Most people who have kids with dental problems must have heard the expression “space maintainer” and wondered what it means.

Premature loss of baby teeth can lead to long-term dental problems if not addressed properly. The space maintainer is one of the most effective appliances to prevent these issues.

What is a space maintainer?

A space maintainer, tooth spacer, or dental space holder is a custom-made dental appliance used to maintain the space for a permanent tooth when a baby tooth is lost prematurely. 

It prevents the adjacent teeth from drifting into the vacant space, allowing the permanent tooth to erupt properly.

This simple device plays a crucial role in preserving the natural alignment of teeth and avoiding future orthodontic issues.

What is the purpose of the space maintainer appliance?

It is essential to consult with an orthodontist or pediatric dentist about using a space maintainer whenever a child loses their baby teeth prematurely.

The earlier premature loss of primary secondary molars (E’s), at the age of 6-7 years old, is the most common use case for a space maintainer in a child’s mouth.

In this Specific year range, the permanent first molars are erupting and shifting to close the gap that was left due to the premature loss of the primary molars.

If the erupting permanent molar stayed in this vacant space alone, it would soon shift and tilt towards this gap, leaving no space for the permanent premolars to erupt in their proper direction and space inside the child’s mouth.

Thus, permanent teeth crowding is likely to happen, most frequently in the permanent premolars and permanent canines space, leading to dental and smile problems, malocclusion, gingival inflammation, and difficulties with oral hygiene.

Consequently, the child may require orthodontic treatment in the near future, typically around 12-14 years of age.

You can think of the primary teeth that each kid has are the gaurds that hold appropriate space for the adult teeth to grow in and prevent the remaining adjacent permanent teeth from moving into the gap.

When does a child need a space maintainer?

Space maintainers are typically recommended when:

• A child loses a primary tooth due to decay, trauma, or early extraction.
• The permanent tooth is not expected to erupt soon.
• There is a risk of adjacent teeth drifting into the space.
• Genetic incidence of any of the parents’ teeth crowding factors that their kid may inherit.

At what age are space maintainers worn?

Space maintainers are typically worn by children between the ages of 4 and 12. This age range corresponds with the period when primary (baby) teeth begin to fall out and permanent teeth start to erupt.

We need to know about the timeline of primary or children’s teeth shedding and eruption, that’s the parent’s guide to determine whether a child needs a tooth spacer (space maintainer) or not.

• At 6 months to 1 year, your child’s primary teeth should start to emerge
• Around 3 years old, your child should have most of their baby teeth
• Around 6 years old, your child’s teeth should begin to fall out, and this can continue until around age 12. Teeth tend to fall out in the order they grew in.

The Mechanism of Dental Space Maintainer

A space maintainer, as a rigid appliance, holds the adjacent primary and existing permanent teeth in their correct position to prevent them from tilting or moving into the space.
A dental space holder is retained on the permanent or primary teeth, extends onto the tooth gap left by the premature loss of primary teeth, and rests rigidly to prevent the natural tendency of the existing teeth to move and shift into the space.
To keep the vacant space available to guide the erupting permanent teeth to their proper alignment, it should then be removed.

Types of Space Maintainer

Space maintainers are divided into 2 main large categories, which are further subdivided into many types.

Removable space maintainers:

Removable space maintainers are similar to orthodontic appliances and are usually made of acrylic. There are cases when an artificial tooth is used to fill a gap that must remain open for the unerupted tooth.

As its name implies, this type of space maintainer can be removed. Useful for cooperative children with multiple missing teeth, and can be removed for cleaning

 For examples:

• Acrylic partial denture:  These are made of acrylic material and are used to replace missing teeth, particularly in the front of the mouth, or when multiple primary teeth are missing in one arch. 
• Removable Hawley appliance with helical spring: the appliance can be used to maintain space, and also to regain space if teeth have shifted.
• Removable distal shoe appliances: These are used to maintain space for the eruption of permanent premolars.

Fixed space maintainers:

• Band and Loop: Most common; a band is placed on the neighboring tooth next to the space, and a loop related to it relies on the tooth on the other side of the space used for a single missing tooth.
  It is used in cases of one side premature loss of a primary first or second molar, especially when the permanent first molar has already erupted and is stable.
• Lingual Holding Arch: A wire placed on the inside of the lower teeth maintains space in the lower jaw (often bilateral).
• Transpalatal Arch: A fixed arch wire that runs across the upper palate, often used for bilateral space maintenance in the upper arch.
• Fixed Distal Shoe: Guides unerupted molars, often used for early loss of a second primary molar.
• Nance Holding Arch: A fixed appliance used in the upper arch to maintain space between molars and prevent their migration. 

Did You Know!
The most commonly used space maintainer is the Band and Loop space maintainer, especially for single missing teeth.

What is the procedure for a space maintainer?

There are several steps involved in creating a space maintainer:

• Diagnosis & X-ray: The Dentist assesses tooth loss and eruption timing
• Impression: A mold of the child’s teeth is taken
• Fabrication: Appliance is custom-made in a dental lab
• Fitting: Appliance is cemented (for fixed) or adjusted (for removable)
• Follow-Up: Periodic checks to monitor fit and tooth eruption

What are the complications of space Maintainers?

• Plaque accumulation and gum irritation:
  This is likely to cause discomfort and pain for patients, in addition to compromising compliance with the treatment plan.
• Discomfort or ulceration:
  Soft tissue irritation or ulceration is associated with poorly adjusted or ill-fitting space maintainers.
• Breakage or loosening of the appliance:
  One of the common challenges associated with space maintainers is that they can become loose in the mouth or dislodged entirely.
  Also, Fixed space maintainers can break under pressure, removable space maintainers could fall and break up, and sometimes the patient is not aware of it. This can compromise the device’s effectiveness and potentially lead to unwanted tooth movement or other complications.
• Allergic Reactions or Tissue Sensitivities:
  Occasionally, patients may exhibit allergic reactions or tissue sensitivities to the materials used in space maintainers, leading to discomfort and potential additional complications.
• Patient Non-compliance:
  Ensuring patient compliance with space maintainer protocols is a very common challenge, particularly with removable appliances. Children may resist wearing the appliance as prescribed, potentially affecting the outcome of the treatment program.
• Tooth movement, if not monitored
• Rarely may it impede the eruption if left too long

When to remove a space maintainer?

• When the permanent tooth starts to erupt
  As the permanent tooth begins to push through the gums, a space maintainer would be serve its purposed and should be removed.
• The dentist determines the best timing to remove the aapliance based on X-rays and clinical examination.
  • X-rays show the permanent teeth buds on thier way to erupt near the oral cavity, below the gum level.
  • Clinical examinations show redness, swelling, sometimes a cusp if the permanent tooth starts to show into the gum, or a har tooth-like feeling below the gum by palpation.

What is the cost of the space maintainer?

The cost of a space maintainer varies depending on the type and complexity of the case. At Suave Dental Clinic, we strive to provide affordable dental care without compromising on quality. For detailed pricing information, we encourage you to contact our clinic directly or visit our website.

• Varies based on type and location
• Range: $200–$600 (USD) per appliance
• Additional cost for dental visits and adjustments

Space maintainer aftercare:

• Regular brushing and flossing to avoid decay
• Avoid sticky or hard foods that can dislodge the appliance.
• Attend regular dental checkups for monitoring.
• Inform the dentist of any discomfort or breakage.

What happens if a kid doesn’t get a space maintainer?

If a child loses a baby tooth too early and doesn’t get a space maintainer, several issues may occur:

• Adjacent teeth may shift into the space.
• This can block the permanent tooth from coming in properly.
• It may lead to crowding, misalignment, or bite problems.
• The child might need braces or more complex orthodontic treatment later on.

Space Maintainer FAQs