Why is a space maintainer needed?
Baby teeth are not only for chewing; they also guide the permanent teeth developing underneath. When a baby tooth is lost early, especially at the back of the mouth, the neighbouring teeth may gradually tip or drift into the gap. The permanent tooth may then not find enough room to erupt; the teeth may become crowded or the permanent tooth may stay impacted.
By preventing this drift, a space maintainer can help reduce the likelihood of more extensive orthodontic treatment being needed later. Not every early loss requires a space maintainer; the decision depends on which tooth was lost, the child's age and how close the permanent tooth underneath is to erupting.
When is it considered?
- Loss of a baby molar long before the permanent tooth below is due to erupt
- A baby tooth having to be extracted because of deep decay or infection
- Loss of a tooth after a fall or a knock
- An X-ray showing that the permanent tooth below will not erupt for a long time
If the permanent tooth is about to erupt, or if there is no permanent tooth at all, a different plan may be made. For this reason the decision is based on an examination and X-rays.
Types of space maintainers
| Type | How is it fitted? |
|---|---|
| Band and loop (fixed) | A ring (band) is fitted to the tooth next to the gap; a thin wire attached to the band keeps the space open. It is often used for single-tooth gaps. |
| Lingual arch (fixed) | A wire in the lower jaw attached to the molars on both sides and running along the inner surfaces of the teeth; it may be preferred when there is more than one gap. |
| Palatal arch / Nance appliance (fixed) | In the upper jaw, it stops the molars drifting by connecting them to each other or to a part resting on the palate. |
| Removable space maintainer | Built on an acrylic plate that the child puts in and takes out. A tooth can be added at the front for appearance. Its effect depends on being worn regularly. |
How is it fitted?
- Examination and X-rays: The condition of the gap and the position of the permanent tooth below are assessed.
- Impression or intraoral scan: Taken so the appliance can be made individually.
- Fitting: Fixed space maintainers are cemented to the tooth; for removable ones, the child is shown how to put them in and take them out.
- Check-ups: Usually every few months; whether the appliance is in place and how the permanent tooth is erupting are monitored.
- Removal: When the permanent tooth starts to erupt, the space maintainer is removed by the dentist.
Daily care and things to watch
- The area around a fixed space maintainer should be cleaned carefully at every brushing; food can collect around the band.
- Sticky and hard foods (toffee, chewing gum, hard sweets) can loosen the appliance.
- The child should not play with the appliance with the tongue or fingers; the wire can bend.
- When a removable space maintainer is taken out, it should be kept in its case and cleaned every day.
- If the appliance comes loose, breaks, gets lost or causes a sore on the gums, contact the clinic.
Space maintainers and orthodontics
A space maintainer can be seen as part of an early orthodontic treatment approach. If the space has already started to close, space-regaining appliances instead of a space maintainer, or comprehensive orthodontic treatment later on, may be needed. Having a child's first orthodontic check-up at around age 7 helps such situations to be noticed in time. For details, see the orthodontics for children and orthodontic appliances guide pages.