Dental professionals will be aware that space maintainers can play a critical role in preserving oral health and development, particularly in pediatric patients. The premature loss of primary teeth can be caused by a range of factors, including thumb, finger, lip or tongue sucking; poor dental hygiene; and some eating behaviors. Early primary tooth loss can lead to difficult and costly complications, such as malocclusion and misalignment.
Space maintainers are invaluable in preventing such issues by preserving the space left by prematurely lost primary teeth. An evidence review of the benefits of space maintainers has been produced by the Canadian Agency for Drugs and Technologies in Health.(1) Space maintainers can also serve a valuable function for adult patients wishing to improve aesthetics during the waiting period prior to fitting a dental implant.
Here is a look at the various types of dental space maintainers and their benefits.
Removable Space Maintainers
Removable space maintainers are custom-made appliances that can be easily taken out by the patient. These devices are often recommended for cases where multiple teeth are missing or if the patient is not comfortable having a fixed appliance.
- Ease of cleaning: Removable space maintainers are convenient for both children and adults as they can be easily removed. According to the American Academy of Pediatric Dentistry (AAPD), this may support optimal oral hygiene, ensuring appropriate maintenance of the appliance and thorough cleaning of the surrounding oral structures.(2)
- Adjustability: Removable appliances can be adjusted as the child’s jaw grows and the oral structure changes, ensuring continued effectiveness over time.
- Improved patient compliance: Some children and adults may find removable appliances more comfortable, leading to increased compliance with the recommended treatment plan.
Fixed Space Maintainers
Fixed space maintainers are cemented onto the teeth adjacent to the gap, providing a more stable and enduring solution.
- Enhanced stability: Fixed space maintainers are securely attached to the adjacent teeth, providing a stable framework to hold the space and prevent neighboring teeth from shifting.
- Continuous preservation: Unlike removable devices, fixed space maintainers remain in place consistently, ensuring continuous preservation of the open space until the permanent tooth erupts or the implant is installed.
- Reduced risk of loss: These appliances are not removable, so there is a lower risk of loss, misplacement or lack of compliance. This means that the practitioner and the patient can be more confident in the successful outcome of the treatment program.
Band and Loop Space Maintainers
This type of space maintainer consists of a stainless steel band wrapped around the tooth adjacent to the gap, with a loop extending into the space left by the missing tooth.
- Versatility: Band and loop space maintainers are versatile and can be adapted to various tooth configurations, making them suitable for a wide range of clinical cases.
- Minimal interference: The design of these maintainers can minimize any interference with neighboring teeth, allowing for a more comfortable experience for the patient.
Crown and Loop Space Maintainers
Similar to the band and loop design, crown and loop space maintainers involve placing a stainless steel crown on the tooth adjacent to the gap, with a loop extending into the space.
- Durability: The crown provides an additional layer of durability, making this type of space maintainer ideal for cases where the adjacent tooth requires further support.
- Improved aesthetics: The crown can be matched to the natural color of the patient’s teeth, enhancing the aesthetic appeal of the appliance.
Other Types of Space Maintainers
There are a number of other fixed space maintainer designs, including the distal shoe, direct bonded space maintainers, transpalatal arch and lingual arch. These types may be appropriate in specific cases.
In pediatric dentistry, the use of space maintainers is indispensable in preventing the potential complications associated with premature tooth loss. Whether opting for removable or fixed devices, dental professionals will consider the unique needs and preferences of each patient. The benefits of these space maintainers extend beyond preserving the immediate space, as they contribute to the overall oral health and well-being of the growing child.
As advocates for optimal pediatric oral care, it is useful for dental professionals to stay on top of advancements in space maintainer technology and application. By doing so, they play a pivotal role in ensuring the healthy development of young patients’ dentition and setting the foundation for a lifetime of optimal oral health.
- Dental Space Maintainers for the Management of Premature Loss of Deciduous Molars: A Review of the Clinical Effectiveness, Cost-effectiveness and Guidelines [Internet]. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2016 Oct 20. Available from: https://www.ncbi.nlm.nih.gov/books/NBK401552/
- American Academy of Pediatric Dentistry. Management of the developing dentition and occlusion in pediatric dentistry. The Reference Manual of Pediatric Dentistry. Chicago, Ill.: American Academy of Pediatric Dentistry; 2023:466-83