Space Maintainers

What are Space Maintainers?

Space maintainers are used when children lose their baby teeth prematurely. They preserve the resulting empty space(s), so the permanent teeth can come in properly. Without a space maintainer, the other baby teeth can move into the space and block the adult tooth from erupting. 

These appliances help prevent malocclusions (misalignment of teeth), overcrowding, and other orthodontic conditions.

Space maintainers shouldn't cause pain because they don’t shift or move teeth. Generally, children adjust to them fairly quickly, though they may initially experience bleeding gums.

Monitoring children during the “mixed dentition phase,” when both permanent and baby teeth are present in the mouth, is crucial since teeth misalignment has a high chance of developing during this process.

Why are Space Maintainers Important?

If your child needs a space maintainer but doesn’t get one, complications can occur. These include:

• Baby teeth shifting into empty spaces, preventing the adult teeth from erupting
• Adult teeth erupting in an abnormal position in the mouth 

When are Space Maintainers Necessary?

Children may need space maintenance treatment for several reasons, including:

1. Premature Tooth Loss or Extraction

Baby teeth can easily fall victim to tooth decay, typically resulting in the need for extractions. Cavities form on a child’s molars more commonly because baby tooth enamel is more fragile than permanent teeth.

If a tooth must be extracted due to severe decay, space maintainers are placed to prevent misalignment or overcrowding as the permanent teeth grow in.

2. Dental Trauma

During the early stages of life, children are still developing motor skills. This means that front teeth injuries in the upper and lower jaws are very common. As a result, front baby teeth (including the incisors and canines) are lost prematurely.

If your child loses a back tooth prematurely due to trauma, space maintainers help prevent misalignment and overcrowding as adult (permanent) teeth grow in.

3 Types of Space Maintainers

Space-maintaining appliances are separated into three categories:

1. Fixed Unilateral Appliances

Fixed unilateral appliances maintain space on just one side of the mouth. Common appliances include the band and loop maintainer and the distal shoe. They are glued into place. 

Band and Loop Space Maintainer

One of the most common fixed unilateral appliances is the band and loop space maintainer. They are positioned on one side of the mouth (unilateral).

Band and loops maintain space after a child loses their primary (baby) first molars or second molars after the permanent first molar erupts around age 6 or 7.

The appliance has a band that cements to the primary second molar. It also has a loop that contacts the distal surface of the primary canine. 

The band and loop can also maintain space after the premature loss of a primary second molar. The band cements onto the permanent first molar, and the loop contacts the back surface of the primary first molar.

For proper band placement, the permanent first molar must erupt first in cases of a missing primary second molar. This appliance is inexpensive and easy to fabricate but requires upkeep to maintain the space properly.

Distal Shoe

Another fixed unilateral appliance is the distal shoe. Like the band and loop, it sits on one side of the mouth (unilateral).

A distal shoe maintains the space after losing a primary second molar but before the permanent first molar erupts around age 6 or 7.

The appliance 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.

2. 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)

The transpalatal arch (TPA) is a bilateral appliance that maintains space after teeth in the upper jaw are missing on both sides.

The TPA consists of a thin 36-mil wire that extends above the palate (roof of the mouth) and connects the banded permanent molars on both sides.

The appliance allows for the proper eruption of the premolars in the maxillary dental arch (upper jaw).

Lingual Holding Arch (Upper and Lower)

A lingual holding arch is a bilateral appliance that connects two permanent molars in the upper or lower jaw.

The appliance preserves space in the mandibular (lower) or maxillary (upper) dental arch. This aids in the proper eruption of the permanent premolars.

Nance Arch (Upper Only)

The Nance arch incorporates an acrylic button that rests on the palatal rugae (roof of the mouth). The appliance can only sit in the upper dental arch because of this feature.

The Nance arch prevents the misalignment of permanent molars and maintains overall dental arch length.

3. 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.

Summary

• Space maintainers are devices used in pediatric dentistry that dentists utilize when children lose their baby teeth prematurely
• Space maintainers ensure the permanent teeth erupt properly
• Tooth loss can be due to trauma, disease, overcrowding, or decay
• Fixed unilateral appliances, fixed bilateral appliances, and removable partial dentures are all types of space maintainers that can be used