Space Maintainers To Help With A Perfect Smile

The primary teeth (or baby teeth) usually fall out when the permanent ones are ready to come in. Premature loss of primary teeth due to injury, tooth decay, or other reasons creates gaps that can potentially affect the eruption of permanent teeth if left untreated. The pressure from biting and chewing causes the adjacent teeth to move or shift, resulting in a loss of space for the permanent teeth to erupt properly. This can result in various scenarios, including:

• Loss of arch length

• Crowding in the permanent dentition

• Malocclusion (improper bite)

• Poor aesthetic appearance

This is where a space maintainer comes into play. It is a dental appliance custom-made by a paediatric dentist or orthodontist using metal or acrylic material. It maintains the gaps created by the fallen milk teeth to allow the permanent teeth to erupt in place. This ensures that the surrounding teeth are unaffected, at a proper distance, and aligned, helping the erupting tooth grow properly.

The concept of dental space maintenance is the same across dental practices worldwide. Hence, the appliances used in India for this purpose resemble those used globally. While there are different types of space maintainers, a dentist can suggest the right one based on your child’s unique oral health history and the position of the missing tooth or teeth.

The design of these orthodontic appliances can vary from simple ones to those with multiple bands and wires. They fit on the teeth or an arch of your child’s mouth. Regardless of the design, they are attached to either (unilateral) or both (bilateral) sides of the mouth. The classification of space maintainers for kids falls into two types based on how they are applied and managed—fixed and removable.

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Fixed space maintainers are designed to remain in the mouth until the primary tooth has erupted properly in the missing spots. They are fixed onto your child’s teeth, which makes them non-removable and work properly. In the mixed dentition phase, the child will have both primary (deciduous) and permanent teeth in the mouth. 

Appliances that maintain the gaps for multiple teeth while facilitating the growth of erupting permanent teeth are more suitable. Depending on the location and the method of fitting, the different types include:

• Band and loop: Often used when a primary molar, or less commonly, a primary incisor, is lost. It consists of a metal band around an adjacent tooth. A loop soldered to the band extends to the gap, holding the space for the erupting permanent tooth. Materials like glass-fibre-reinforced composite resins offer an aesthetic alternative to traditional metal appliances.

• Crown and loop space maintainer: It is similar to band and loop appliances and involves placing a stainless steel crown on the abutment tooth (the tooth near the gap that supports the appliance). This method is used when the abutment tooth is weak or has a significant loss of tooth structure and requires protection. 

• Distal shoe space maintainer: It is used when the primary second molar falls out before the first permanent molar erupts. A metal band is attached to an adjacent tooth, and its extension is inserted below the gum line to help the erupting tooth grow properly. The method ensures proper alignment, avoids loss of space, and requires careful monitoring by the dentist.

• Lower Lingual Holding Arch (LLHA): Designed to manage space in the lower jaw (mandible). Bands are placed around the back teeth with a wire along the inner side of the lower front teeth (lingual arch) to hold the space. The appliance helps maintain the mandibular arch length and avoids drifting of the molars when the primary teeth fall out.

• Transpalatal arch: Fits in the upper jaw (maxilla) and helps when multiple primary teeth are missing. Bands are attached to the first permanent molars. They are connected by a wire across the palate, helping stabilise upper molars and holding space for the erupting permanent teeth while preventing tooth rotation or shifting in the maxillary arch.

• Nance appliances: They are used upon the early loss of the second primary molar in the upper jaw. They consist of bands around the first permanent molars connected to an acrylic button that rests against the mid-palate. The appliance has no contact with the anterior teeth. It prevents molars from drifting forward during the mixed dentition phase.

Removable space maintainers are less common as they require the individual’s cooperation. They are usually available in dental clinics that offer advanced services. Removable appliances are typically recommended for older children who can manage and care for them. The most popular among them include:

• Removable Acrylic Plate: It is designed using acrylic material and may include artificial teeth to fill in the gaps temporarily. Also called the Hawley retainer, it helps when multiple primary teeth are lost, and space maintenance and proper chewing of the food are of concern. These appliances are usually small, susceptible to loss or fracture, and pose the risk of swallowing in children.

A space maintainer is useful when your child's primary teeth are lost prematurely. It depends on your child’s unique oral conditions and various factors, including the timings of tooth loss, eruption and the number of missing teeth. Here are the scenarios where this appliance helps ensure proper occlusion and smile for your child:

• Premature loss of teeth: The early loss of the molars, premolars, or incisors necessitates using space maintainers to maintain the space for the permanent teeth to erupt correctly.

• Prevent tooth migration: When milk teeth are prematurely lost due to various reasons, these appliances prevent the shifting of the adjacent teeth to the missing spots.

• Eruption timing: The timing of permanent teeth eruptions varies. When a primary tooth falls out early, a space maintainer ensures the gap remains unobstructed till the permanent one erupts.

• Multiple tooth loss: If more than one primary tooth is lost, these appliances maintain the gaps, preserve the dental arch length, and avoid complications from multiple gaps.

Dentists use technologies, such as X-rays or radiographs, to determine the necessity of a space maintainer for your child. It may not be necessary if the permanent teeth will erupt soon and have sufficient space to come in. These appliances may have a minimal effect in cases of severe crowding, which requires advanced orthodontic treatment.

A space maintainer works by preserving the gap of a prematurely lost primary tooth to ensure the adjacent teeth do not drift to the space and the permanent tooth erupts in the gap properly. Some can only hold the space, while others can support oral functions and align the newly erupting teeth. Based on their functioning, they can be distinguished as:

• Passive vs. active: Passive appliances like Band and Loop and LLHA can only retain the space. On the other hand, active space maintainers not only hold the space but apply gentle forces to move teeth into their correct position.

• Functional vs. non-functional: Functional space maintainers like Crown and Loop and Distal Shoe help restore chewing and biting functions as well as preserve the gaps and guide tooth eruption. Non-functional ones, such as Band and Loop and Transpalatal Arch, hold the spaces without aiding any oral functions.

• Unilateral vs bilateral: Unilateral space maintainers, such as Band and Loop and Distal Shoe, maintain space on one side of the mouth. Bilateral ones, like the Transpalatal Arch, hold the space on both sides of the mouth.

Space maintainers promote your child’s dental health and oral functions in various ways. While primary dentition plays a major role in developing speech, chewing, and biting abilities, these facilitate a smooth transition to permanent dentition, resulting in proper occlusion and a beautiful smile. The key benefits include:

• Maintains the space upon premature loss of primary teeth, preventing migration of adjacent tooth to the gap.

• Positions the teeth correctly in the dental arch for proper alignment.

• Guides the eruption of new teeth by making sure it has adequate space to erupt in place.

• Prevents crowding, misalignment, and improper bite.

• Maintains the dental structure to support proper chewing and speech development.

• Reduces the likelihood of complex orthodontic treatments in the future.

Caring for the tooth space maintainer is crucial for your child’s oral health. It ensures proper working and longevity of the dental appliance. Proper oral hygiene, dietary changes, and regular dental check-ups are vital. Here are some helpful tips to consider:

• Brush and floss regularly to keep the dental appliance clean and prevent plaque buildup and dental caries.

• Avoid hard and sticky foods that can potentially damage or misplace the appliance.

• Ensure regular follow-up checkups with the dentist to monitor the appliance and make necessary adjustments.

• Consult a paediatric dentist immediately if the appliance becomes loose, breaks, or causes discomfort for your child.

Space maintainers benefit your child's oral health in different ways. They maintain the gaps caused by the early loss of primary teeth and guide the permanent ones to erupt in place. This prevents potential problems like tooth migration, crowding, and malocclusion. They help your child flaunt a healthier and more aesthetically pleasing smile. A dentist can suggest a proper treatment plan based on your child's unique oral needs. Proper oral care and regular dental visits are crucial for your kid's healthy smile.

1. How long does a space maintainer need to stay in place?

   The duration of having a space maintainer in place depends on the child's tooth loss and eruption phases. Generally, it is retained until the permanent tooth has fully erupted in the missing spot created by the lost primary tooth. The dentist can safely remove the appliance.

2. Are space maintainers uncomfortable?

   In some kids, space maintainers may cause initial discomfort after being placed or adjusted. It is often temporary as the child's mouth adjusts to the appliance. Proper oral hygiene and regular dental follow-ups are crucial. If the discomfort lasts, consult a paediatric dentist immediately for proper evaluation and necessary adjustments.

3. How do I care for my child's space maintainer?

   Keep the dental appliance clean. Maintain proper oral hygiene with regular brushing and flossing. It is ideal to avoid sticky, hard foods that can potentially damage or misplace the appliance. Ensure regular follow-up checkups with the child’s dentist to monitor the appliance and make necessary adjustments.

4. Will a space maintainer affect my child's speech?

   Some dental appliances can temporarily affect your child's speech when initially placed. This usually improves as the mouth adjusts to the device. In such cases, functional space maintainers can help. They maintain the gap and aid the child’s oral functions, including speech, chewing, and biting. Consult a paediatric dentist to find out what is best for your child.