Short answer: A space maintainer is a fixed or removable appliance used to preserve the space needed for the permanent tooth coming in underneath when a baby tooth is extracted or lost before its time. By preventing neighboring teeth from drifting into the gap, it helps the permanent tooth come in at the right place and can reduce the risk of crowding later on. Whether one is needed is determined by examination and X-ray.
Although baby teeth stay in the mouth for only a few years, they play important roles in a child's eating, speech and the permanent teeth coming in at the right place. When a baby tooth is lost prematurely because of decay, infection or an accident, the resulting gap does not always stay as it is. A space maintainer is a small but effective orthodontic appliance used to preserve this gap until the permanent tooth comes in.
In this article we explain what a space maintainer does, what can happen in the mouth when a baby tooth is lost early, the types of space maintainers, the fitting and follow-up process, and the situations in which a space maintainer is not needed.
What is a space maintainer?
A space maintainer is an appliance that keeps the gap left by a baby tooth lost early open until the permanent tooth coming in underneath erupts. It usually consists of a thin wire loop or an acrylic plate attached to the teeth on one or both sides of the gap.
Baby teeth work as natural "space holders" for the permanent teeth. The permanent tooth gradually dissolves the root of the baby tooth and comes in in its place. If the baby tooth leaves the mouth much earlier than expected, this natural guide disappears. A space maintainer temporarily takes over this guiding role.
What happens if a baby tooth is lost early?
When a baby tooth is lost early, the most common result is that neighboring teeth drift into the gap and the space needed for the permanent tooth to come in narrows. This drift can be faster especially when baby molars are lost and during the period when the first permanent molar, known as the six-year molar, is coming in.
Possible consequences of space loss include:
- Impaction: The permanent tooth may remain in the bone because it cannot find room to come in.
- Erupting in the wrong place: The tooth may come in on the tongue or cheek side, outside the dental arch.
- Crowding: Teeth may overlap because they do not fit in the arch.
- Bite problems: Teeth in the opposite jaw may over-erupt into the gap, disrupting the relationship between the upper and lower teeth.
- Midline shift: If space is lost in the front, the midline of the teeth may shift to one side.
Some of these problems can be corrected with orthodontic treatment at a later age. However, preserving the space from the start is often a simpler and shorter route. For crowding problems that may arise later and the treatment options, you can also see our article on treating crowding with clear aligners.
What are fixed and removable space maintainers?
Space maintainers are divided into two main groups, fixed and removable; the choice depends on the location and number of lost teeth, the child's age and their cooperation.
Fixed space maintainers
Fixed space maintainers are cemented to the teeth and cannot be removed by the child. Because they are easy to live with, they are the most commonly preferred group.
- Band and loop: It consists of a metal band fitted to the tooth next to the gap and a wire loop extending from it. It is common when a single baby molar is lost.
- Crown and loop: If the neighboring tooth is also going to be treated with a crown, the loop is attached to that crown.
- Lingual arch: This is a wire that connects the molars on both sides of the lower jaw on the tongue side. It is used when more than one tooth is lost.
- Nance appliance and transpalatal arch: These are fixed appliances in the upper jaw that take support from the palate.
- Distal shoe: This is a special design used to guide the permanent molar when the second baby molar is lost before the six-year molar has come in.
Removable space maintainers
Removable space maintainers are acrylic plates that the child can put in and take out. They may be preferred when more than one tooth is lost or when the appearance of the front teeth also needs to be supported; artificial teeth can be added to these plates. To be effective they must be worn regularly, so the child's age and cooperation are important. The risk of loss and breakage is higher than with fixed types.
How are fitting and follow-up done?
Fitting a space maintainer is usually completed in two short appointments, does not require anesthesia and is often a comfortable procedure for children.
- Examination and X-ray: The presence of the permanent tooth, its developmental stage and the approximate time left until it comes in are assessed.
- Impression or digital scan: The appliance is custom-made. For some types, small separating elastics may be used to choose a band that fits the supporting tooth.
- Fitting: Fixed types are cemented by the dentist; with removable types, the child and family are taught how to put it in and take it out.
- Check-ups: Check-ups are usually every few months. Whether the appliance has shifted, whether it is pressing on the gum and the eruption progress of the permanent tooth are monitored.
- Removal: The space maintainer is removed when the permanent tooth starts to appear in the mouth or when its path of eruption has been secured.
As long as the space maintainer is in place, chewing gum, caramel and sticky candies should be avoided, and the area around the appliance should be brushed carefully. If plaque builds up along the edges of the band, the risk of decay in the supporting tooth can increase. If the appliance loosens or breaks, or the child feels discomfort, you should see the dentist without waiting for the check-up date.
Is a space maintainer necessary? When is it not needed?
A space maintainer is not necessary every time a baby tooth is lost; the decision depends on when the permanent tooth will come in, the location of the gap and the space currently available. The dentist avoids an unnecessary appliance while also taking the risk of space loss into account.
Situations in which a space maintainer is generally not needed include:
- If the permanent tooth is about to come in: If the X-ray shows that the root development of the permanent tooth is advanced and the bone over it is very thin, it can be expected to come in shortly.
- Some front tooth losses: If the canines have come in, significant space loss is often not seen after losing a baby incisor. Still, an assessment is made in terms of appearance and speech.
- If there is no permanent tooth: If the tooth that should come in underneath is congenitally missing, whether to preserve the gap is decided according to the long-term orthodontic and prosthetic plan.
- If there is already extra space: If there is enough space between the teeth and the risk of drifting is low, monitoring may be preferred.
Conversely, loss of baby molars during the period when the six-year molar is coming in, loss of more than one tooth and situations in which the teeth are already crowded increase the need for a space maintainer. That is why it is important for the decision to be made individually for each child.
Space maintainers and the later orthodontic period
A space maintainer does not always eliminate the need for orthodontic treatment later on; in most cases, however, it can reduce that need or simplify treatment. The child's dental development continues to be monitored with regular check-ups. If mild crowding or bite problems appear during the mixed dentition period, early options such as Invisalign First may be considered in suitable cases. For treatment options by age, you can read our article at what age can clear aligners be used.
When should you see a dentist?
If one of your child's baby teeth has been extracted, lost in an accident or recommended for extraction because of decay, it is helpful to plan an examination within a few weeks to assess the gap, because in some cases space loss can begin quickly. At our clinic in Oran, Çankaya, we look at the situation from both a pediatric dental health and an orthodontic perspective and discuss with the family whether a space maintainer is needed.
Frequently asked questions
Does getting a space maintainer hurt?
Anesthesia is usually not needed when a space maintainer is fitted, and the procedure is comfortable for most children. In the first days there may be a slight feeling of strangeness or pressure; this feeling usually subsides within a few days.
How long does a space maintainer stay in the mouth?
A space maintainer stays in the mouth until the permanent tooth starts to come in. Depending on the child's age and which tooth was lost, this can range from a few months to a few years. The time for removal is determined with regular check-ups.
The baby tooth would fall out anyway, so is a space maintainer really necessary?
A baby tooth falling out at its normal time is different from it being lost very early. With early loss, neighboring teeth can drift into the gap and the permanent tooth may not find room. Whether a space maintainer is needed is assessed by examination and X-ray.
What should be done if a space maintainer comes out?
If the appliance comes out, breaks or loosens, it should be kept and you should see the dentist without waiting for the check-up date. Going without a space maintainer for a long time can lead to the loss of the space it was meant to preserve.
