There are occasions when baby teeth are lost prematurely, sometimes due to impact from an accident, severe decay or from some other reason such as disease. When the baby tooth is lost early, the permanent tooth loses its guide and there is a chance that the budding permanent tooth can drift or come out in an incorrect position.
For this reason, dentists fit space maintainers adjacent to a gap where a permanent tooth should be erupting.
The purpose of space maintainers is twofold: one, to keep open a space where the baby tooth was once located and two, serve as a guide for the permanent tooth to grow into. In short, it temporarily fills in a space so that the permanent tooth can grow in properly.
Space maintainers may be made of stainless steel wires or plastic acrylic. They can also be made to look like artificial, temporary teeth.
There are basically two types of space maintainers: fixed and removable.
Fixed Space Maintainers
- Unilateral space maintainers are fitted on just one side and usually replace just one tooth. It can be constructed in a band-and-loop or a crown-and-loop type. It can also be a distal-shoe type that is inserted under the gums. This latter type of maintainer is used when a child loses the baby tooth and the 6-year molar has not emerged.
- Bilateral space maintainers are normally cemented with bands on back teeth on both sides connected by a wire just behind the lower incisors.
Removable space maintainers are similar in construction to orthodontic retainers and can be fitted alone by the wearer. This type of space maintainer works better in older children because it requires closely following directions on care and maintenance.
Custom-made and -fitted Just like braces, retainers, dentures and other dental appliance space maintainers are custom-made and fitted by a dentist or orthodontist to the patient. In making a fixed space maintainer, a metal band is placed around one of the teeth next to the space, and impressions are made. This allows the dental technician to make a copy of the teeth to use in making the space maintainer. The band is also removed and sent to the dental laboratory with the impressions. The lab creates the space maintainer and sends it back to the child's dentist. The dentist cements it into place.
For a removable space maintainer, the dentist first makes impressions and then sends them to a lab, which makes the appliance.
Care and Maintenance
Just like maintaining healthy teeth and gums, space maintainer care and preservation directions need to be religiously followed. If a space maintainer wearer is not taken to dentist regularly for a checkup every six months, problems can set in, especially if the wearer does not observe proper dental hygiene such as brushing and flossing regularly.
There also is a chance that the gum tissue in the space can grow over the wire arm, putting the wearer at risk of infection. If this occurs, surgery may be necessary to remove the gum tissue.
It is necessary for a child with a fixed space maintainer to avoid chewy candy and gum, as these can loosen the band or get caught in the wire arm. If the space maintainer comes loose, there is a risk of swallowing the object. The child shouldn't push on the space maintainer with his or her tongue or fingers, as this could damage its shape and eventually loosen it.
The incoming permanent tooth's development will be monitored regularly by the dentist or orthodontist through X-ray photography. When the tooth is ready to come out, the space maintainer is taken off.
If no permanent tooth comes out, the space maintainer will continue to be used until the child's growth is complete at around age 16 to 18. After this, the dentist will place a bridge, implant or removable partial denture in the space.
A partial denture is used on children missing several teeth. For example, children with a congenital disease called ectodermal dysplasia often are missing several baby teeth. There are no permanent teeth to replace them and a child with this condition will have to use a removable denture into adulthood. Following this, the child can receive dental implants or a bridge.