Space Maintainers: Why Your Child Might Need One

Ensuring your child’s proper dental development is important for their health and self-esteem. In most cases, permanent teeth come in properly.

However, some children may develop crooked teeth if they’re not guided properly. Fortunately, space maintainers can do just that.

In this article, we’ll talk about how space maintainers can help protect your child’s smile and prevent costly orthodontic treatment in the future.

Why are Space Maintainers Important?

Space maintainers are appliances that prevent malocclusions (misalignment of teeth), overcrowding, and other orthodontic conditions. These help guide permanent teeth into position, much like reserved parking spots.

If your child needs a space maintainer but doesn’t get one, they may experience:

• Speech and pronunciation issues
• Problems with eating or chewing
• Crowding and misalignments

Research shows that when children lose a primary molar too soon, their chances of developing orthodontic issues more than double. Preserving space early on can significantly reduce these risks and protect your child's future oral health.

When are Space Maintainers Necessary?

Your child may need space maintainers due to premature tooth loss, injury, or extraction. If a tooth needs to be removed in any way, space maintainers can prevent overcrowding and misalignment.

Reasons your child’s tooth may be removed include:

• Tooth decay
• Cavities
• Premature tooth loss due to injury

In some cases, children don’t have adult teeth under their primary teeth, preventing them from holding space. Their teeth may also erupt in incorrect positions. Both of these conditions require space maintainers.

What Are the Different Types of Space Maintainers?

Space-maintaining appliances are separated into three categories: fixed unilateral appliances, fixed bilateral appliances, and removable dentures.

Let’s discuss each type:

Fixed Unilateral Appliances

Fixed unilateral appliances maintain space on just one side of the mouth and are glued into place. There are two types of fixed unilateral appliances; the most common one is the band and loop space maintainer.

Band and loops maintain space after a child loses their primary first or second molars, after the first permanent molar erupts around 6 or 7. This appliance is inexpensive and easy to fabricate, but requires upkeep to maintain the space properly.

Another type of fixed unilateral appliance is the distal shoe. A distal shoe maintains the space after losing a primary second molar but before the permanent first molar erupts around age 6 or 7.

It has a stainless steel wire that extends in front of the unerupted permanent first molar to help guide it into place as it grows in. Distal shoes can only fit over a single tooth.

Fixed Bilateral Appliances

The second category of space maintainers includes fixed bilateral appliances. Bilateral space maintainers are placed after teeth are lost on both sides of the mouth.

Common types include:

• Transpalatal arch (TPA) — This appliance maintains space when the teeth in the upper jaw are missing on both sides. The appliance allows for the proper eruption of the premolars in the upper jaw.
• Lingual holding arch (lower) — Connects two permanent molars in the lower jaw. It preserves space in the lower dental arch, aiding in the proper eruption of the permanent premolars.
• Nance arch (upper only) — Uses an acrylic button that rests on the roof of the mouth. It prevents the misalignment of permanent molars and maintains overall dental arch length.

Removable Partial Dentures

Removable partial dentures maintain space after baby teeth are lost prematurely. The appliance is similar to the lingual arch but has artificial teeth attached to it.

Removable dentures are typically placed for esthetic reasons rather than to prevent space loss, especially when anterior (front) teeth are missing.

After your child becomes an adult, they can continue to use a partial denture or replace the appliance with dental implants.

How Do Space Maintainers Work?

The appliance's loop or wire segment acts as a barrier, holding back adjacent teeth from drifting into the open space. It remains in place passively, meaning no force is applied to move teeth, simply to keep the area clear. 

The mechanics involve:

• Anchoring securely to stable neighboring teeth
• Acting as a placeholder, blocking drift
• Being removed once the permanent tooth beneath is ready to erupt

This ensures your child's adult teeth have the space they need to come in straight and healthy.

How to Take Care of Space Maintainers?

You should teach your child to thoroughly brush around the appliance to prevent plaque build-up and cavities. Avoid feeding them sticky or hard foods like gum, caramel, or ice, which can loosen or damage the device.

Additionally, consider going to routine dental visits every six months. This will include quick checks and occasional X-rays to monitor progress and appliance stability.

How Much Do Space Maintainers Cost?

Space maintainers are relatively affordable investments in your child’s long-term dental health. In the U.S., the typical cost ranges from $250 to $700.

However, the overall cost of space maintainers depends on the appliance’s type and where you get them.

Average Costs at a Glance:

Are Space Maintainers Covered by Insurance?

Dental insurance often helps with the cost of space maintainers. Medicaid usually covers these appliances fully, though payout rates vary by state. 

Most insurance plans will cover them if:

• The child loses a baby tooth early (due to decay, trauma, or extraction)
• The appliance is necessary to prevent orthodontic issues (like crowding or misalignment)
• The plan includes pediatric preventive or restorative care

Although some plans fully cover space maintainers, others cover up to 80% of the cost. However, you may still have to pay for consultations, X-rays, and follow-up checkups or adjustments.