Space maintainers in dentistry

February 21, 2016

  

Few people realize the importance of primary (deciduous or baby) teeth. They do much more than help children chew food. The first set of teeth help with speech production and development, establish healthy and nutritious eating patterns, and give children self-confidence. But perhaps most importantly, primary teeth hold the appropriate amount of space for the secondary (permanent or adult) teeth that follow. They act as a guide for permanent teeth.

Premature loss of primary teeth can cause shifting. Neighboring teeth can tilt or move into the empty space, not leaving enough room and adult teeth come through in the wrong position. To “hold the space,” and guide adult teeth into proper position, the dentist might recommend a space maintainer.

Leading Causes of Early Tooth Loss

Primary teeth are often lost too early because of trauma, severe decay, or infection. Some conditions or diseases, like uncontrolled diabetes or immunological problems, can also cause premature tooth loss. Some children even have congenitally missing primary teeth that never grow in. Sometimes if the deciduous tooth is missing, the permanent tooth may be missing as well. All of these conditions could require treatment to keep teeth in the right place while development continues.

What are Space Maintainers?

Much like orthodontic appliances, the dentist custom makes these stainless steel and/or plastic space maintainers. They help help support the jaw and hold remaining deciduous teeth in proper position. There are numerous variations, each one designed to meet a specific need.

Types of Space Maintainers

The dentist can make the appliance removable, or fixed by cementing it in place. Unilateral appliances attach to just one side of the mouth, bilateral attach to both sides. The dentist can also place them in the mandibular or maxillary arch. These are some main types of fixed appliances:

1. Band and Loop

This unilateral appliance is made of stainless steel and held in place by either an orthodontic-like band or attached to teeth next to the empty space. Attached to the band is a wire loop that bridges across the space to hold it open.

2. Crown and Loop

This type of space maintainers is the same as the Band and Loop but the attachment to the tooth is made of a full stainless steel crown instead of a metal band going around the permanent tooth.

3. Lingual Arch

The dentist uses this appliance when several teeth, particularly back primary molars, are missing. This space maintainer is cemented to six year old molar teeth and connected by a wire on the “lingual,” or tongue side of teeth. Usually the dentist uses this appliance after the eruption of permanent incisors.

4. Nance Appliance

This is much like the lingual arch, but instead of resting against anterior incisors, this appliance is embedded in an acrylic button that rests directly on the soft tissue of the palatal rugae. This helps preserve the occlusion of mandibular and maxillary incisors.

5. Distal Shoe

For this more complicated appliance the dentist inserts the space maintainer under the gums. Professionals use this type of appliance when a child losses baby teeth in front of a six year old molar that hasn’t grown in yet. The dentist must monitor this appliance more closely to make sure the molar can still come through properly.

6. Transpalatal Arch (TPA)

This appliance is comprised of two bands attached to posterior teeth with a looped wire spanning across the palate, without touching the soft tissue. This appliance helps hold molars in place during the movement of other teeth.

7. Removable Space Maintainer

These appliances are used in permanent and deciduous dentition. They are recommended for prematurely tooth loss and are also known as partial denture space maintainers because they resemble the outlook of a partial prosthetic appliance. Problems with this type of space maintainers include breakage, loss of the appliance and lack of compliance (patient is not wearing the appliance). In some countries they are known as Kemeni space maintainers.

8. Maryland Bridges (No-prep Bridges)

Maryland bridges are prosthetic appliances used in permanent dentition that can be used as space maintainers to avoid teeth drifting and overerupting. They consist of a pontic body of one or several units that can be made of acrylic and porcelain. There are one or two metal wings that get attached to the adjacent teeth with composite or cement which makes Maryland bridges a perfect choice for minimal invasive dentistry. Acrlylic Malyland bridges allow adjustments of the tooth surfaces and incisal edges but can change their color in a long run. Ceramic Maryland bridges have a slightly better outlook due to the esthetic qualities of the porcelain. The downside of the porcelain resin bonded brisges is that they cannot be adjusted properly by drilling out the porcelain pontic. 

How Long Does Treatment Take?

The dentist closely monitors the patient’s progress with regular x-rays to check on incoming secondary teeth. As soon as the tooth is ready to come through and fill the gap, the dentist can remove the space maintainer. If the permanent tooth is missing, then the space maintainer can remain until growth of remaining teeth and jaws is complete (usually the age of 16 to 18). Then the dentist places a bridge, implant, or partial denture to fill in the gap.

Taking Care of Space Maintainers

Many dentists prefer fixed appliances over removable, especially in young children mainly because of compliance issues. It will take a few days for the child to get accustomed to the new appliance. They should not push any wires with their tongue or finger, otherwise it could bend. As for dental hygiene, the dentist should review proper ways to clean the appliance. The child needs to brush well and regularly. This will keep teeth and gums free of dental plaque. It can also be important to avoid sticky, chewy foods that could get caught in wires or loosen the bands.

Not every child who loses a baby tooth early will require treatment with a space maintainer. However, you should always consult with your dentists or orthodontist if you’re child loses a baby tooth because of trauma or decay. Early intervention could ultimately save your child’s smile.

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