A space maintainer is a specialized dental appliance used in pediatric dentistry when a primary, or baby, tooth is lost too early. These custom-made devices hold the exact position of the empty space left behind by the prematurely lost tooth. Typically made of metal or acrylic, they prevent the adjacent teeth from shifting into the gap. The appliance remains in place until the permanent tooth underneath is ready to erupt, guiding the adult tooth into its correct position along the dental arch.
The Purpose of Space Maintainers
Primary teeth are not only for chewing and speaking, but they also serve as natural placeholders that reserve space for the permanent teeth developing beneath the gums. When a baby tooth is lost prematurely due to severe decay, trauma, or infection, the adjacent teeth will naturally begin to move toward the vacant area. This movement is a natural response to the loss of physical contact and support, and it can happen quickly, sometimes within just a few months.
If the space is not actively maintained, the shifting of neighboring teeth can cause the permanent tooth to become blocked or lose its intended path of eruption. This loss of space often results in the adult tooth erupting at an incorrect angle, a condition known as malocclusion. Using a space maintainer can significantly reduce the potential for future orthodontic problems, such as severe crowding that would require extensive treatment with braces.
Fixed and Removable Designs
Space maintainers are broadly categorized into two main groups: fixed and removable, with the choice depending on the child’s age, cooperation, and the specific teeth involved. Fixed space maintainers are cemented onto the teeth and cannot be removed by the child, making them a reliable option, especially for younger patients.
One common fixed type is the Band-and-Loop maintainer, which consists of a metal band wrapped around a supporting tooth and a wire loop extending across the gap. This unilateral design is frequently used when a single molar is missing. The Distal Shoe is a specialized fixed appliance used when the primary second molar is lost before the first permanent molar has erupted.
For multiple missing teeth, a Lingual Holding Arch may be utilized, connecting bands on the molars with a wire that runs along the inside of the lower front teeth. Removable space maintainers are similar to clear retainers and are usually made of acrylic, sometimes with an artificial tooth attached for aesthetics. These are reserved for older, compliant children or when front teeth are missing, as they rely on consistent wear.
Living With a Space Maintainer
Caring for a space maintainer involves specific changes to diet and oral hygiene to ensure the appliance remains effective and the surrounding teeth stay healthy. Children must avoid sticky, chewy foods like gum, caramel, and taffy, as these can pull the appliance loose or bend the metal components. Hard foods such as ice, hard candies, and nuts should also be avoided because they can damage the wires or bands. Parents should encourage chewing food on the opposite side of the mouth from the appliance during the initial adjustment period.
Proper oral hygiene around the fixed appliance is important because the bands and wires can easily trap food debris and plaque. Brushing must be thorough, focusing on the area where the band meets the tooth and the wire component. Flossing around the maintainer may require a floss threader to carefully pass the floss under the wire to clean the adjacent teeth and the gum line.
If the appliance feels loose, is broken, or comes out, contact the dentist immediately, as a delay allows teeth to shift, potentially requiring the device to be remade or the space to be regained. The space maintainer remains in place until X-rays confirm the permanent successor tooth is ready to erupt, at which point the dentist will remove the appliance.