What is Dental Space Maintenance?

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A pediatric dentist or orthodontist may tell you that you or your child require space maintenance, which is exactly what it sounds like. Children often lose primary teeth early and it is important to maintain the space between their remaining primary teeth for permanent teeth that have yet to erupt. In adults, tooth crowding may mean that extractions are required and the space needs to be maintained as other teeth are moved using braces or clear aligners. In either children or adults, appliances aptly named space maintainers are used.

Types of Space Maintainers

Space maintainers can be fixed in the mouth or removable. Removable space maintainers tend to be made of acrylic and an artificial tooth may be used to fill a space. Fixed appliances are often easier for children as the appliance stays in their mouth, bonded to their teeth with cement. There are 4 types of fixed space maintainers-unilateral, crown and loop, distal shoe and lingual.

Band and loop are unilateral (on one side of the mouth) space maintainers in which one tooth has a metal band placed around it and on the side of the band is a metal loop which sits just over the space where a tooth was lost or extracted. The loop presses up against the tooth on the other side of the space, keeping it open. Crown and loop space maintainers are very similar but instead of a band around the tooth, it has a whole crown on it.

A distal shoe space maintainer is used if you lose a primary second molar and do not yet have a permanent first molar erupted. The tooth you still have will get a crown or band. Attached will be a metal arm that extends beyond the space where the molar will erupt and then turns 90 degrees down, below the gum on the opposite side. The metal that extends below the gum will help guild the molar to erupt straight up.

Lingual space maintainers are used when more than one tooth is missing or patients have mixed dentition. Bands are cemented on the back teeth on both sides of the mouth and a wire runs between them along the inside bottom of the lower teeth or across the palate.

Best Practices

When a child receives a space maintainer, either removable or fixed, they will usually take a few days to get used to the new feeling in their mouth. They will be told how to properly clean the space maintainer as well as their teeth while wearing it. It is important to maintain excellent oral hygiene to keep gums healthy and teeth free of cavities.

If a patient has a fixed space maintainer, they will want to avoid chewy and sugary foods which may get caught on the appliance. The patient should also not play with the appliance, either with their tongue or fingers. A dental professional, be it a general dentist or orthodontist, will check on the appliance on a regular basis to monitor progress and access the need of keeping the space maintainer in. Children should continue to receive their 6 month check ups to make sure their teeth are clean and their oral hygiene impeccable!

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