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| CASE REPORT |
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| Year : 2021 | Volume
: 9
| Issue : 1 | Page : 33-35 |
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Space management with gerber space regainer
Vaishnavi Umeshbhai Shah1, Bhavna Haresh Dave2, Susmita Shrenik Shah2, Paridhi Samir Shah1
1 MDS Pediatric and Preventive Dentistry, Yaksha Dental Hospital and Implant Center, Bodeli, Chhota Udaipur, Gujarat, India
2 Department of Pedodontics and Preventive Dentistry, K.M. Shah Dental College, Sumandeep Vidyapeeth, Vadodara, Gujarat, India
| Date of Submission | 05-Apr-2021 |
| Date of Decision | 02-Jun-2021 |
| Date of Acceptance | 03-Jun-2021 |
| Date of Web Publication | 17-Aug-2021 |
Correspondence Address:
Dr. Bhavna Haresh Dave
Department of Pedodontics and Preventive Dentistry, K.M. Shah Dental College, Sumandeep Vidyapeeth, Vadodara, Gujarat
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/jihs.jihs_8_21
Mesial migration of primary 2nd molar and 1st permanent molar occurs due to early exfoliation of primary first molar. Early exfoliation of deciduous teeth may lead to destruction in the integrity of normal occlusion. Early orthodontic procedures are often used to facilitate favorable developmental modifications in the developing occlusion. There are different space regaining methods described in literature. This case report presents a space regaining accomplished with distal movement of tooth by Gerber Space Regainer.
Keywords: Early exfoliation, Gerber appliance, interceptive orthodontics, premature loss, space regainer
How to cite this article:
Shah VU, Dave BH, Shah SS, Shah PS. Space management with gerber space regainer. J Integr Health Sci 2021;9:33-5 |
| Introduction | |  |
The importance of healthy and well-aligned primary teeth lays a foundation for the future dental health of the child. An important aspect of this includes proper handling of space that was developed by the premature loss of deciduous teeth. The technique of space management is an art of treating space discrepancy problems in mixed dentition, for example, maintenance of leeway space.[1]
Early loss of deciduous teeth necessitates space maintenance because it leads to the formation of occlusal disharmonies. When space is gradually lost, however, intervention to recover it should be considered to avoid further disharmonies. Serial extractions, space regaining, and other methods are used to reduce or eliminate emerging irregularities and malocclusions. When there is no space for permanent teeth to erupt, a space regainer appliance can be used.[2],[3]
Space regainers are broadly classified into removable and fixed types. Removable space regainers mostly use springs and screws to regain the lost space.[4] Fixed space regainers such as sliding loop regainer, open coiled space regainer, lip bumper, distal jet appliance, and Gerber space regainer are some of the appliances listed in the literature for space regaining. The objective of space regaining is to recover the arch width and perimeter that have been lost.[5] Any interceptive procedures, such as any mesial/distal movement of teeth and space regaining, require accurate diagnosis. Because it is a fixed unit, patient cooperation is required, and oral hygiene must be maintained as the component is self-cleaning. In this case report, we have used a Gerber space regainer because it can be easily fabricated chair-side device that can be made in a reasonable amount of time because it does not need laboratory processes and significant results can be obtained within short time period.
| Case Report | | |
A 9-year old male patient reported to the department of pediatric and preventive dentistry with a chief complaint of missing tooth in the lower left back tooth region. Past dental history had shown that the patient underwent extraction in the lower left back tooth region under local anesthesia in a private clinic. Lower left primary first molar (74) had been extracted. After extraction of 74 patient could not report for next dental visit or further treatment due to some circumstances. The patient then reported to the department after 3 months; on examination, we observed space loss in 74 region [Figure 1]. For further investigation, intraoral periapical radiograph [Figure 2]a and panoramic radiograph [Figure 2]b were taken and study models were prepared. Moyer's mixed dentition analysis showed that there was a space loss of 5 mm in the lower left quadrant. Therefore, treatment plan was made such that the space can be regained for eruption of permanent first premolar. The patient's parents were informed about the space loss and its consequences as well as importance of early intervention for the preservation of the loss of arch length. | Figure 2: (a)Preoperative periapical radiograph of 75 region; (b) Preoperative Orthopantomogram
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The space regainer designed to regain space for erupting permanent first premolar was Gerber space regainer which was introduced by Bench R et al. in 1978. The primary left second molar was banded (0.005 × 0.180 × 2”) with molar tubes (0.7 mm diameter, 10 mm length) welded to band buccally as well as lingually; a 23-G wire was used with an open coil spring [Figure 3]. The assembly was cemented with type I glass-ionomer cement (luting) onto the tooth with the springs held in compression to half their lengths [Figure 4]. On follow-up visit of the patient, the space regained after 1 month was 4.8 mm [Figure 5]. The total space available between primary second molar and primary canine was approximately 7 mm. The appliance was removed once the permanent first premolar achieved contact with adjacent tooth [Figure 6].
| Discussion | | |
The early loss of primary molars causes a reduction in the arch length by mesial movement of the permanent first molar.[6] Children between age group 7 to 10 years proved to be best for regaining lost arch length as the roots of permanent first molar are incomplete at this age group and distalization of permanent molar becomes easier.[7]
Due to excellent spring back and superelasticity of nickel–titanium with minimal load fluctuation despite high deflection, it is possible to achieve massive tooth movement without needing to replace the springs because of this property.[8] There is no definitive evidence present regarding tooth movement which occurs after unilateral fixed/ removable appliance is used to distalize two teeth i.e. primary second molar and permanent first molar.
Around 1 mm per month distal movement has been reported for permanent first molars, but then again, there is distinct individual variation.[9] In the present case, the total space regained was 4.8 mm within 1 month of time period. Distalizing the permanent first molar was possible without difficulty in the present case because the root formation was incomplete, and no tipping was observed [Figure 7] and [Figure 8].[10]
Management of space problems in the mixed dentition plays a vital role in pediatric dental practice. Understanding how the deciduous and mixed dentitions develop can assist in assessing when and how to intervene malocclusion caused by the premature loss of deciduous teeth is necessary.
| Conclusion | | |
Gerber appliances can reclaim the space lost due to the displacement of mandibular first permanent molar. The appliances provide more distal force and less stress concentration on the crown of the mandibular first permanent molar. More nonlinear analysis studies on Gerber space regainers might be advantageous.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Graber, Vanarsdall, Vig, Huuang. Treatment of patients in the mixed dentition. Orthodontics Current Principles and Techniques. 6th ed. USA. Elsevier Publishers; 2005. P: 545.  |
| 2. | Damle SG. Space management. Textbook of Pediatric Dentistry. 5th ed. India: Arya Medi Publishing House; 2018. p. 341. |
| 3. | Bhalajhi SI. Interceptive orthodontics. Orthodontics the Art and Science. 3rd ed. India: Arya Medi Publishing House; 2006.p. 234. |
| 4. | Singh G. Interceptive orthodontic procedures. Textbook of Orthodontics. 2nd ed. New Delhi India: Jaypee Brothers Medical Publishers; 2007;p. 557-9. |
| 5. | Bondemark L, Karlsson I. Extraoral vs intraoral appliance for distal movement of maxillary first molars: A randomized controlled trial. Angle Orthod 2005;75:699-706. |
| 6. | Papadopoulos MA, Mavropoulos A, Karamouzos A. Cephalometric changes following simultaneous first and second maxillary molar distalization using a non-compliance intraoral appliance. J Orofac Orthop 2004;65:123-36. |
| 7. | Bondemark L. A comparative analysis of distal maxillary molar movement produced by a new lingual intra-arch Ni-Ti coil appliance and a magnetic appliance. Eur J Orthod 2000;22:683-95. |
| 8. | Paul LD, O'Brien KD, Mandall NA. Upper removable appliance or Jones Jig for distalizing first molars? A randomized clinical trial. Orthod Craniofac Res 2002;5:238-42. |
| 9. | Gianelly AA. Distal movement of the maxillary molars. Am J Orthod Dentofacial Orthop 1998;114:66-72. |
| 10. | Chandak P, Baliga S, Thosar N. Space regainers in pediatric dentistry. Int Dent Med J Adv Res 2015;1:1-5. |
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8]
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