Introduction: Exfoliation of primary teeth
and eruption of permanent teeth is a normal physiological process. When this
normal process is disrupted, due to factors like premature loss of primary
teeth, proximal carious lesions it may lead to mesial migration of teeth resulting
in loss of arch length which may manifest as malocclusion in permanent
dentition in the form of crowding, impaction of permanent teeth, supraeruption
of opposing teeth.Primary teeth are
considered to be the best space
maintainer under normal physiological conditions. However, in cases with
premature loss of primary teeth, the best way to prevent future malocclusion
would be to place an effective, affordable, and perdurable space maintainer.Band and loops has been used
since long as a space maintainer with good high success rates but inspite of
good patient compliance, disintegration of cement, solder failure, caries
formation along the margins of the band and loop construction time are some of
the disadvantages associated with them. Intra oral scanning is one of the
recent advances which provides patient comfort with high imaging accuracy. This
intraoral scanning can be done at ease even in very uncoperative children.
Meanwhile the computer aided designing provides precise fit and isfabricated as a single unit
which further reduces the laboratory errors.
Objectives:
The primary outcome of the study is to compare the clinical efficacy and
gingival health of conventional Band and Loop versus digital 3D fabricated Band
and Loop Space Maintainer
Patient satisfaction and the coperativeness is measured as the secondary
outcome.
MATERIALS
AND METHODS:
This
study is a comparative study. Patients in the age range of 4 to 9 years
visiting the Out- patient Department of Pediatrics and Preventive Dentistry,
APDCH,, wIll be screened and the patients who either required extraction of the
primary first/second molar or having pre-extracted primary 1st or 2nd molar in
any of the arches will be selected for the purpose of study. These patients
will be further screened on the basis of
inclusion criteria.A brief history will be
recorded and clinical examination will be done. Intraoral periapical radiographs will
be taken in areas of tooth loss. Study
models will be prepared, and space
analysis will be carried out for every
child. For every selected child, oral prophylaxis will be done prior to
placement of space maintainer. Thirty-six patients will be selected, and these
children were further divided into 2
groups .
Group
1(19) patients -Conventional band and loop.
Group
2 (19) patients - Digital 3D Fabricated Band and Loop .
A
conventional Band and Loop was fabricated according to the technique described
by finn .
Digital
3D Fabricated Band and Loop was made by DMLS using Co-Cr alloy.
Assessment of clinical
performance to be evaluated at 1 month 3 months 6 months in terms of survival rate ,caries,gingival
health and patient satisfaction and cooperativeness.
SOURCE
OF SAMPLE TO BE TAKEN:
Out
patients from the Department of Pediatric and Preventive dentistry, Pediatric
dental out patient(MAPIMS), school dental camps.
INCLUSION CRITERIA
1) Systemically healthy children.
2) Grossly mutilated single molars
on either side, requiring extraction.
3) Freshly extracted single molars
bilaterally in the same arch or opposite arch. Sound and healthy teeth adjacent
to the extraction site.
4) No abnormal dental conditions
such as cross bite, open bite, and deep bite.
EXCLUSION CRITERIA
1) Grossly carious teeth were adjacent to the created space.
2) Absence of teeth on the
mesial or distal side of the teeth to be extracted.
Methodology:
Group 1 -Conventional band and
loop space maintainer
Clinical evaluation of space
loss will be assessed.Digital Intraoral periapical radiographs will be taken in
the areas of tooth loss A 0.180×0.005 inch thickness of band material was
taken and a ring was made. This band material was seated in the patient’s mouth
with a band pusher and contoured with a Johnsons contouring plier and then a
straight hoe was used to approximate the ends of ring . This ring was then
pinched as close to tooth surface as possible and then spot welded .This band
was then seated in patient’s mouth and excess band material was cut off with
band cutting scissors . The remaining band material was adapted along the contours
of band . Band was then festooned and trimmed and ensured that the band coveredthe entire surface of
tooth.Impression was made with alginate, band was removed from the patient’s
mouth with a band removing plier and was stablised in impression and then it
was poured in dental stone. A loop was then made with a stainless steel 19 gauge
wire using universal plier and it followed the contours of the gingiva. The
loop spanned the edentulous area to contact abutment just below the contact
point. The buccolingual width of the loop was such to permit the eruption of
the cusps of the underlying permanent tooth. A silver solder was used to solder
loop with the band at the middle one-third.The appliance was checked for any
occlusal or gingival interferencesinterference prior to cementation.
Group 2- Digital 3D fabricated
band and loop space maintainer
Clinical evaluation of the
space loss will be assessed. Digital intraoral periapical radiographs will be
taken in the areas of tooth loss. Intraoral scanning will be done using the
intraoral scanner for upper and lower arch along with the bite .Then the
scanned STF will be send to the EXOCAD software in which designing of the space
maintainer will be made following which the space maintainer is fabricated
accordingly. The designed space maintainer will be luted using resin modified
GIC. Instructions for oral hygiene and appliance maintenance were given to the
children and parents. Statistical analysis: Chi-square test and P value will be performed
Clinical efficacy outcome:
Survival Rate
The survival rate was checked
as per following comparable criteria 4(Tulonglu O et al (2005)
Lost to follow-up (LF):Patients
who were non-complaint with a regular follow up schedule.
Failed (F):Patients who
returned after insertion of the appliance before the first appointment at the
third month due to the loss or breakage of the appliance or the lack of
willingnesss to wear the appliances.The appliance deteriorated either as a
consequence of the degradation in cement breakages at the loop or soldered
parts, or soft tissue lesions.
Successful (S):Those patients
who wore their appliances and were still under observation until the eruption
of permanent teeth and adhered to the recall schedule.
Censored at the end of study
(C): Those patients whose appliance were inserted at dates close to the ending
date of the study and who were successfully wearing their appliance at that
time.
Caries
The presence of dental caries
was checked visually and with a explorer at 1, 3, 6, 12 months according to the
following scale:
Presence of caries – ‘P’
Absence of caries – ‘A’
Gingival Health
Plaque deposition of the
abutment tooth of the space maintainer was evaluated according to the index
used by Sillness and Loe H.Implications:
The clinical efficacy of
digital 3D fabricated band and loop space maintainer will be non inferior to
conventional band and loop space maintainer. Patient co-operation and
satisfaction will be more in digital 3D fabricated band and loop space
maintainer in comparison with conventional band and loop space maintainer.
References:
1) Garg A, Samadi F, Jaiswal
JN, Saha S. ’Metal to resin’: a comparative evaluation of conventional band and
loop space maintainer with the fiber reinforced composite resin space
maintainer in children. J Indian Soc Pedod Prev Dent. 2014 Apr-Jun;32(2):111-6
2) Tokuc M, Yilmaz H.
Comparison of fit accuracy between conventional and CAD/CAM- fabricated
band-loop space maintainers. Int J Paediatr Dent. 2022 Sep;32(5):764-771.
3) Setia V, Kumar Pandit I,
Srivastava N, Gugnani N, Gupta M. Banded vs Bonded Space Maintainers: Finding
Better Way Out. Int J Clin Pediatr Dent. 2014 May-Aug; 7(2): 97–104.
4) Tulunoglu O, Ulusu T, Genç
Y. An evaluation of survival of space maintainers: a six-year follow-up study.
J Contemp Dent Pract. 2005 Feb 15;6(1):74-84.
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