Space Maintenance

Sometimes a baby tooth is lost before the adult tooth below it is ready to come in. If a baby tooth is lost too early, nearby teeth can shift into the open space. When the adult tooth is ready to come into the space, there may not be enough room. The new tooth may be unable to come in. Or, it may come in crooked or in the wrong place.

If your child loses a tooth early, the dentist may recommend a space maintainer. This is a plastic or metal retainer that holds open the space left by the missing tooth. The dentist will remove this retainer once the adult tooth begins to appear.

Types of Space Maintainers

There are two types of space maintainers for children, removable and fixed.

Removable 

Removable space maintainers are similar to orthodontic appliances and are usually made of acrylic. In some cases, an artificial tooth may be used to fill a space that must remain open for the unerupted tooth. If your child is older and can reliably follow instructions, a removable space maintainer can be a good option.

Fixed 

There are four different kinds of fixed space maintainers: unilateral (band-and-loop), crown and loop, distal shoe and lingual arch

The unilateral (band-and-loop) and crown-and-loop space maintainers are placed on one side of the mouth to hold space open for one tooth. The unilateral space maintainer wraps around the outside of the tooth and is connected to a metal loop that holds the space intact. The crown-and-loop is an actual crown that covers the tooth and is attached to the loop to ensure there is space for the erupting tooth.

The distal shoe space maintainer is usually used for an unerupted first permanent molar tooth. It is a more complicated space maintainer because the end of the metal is usually inserted into the gum line to keep the open space from closing. A dentist will need to monitor the progress of the erupting permanent molar to make sure it can erupt properly with this space maintainer.

The lingual arch space maintainer is usually bilateral in nature and may be cemented to molar teeth and connected by a wire on the inside of the lower front teeth. Usually this is used for more than one missing tooth.

Sometimes children may be missing teeth due to congenital diseases and may require a partial denture versus a space maintainer. It is important to meet with your dental professional to determine if this is an option.

Caring for Your Child’s Space Maintainer

Once the space maintainer is made by the dentist, it may take the child a few days to get accustomed to wearing the appliance whether it is removable or fixed. There are four general rules for taking care of your child’s appliance.

  • Your child should avoid chewy and sugary foods, and gum or candy, which may loosen or get caught on the appliance.

  • Encourage your child not to press or push the space maintainer with the tongue or fingers because it could loosen or bend the appliance.

  • Keep your child’s space maintainer clean through effective brushing and flossing.

  • Your child should continue seeing the pediatric dentist on a regular basis to monitor the progress of treatment with the space maintainer and continue to receive a regular six-month professional cleaning appointment.

Reference for information: www.ada.org