (Figure 9, 10, 11, 12).  This design is conducive to raising a flap and placing an implant, without removal of the space maintainer.

A Nobel Biocare Sterioss Select 4.5 x 7.0 mm implant was placed into the edentulous area.  After osseo-integration of the implant, a screw-retained porcelain fused to metal crown was inserted.  The screw was tightened to 35 Ncm and the screw opening was filled with gutta percha and a restorative composite material (Figure 13, 14).


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