BAND AND PONTIC: A MODIFIED BAND AND LOOP SPACE MAINTAINER - CLINICAL INNOVATION

Primary teeth play an important role in preventing malocclusion of permanent dentition.When there is prematureloss of primary teeth, the space shouldbe maintained for preserving the arch integrity and preventing space loss. Space maintainers are the treatment of choice in such conditions. The fixed space maintainers are usually indicated to maintain the space created by unilateral/bilateral premature loss of primary teeth in either of the arches.In this clinical scenario, we have modified the band and loop spacemaintainer with a pontic to make it a functional

Primary teeth play an important role in preventing malocclusion of permanent dentition.When there is prematureloss of primary teeth, the space shouldbe maintained for preserving the arch integrity and preventing space loss. Space maintainers are the treatment of choice in such conditions. The fixed space maintainers are usually indicated to maintain the space created by unilateral/bilateral premature loss of primary teeth in either of the arches.In this clinical scenario, we have modified the band and loop spacemaintainer with a pontic to make it a functional space maintainer.

…………………………………………………………………………………………………….... Introduction:-
Arch integrity is an ideal requisite for harmonious occlusion ofthe permanent dentition. Transition of primary to secondarydentition is always a critical determinant, and timelymanagement of malocclusion is the need of the hour. Premature loss of tooth leads to loss of archcircumference, crowding, drifting of the adjacent tooth [1], impaction of the succedaneoustooth, midline shift, and subsequent impairment of function [2].The best way to avoid these problems is to preserve the primary teeth in the arch till their normal time of exfoliation is attained [3].However, if premature extraction or loss of tooth is unavoidable due to extensive caries or other reasons, the safest option to maintain arch space is by placing a space maintainer. The fixed space maintainers are usually indicated to maintain the space created by unilateral/bilateral premature loss of primary teeth in either of the arches. Of the various fixed space maintainers, Band and Loop type of space maintainers are one of the most frequently used appliances [4].Although it is easier to construct, is economical,and consumes less chair-side time, it fails to restore theocclusal function of the lost tooth.
Modifying Band and Loop by incorporating a pontic makes it a functional space maintainer along with all its inherent advantages. Hence, an attempt is madeto modify the appliance so as to make it aFixed functional space maintainer.

Technique of Fabrication of the Functional Band and Loop Space Maintainer
The first step is to construct a conventional band and loop space maintainer in the region of 85. Thisis followed by the placement of custom made pontic which make its functional as well as acts a posterior bite plane in the edentulous area of the cast. The occlusion is then checked with the cast of the opposingarch and adjusted such that 2-3 mm clearance will be provided in anterior region. The completed appliance is then finished and polished ( Figure  2). Trial fit is done in patient's mouth, andthe appliance is checked for the presence of soft tissueirritation and adjusted accordingly.The final cementation of the appliance is done (Figure 3).

Discussion:-
The fixed space maintainers are usually indicated to maintain the space created by unilateral/bilateral premature loss of primary teeth in either of the arches. Of the various fixed space maintainers Band and Loop type of space maintainers are one of the most frequently used appliances [4].However, thedisadvantage is that it is not functional. Apart from maintainingthe mesiodistal dimension of the space created bypremature loss of a tooth, a space maintainer should aidin mastication and prevent supraeruption of the opposingtooth or teeth. It should also be simple, not interfere withnormal occlusal adjustments, or restrict normal growth and development [7]. This appliance has advantages such asprevents supraeruption of the opposing tooth and development of abnormal tongue habits and also aids in masticatory function. Limitations with in appliance are direct visualization of the eruption of the successor is notpossible and cement loss and solder failure can be possible.These limitations can be overcome by long-term and frequent follow-up; parents should be informed that the pontic alone will beremoved from the appliance when the child approaches theeruption age of the successor.

Conclusion:-
Maintaining space and function simultaneously along with addressing other developing malocclusion such as crossbitein early loss ofthe primary teeth are challenging tasks. The functional bandand loop space maintainer described in this report will be agood choice for use in premature loss of a single tooth with developing anterior crossbite in veryyoung children.