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).