These are appliances that maintain space after extraction of the milk tooth has been done in order to maintain space for the permanent tooth to erupt in its place.
Children may need space maintainers if they lose a tooth early or have a baby (primary) tooth extracted due to dental decay. If either is the case, it is important to know the benefits of using a space maintainer and how it can help support your child’s dental health.
A space maintainer is an appliance that is custom-made by a dentist or orthodontist in acrylic or metal material. It can be either removable or cemented in a child’s mouth. Its purpose is to keep the space open to allow the permanent tooth to erupt and come into place. Baby teeth are important to the development of the teeth, jaw bones and muscles and help to guide permanent teeth into position when the baby teeth are lost. If a space is not maintained, then teeth can shift into the open space and orthodontic treatment may be required. Not every child who loses a baby tooth early or to dental decay requires a space maintainer; however, a professional consultation with your dentist or orthodontist should be conducted to determine if using a space maintainer is needed.
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.
- Fixed ? there are four different kinds of fixed space maintainers: unilateral, crown and loop, distal shoe and lingual.
The unilateral 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 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.
Wearing the Space Maintainer
Once the space maintainer is made by the dentist or orthodontist, it may take the child a few days to get accustomed to wearing the appliance whether it is removable or fixed. The dentist should review with the child and parent the proper ways to clean the space maintainer thoroughly in order to keep the gum tissue healthy and free of dental plaque. Proper instruction for tooth brushing and flossing should be considered for improved oral hygiene.
If the space maintainer is fixed, it will be important to avoid chewy and sugary foods, and gum or candy, which may loosen or get caught on the appliance. Also, the space maintainer should not be pressed or pushed with the tongue or fingers because it could loosen or bend the appliance.
The child should be seen by the dentist or orthodontist 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 with your dental professional.
Guidance eruption is a method used to create enough room for crowded lower permanent incisors. Crowding can often be seen with the eruption of the permanent teeth of the lower jaw at 6 to 7 years old. The permanent incisors will usually compensate for this crowding by erupting behind the primary teeth. If this happens, both sets of teeth may be apparent at the same time.
Additional room for a permanent lower incisor can be achieved through either the extraction of a primary tooth, or the discing away of portion of the primary tooth. If enough room is provided, the permanent lower incisors usually glide into a straight orientation without further intervention.
Guidance eruption may reduce the need for future orthodontic movement of the permanent lower incisors. Guidance eruption may also reduce the risk of future gingival recession and periodontal concerns of the lower front incisors, however, it will not gain any room for future permanent tooth eruption. Because more crowding may be encountered at about 9 years old, the need for space maintenance or future orthodontic treatment may be warranted.