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2007年10月05日●space maintainer(空間保持器)  

2007-10-05 17:43:27|  分类: 矫正装置与材料( |  标签: |举报 |字号 订阅

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●space maintainer(空間保持器)

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為防止乳牙過早喪失(premature loss)後所造成的問題,一般會放置空間維持器(space maintainer)來維持恆牙萌出的空間,如果乳牙過度早失,不將空間維持住,很容易在日後產生擁擠的牙齒排列情況,很可能產生將來必須配戴矯正器的能,但是臨床上常會遇到軟組織受到空間維持器壓迫、牙齒萌發受影響、牙齒不正常的移動、牙菌斑堆積、有可能造成齲齒及裝置本身的破損或完全喪失等問題,因而造成空間維持器的失敗。

1. Looseness(鬆脫): Occasionally a fixed space maintainer will become loose. If this happens it can be uncomfortable and if left unattended, cause decay on the tooth holding it. If a space maintainer becomes loose or comes out, an appointment should be made as soon as possible to re-cement.(有時候固定式的空間維持器會變鬆,若是發生這樣的情形,病人會覺得不舒服,假若置之不理的話,很容易讓承載牙受到齲壞,如果空間維持器鬆脫或是脫出,請應趕緊回院重新黏上為宜)

2. Food trap(嵌塞食物): Occasionally food can get caught under the spacer wire. Usually this is easily removed with the tongue or toothbrush however, dr. will always be happy to assist if necessary.(有些時候食物也會從空間維持器線的下方嵌入,這經常很容易用舌頭或是經由牙刷移除,也可以請醫生來幫助)

3. Loss or damage(遺失或損壞): Removable space maintainers are easily lost or damaged. If they are not worn regularly, the teeth will shift and it will no longer fit. If for any reason the space maintainer is lost, damaged, or doesn't fit comfortably; please make an appointment with Dr.  for adjustment or replacement.(活動式的空間維持器很容易丟失或是損壞,如果沒有正確的使用,牙齒會漂移,很快的你會看到戴不下去的現象,不管任何的理由 ,維持器丟失,損壞,或無法舒適的戴用,應立即與醫生約診來調整或是修復)

空間維持器顧名思義,是所有矯正裝置中最基本的裝置形態。 他的使用觀念就是將乳牙拔牙的空間(space),藉由空間維持器的戴用而保存下來,以利小孩在換為恆牙的過程當中,能有足夠的空間順利換為成人牙。

A space maintainer keeps baby teeth from shifting into the space where the tooth was lost so the permanent tooth can erupt in its natural proper space(這是英文的字義)簡單一點的為A fixed or removable appliance designed to preserve the space created by the premature loss of a tooth

◎Indications: (適應症)

  • The premature loss of primary molars may require the placement of a space maintainer to prevent the migration of the adjacent teeth, depending upon the teeth present and the arch length. (乳大臼齒早失的案例,空間保持器可以防止相鄰牙的漂移,視尚有的存在牙齒與牙弓的長度)
  • When loss of a primary canine occurs, the dental arch midline may be compromised and the arch length also may be reduced. The premature loss of primary canines may therefore require the placement of a space maintaining appliance to prevent midline deviation and/or loss of arch length, perimeter and/or circumference. (乳犬齒產生喪失,牙弓的中線可能重組偏移,牙弓長度會減少,因此,乳犬齒的早失,需要空間保持器來防止中線的偏移,與牙弓長度的減少,周界與口腔周圍環境的縮小)
  • The premature loss of primary incisors does not usually require the placement of a dental appliance for the maintenance of space because mesial movement of the adjacent teeth is not generally expected. (乳切牙的早失,不一定需要空間保持器的置放,這是因為鄰牙的偏移較少會產生)

◎Contraindications: (禁忌症)

  • A space maintainer is usually not necessary if there is a sufficient amount of space present to allow for eruption of permanent tooth/teeth. (如果替代的永久恆牙空間足夠,則不需間隙保持器的制作)
  • A space maintainer may not be recommended if severe crowding exists, such that space maintenance is of minimal effect and  subsequent orthodontic intervention is indicated. (如果嚴重的齒列擁擠,是不適做保持器的,因為效果會不好,這時應是固定矯正器介入的適應症)
  • A space maintainer may not be necessary if the succedaneous tooth will be erupting soon.(如果替代恆牙已快萌出,就不需要間隙保持器了)

●(以下是各類間隙保持器的使用適應症與優缺點)

  • A)Band and Loop Space Maintainer

    Indications: Loss of first primary molar (乳大臼齒缺失)
    Advantages: Ease of fabrication for the clinician and ease of maintenance for the patient  (易操作)
    Disadvantages: Opposing tooth may supererupt(對咬牙會過萌出)

    B)Crown and Loop Space Maintainer

    Indications: Loss of first primary molar with significant loss of tooth substance of the abutment tooth 
    Advantages: Same as above 
    Disadvantages: More difficult to fabricate than band and loop(較不易操作)

    C)Distal Shoe (Intra-alveolar Space Maintainer)

    Indications: Loss of second primary molar prior to eruption of the first permanent molar  (乳第二大臼齒早失,在恆第一大臼齒尚未萌出前)
    Advantages: Maintains the second primary molar space(保持第二乳大臼齒的空間) 
    Disadvantages: Difficult to fabricate; contraindicated in some medically compromised patients, ie. pathological heart murmur (不易操作,有些如病理性的心雜音病人不適合做)

    Lower Lingual Holding Arch (LLHA)

    Indications: Loss of second primary molar in the mandible (counterpart to Nance)  (乳第二大臼齒早失)
    Advantages: Maintains the tooth space and the leeway space 
    Disadvantages: First permanent molars may be susceptible to decalcification; may be prone to breakage unless the patient is well-informed on maintenance(恆第一大臼齒易脫鈣)

    D)Nance

    Indications: Loss of second primary molar in the maxilla-counterpart to LLHA 
    Advantages: Maintains the tooth space and the leeway space 
    Disadvantages: Meticulous hygiene of the acrylic button is required

    E)Hawley Appliance / Removable Acrylic

    Indications: When multiple teeth are lost and the space maintenance and mastication are of concern  (多顆牙不見)
    Advantages: Can maintain space as well as aid in mastication 
    Disadvantages: Susceptible to fracture or loss

超連結→
SPACE MAINTAINERS

space maintainers

如何操作間隙保持器與製作

How to Bend a Band Loop Spacer(圖解如何彎制band loop spacers)

Basic Wire Bending(圖解基本彎線技巧)

Crown-Loop Examples(一些好的或是不好的空間保持器之圖示)

Chairside Space Maintainers / Space Maintainer Kits(成品圖示)

●Kinds of Space Maintainers:(空間保持器的種類)

1. Fixed Space Maintainers:(固定式的)

a. Unilateral(單側的): 僅在牙列裡的單側用來替代一顆牙齒的空間,可以是band也可以是loop,或是以crown+loop的形態出現.這一種叫 Distal Shoe type.遠心鞋樣的保持器是使用在當永久第一大臼齒尚未萌發的狀態

b. Bilateral(雙側的): 這一類型是非常常用的通常是牙列的兩側後方以band來黏在後方的臼齒上,舌側沿著下顎的前牙以一條弓絲來做連接,稱為lingual arch,這常用在多顆牙缺失的情況下, 或者是你想要保持下顎前牙防止其舌傾時可以使用. lingual arch也可以彎制loop的形態來使用,上顎的雙側保持器可以用類似nance button的裝置那樣的設計,所以又可稱為 Nance space maintainer.

2. Removable(活動式的): 不常使用在小孩身上,儘管它可以使用在一些特殊的場合下,它們就像一個活動式假牙那樣,來戴用以取得保持與防止牙齒漂移的效果

band &loop  space maintainer 單側crown & loop maintainer

雙側band & loop maintainer

一側crown+loop,另一側band+loop maintainer

活動式的space maintainer

nance type space maintainer

distal shoe maintainer

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