Use of Space Maintainers for Children Dentistry

Replacement of the primary teeth with the permanent teeth in children is a normal and natural process. Sometimes this normal process is disrupted due to a premature loss of primary teeth or dental caries.

Undesirable Drifting  of Primary Molars

When primary molars are lost too early, the adjacent teeth drift. The gradual migration of the teeth leads to the loss of arch length. This space loss leads to the misalignment or crowding in the permanent teeth of the child.

This problem is avoidable using space maintainers. Space maintainers are used for preventing the migration of adjacent teeth after an early tooth loss in children.

Many children in Brisbane lose their primary teeth too soon due to early childhood caries or dental traumas every year. Space maintainers are the safest way to prevent misalignment of teeth after early tooth extraction in children. It is an orthodontic appliance used to initiate an early intervention to promote a desirable outcome. These devices hold the space for the eruption of permanent teeth. Space maintainers promote favourable tooth eruption and can reduce or eliminate misalignment in developing teeth in children.

What is the Best Space Maintainer?

Primary teeth are the best space maintainers. They guide the eruption of permanent teeth in children. The best way to avoid misalignment of permanent teeth is to preserve the primary teeth in the arch until their natural time of exfoliation is attained. Preventive orthodontics is part of paediatric dentistry and regular visits to a  Brisbane kids dentist can preserve the primary teeth of the child in the dental arch until its normal time of exfoliation is reached.

Unfortunately, sometimes premature extraction of baby teeth is necessary. In such cases, space maintainers are recommended to preserve the empty space for the normal eruption of the permanent teeth.

Band and Loop Type of Space Maintainers

Band and loop space maintainers have a long history of the application by paediatric dentists in Brisbane. The conventional application of these appliances have had a great success rate but they have some disadvantages including:

  • Failure of the solder
  • The disintegration of the cement
  • Formation of caries along the margins of the band
  • Long fabrication time (increased chair time and lab time)
  • Inability to prevent tipping or rotational movements in the adjacent teeth

Due to the disadvantages above, some paediatric dentists prefer to use prefabricated bands in various sizes.

Glass Fibre Reinforced Composite Resin Type of Space Maintainers

These space maintainers are more modern compared to band and loop types of space maintainers and are still being studied and researched. These splints are adhesive and are directly bonded

3D-Printed Space Maintainers

3D printing technology will soon be integrated into paediatric dentistry as well. The space maintainer is designed and then fabricated using a 3D printer. This technique reduces the human error in fabrication and the process includes:

  • Taking impression
  • Pouring cast
  • Digitising using a 3D scanner
  • Design of the Space Maintainer
  • 3D printing

With this 3D printing these steps are no longer required:

  • Extensive lab work
  • Stabilising the loop
  • Soldering the loop on the band and polishing

A 3D space maintainer is fabricated as one piece which makes it more reliable compared to multi-part maintainers. It tends to fail less compared to a conventional appliance.

Space Maintainer for Premature Loss of Primary Teeth

A space maintainer is a dental appliance that maintains the required gap between the teeth until the adult tooth erupts. This appliance may be required when a child loses a primary tooth (baby tooth) too early. The role of the space maintainer is to keep the gap open until the permanent adult tooth comes through.

Requirements for a Space Maintainer

A space maintainer may be required when a primary first molar is lost too early. When  a space maintainer is to be used, it should be used in a mouth that:

Construction of a Space Maintainer

A space maintainer is an appliance made out of plastic or metal. A space maintainer is designed for a custom fit to the child’s mouth. The device maintains the space intended for the eruption of a permanent tooth in future.

Diagnostic Decision for Space Maintenance

A space maintainer is designed and fitted to the patient mouth to prevent a mesial drift of the permanent first molar. the decision for using a space maintainer is affected by the considerations below:

  • Which specific baby tooth is lost
  • Which arch contains the missing tooth
  • Will the adult tooth grows immediately or does it take a while
  • Is the permanent successor developing normally
  • The length of the arch and its status

Fixed Space  Maintainer

A fixed space maintainer is fitted or fixed to the patient teeth and once fixed, it cannot be removed by the patient. The advantages of fixed space maintainers include:

  • Minimal tooth prep (bands & crowns are used)
  • No interference with the passive eruption of abutment teeth
  • The development of the jaw is not hampered
  • A succedaneous permanent tooth is free to erupt
  • Suitable for uncooperative children
  • The masticatory function can be restored if pontics are placed

 

Fixed space maintainers have some disadvantages which include:

  • Expert skills are required to fabricate quality fixed space maintainers
  • Careful oral hygiene is required because there may be tooth decalcification under the bands
  • If pontics are not used, supra eruption of opposing tooth can occur 

On the other side, pontics may interfere with vertical eruption of the abutment tooth a

Removable Space Maintainers

A removable space maintainer is very similar to a partial denture. With this type of space maintainers, not only mesiodistal space is maintained but also the vertical space maintenance is also provided. with removable space maintainers, the masticatory function is also restored to some level. Removable space maintainers can improve the esthetics in the anterior region of the mouth. space maintainers can also prevent speech defects due to loss of anterior teeth.

Removable space maintainers are not common practice in Australia, but may be used in other countries.

Indications for a removable Space Maintainer

  • Aesthetics in the anterior region of the mouth
  • Loss of front teeth
  • Loss of primary tooth bilaterally (more than one primary tooth)
  • Loss of more than 2 primary molars unilaterally
  • When the abutment teeth cannot support a fixed dental appliance
  • A child with an oral cleft is required obturation of the palatal defect along with teeth