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Orthodontics - 8th Lecture

Space closure is one of the more challenging types of orthodontic treatment. It can occur due to discrepancies in tooth size, large jaw size, congenital missing teeth, proclination of teeth, thick median frenums, or premature loss of teeth due to trauma. Management of spaces may include use of wider metal brackets, power chains, mini implants, frenectomies, and extended retention periods. Alignment is less time consuming than crowding cases but leveling is similar, and closure of extraction spaces is skipped.

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67 views4 pages

Orthodontics - 8th Lecture

Space closure is one of the more challenging types of orthodontic treatment. It can occur due to discrepancies in tooth size, large jaw size, congenital missing teeth, proclination of teeth, thick median frenums, or premature loss of teeth due to trauma. Management of spaces may include use of wider metal brackets, power chains, mini implants, frenectomies, and extended retention periods. Alignment is less time consuming than crowding cases but leveling is similar, and closure of extraction spaces is skipped.

Uploaded by

Marwan Qasim Gh
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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Orthodontics

Fifth Class College of dentistry


Dr Firas Lecture no 8

Space closure
Space closure is more challenging orthodontic treatment as the techniques are differ and the
problems of neutral zone and relapse is more than any other treatment type. Spacing in
orthodontics came along with all classes I,II, and III and the management is almost the same but
with some modifications.

These modifications could be explained to as follows:

1- Alignment is less time consuming than crowding cases but leveling is the same in deep
bite cases.
2- Bracket sizes have to be wider in mesio-distal width than other cases.
3- Metal brackets is better used than ceramic brackets, for friction problems.
4- Closure of extraction space phase of comprehensive orthodontic treatment is skipped.
5- In some cases of spacing with no alignment phase at all; the patient will not see any
progress until we reach the final size stainless steel arch wire then the space closure is
heralded; that will affect the cooperativeness.
6- Retention phase is extended more than crowding and its little bit complicated.
Types of spaces:

1-discrepency in teeth sizes.

a-description:

A tooth size discrepancy can compromise the attainment of an ideal occlusal fit, especially
between the anterior teeth. To obtain a good occlusal fit and an ideal static occlusion, the total
mesiodistal dimension of the mandibular dentition should be approximately 92% of that in the
maxilla. The ratio of these dimensions was ascertained from ideal occlusions and is called the
Bolton ratio after its originator, Wayne Bolton (Bolton, 1958). One of the commonest
manifestations of a tooth size discrepancy is a diminutive upper lateral incisor.

b-management:

This can be clinically masked by a composite build up of the diminutive teeth or reducing the
width of teeth in the opposing arch; both of them or one of them.

2-large jaw size.

a-description:

Size of the jaws and the size of the teeth are both determined genetically; and the amount of the
spacing could be measured be the difference between the size of the teeth and the size of the
jaws.

b-management:

The spaces could be closed to the midline by power chain elastics on hard SS arch wire; by doing
this we prevent the unwanted retroclination of the anterior teeth crowns.

3-congenital missing teeth.

a-description:
Congenital absence of teeth results from disturbances during the initial stages of formation of a
tooth: initiation and proliferation. Anodontia, the total absence of teeth, is the extreme form. The
term oligodontia refers to congenital absence of many but not all teeth, whereas the rarely used
term hypodontia implies the absence of only a few teeth. As a result of this spacing the remaining
teeth gets drifting to the area of space gives rise to the pan-spacing.

b-management:

Space regaining by open coil spring and close all the remaining spaces by power chain elastics
with the aid of mini implants or not and preserving this space by temporary prosthesis after
brackets removal to prevent relapse.

4-Proclination of teeth.

a-description:

Anterior spacing with proclination mostly seen in patient with class II or in patients with thumb
or digit sucker and also increased overjet is noticeable in these cases.

b-management:

Spaces are closed with the aid of either class II elastics, class II correctors, or with the
reinforcement of mini implants.

5-Thick median frenum.

a-description:
A maxillary midline diastema is often complicated by the insertion of the labial frenum into a
notch in the alveolar bone, so that a band of heavy fibrous tissue lies between the central
incisors.

b-management:

When this is the case, a stable correction of the diastema almost always requires surgery to
remove the interdental fibrous tissue and reposition the frenum. The frenectomy must be carried
out in a way that will produce a good esthetic result and must be properly coordinated with
orthodontic treatment. Removal may be indicated after treatment to change irreversible
hyperplastic tissue to normal gingival form and to enhance posttreatment stability.

6-Premature loss induced by trauma.

a-description:

Avulsion and loss of permanent tooth is common among children and teenagers, that caused by
direct trauma to the tooth during periods of growth. This leads to adjacent teeth drifting to the
remaining space and multiple spaces in the arch.

b-management:

management of the spaces resultant from premature loss of teeth is the same as that of congenital
missing teeth.

Ended

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