A space maintainer is a small orthodontic appliance that holds open the space left by a baby tooth that was removed or lost early, until the permanent tooth underneath comes in. Baby teeth are not just for chewing; they also save room for the permanent teeth. When a baby molar is lost early, the teeth behind and in front of it can drift into the gap; when it is time for the permanent tooth to come in, it may not find enough room and end up crowded, tilted or impacted. A space maintainer helps prevent this drift. That said, not every lost baby tooth requires a space maintainer. The decision depends on which tooth was lost, the child's stage of dental development, how far along the permanent tooth underneath is and the overall space in the mouth. For basic information on what a space maintainer is and why it matters, see our article on what a space maintainer is; this page focuses on the decision and the treatment process.
What should the first step be when a baby tooth is lost early?
Space loss is known to progress faster in the first months after a tooth is lost. That is why, rather than putting off the evaluation for months, it is better to have it shortly after the extraction or, if possible, while the extraction is being planned. If a baby tooth is going to be removed because of decay or infection, whether a space maintainer is needed can be discussed before the extraction; in some cases, an impression or intraoral scan is taken before the extraction and the appliance is fitted right after it. You can find information about the extraction of baby teeth itself in our article on baby tooth extraction.
At the exam, the following questions are usually addressed:
- Which baby tooth was lost, and when?
- On the X-ray, what stage is the root development of the permanent tooth underneath at, and how much bone is covering it?
- Roughly how long is it until the permanent tooth comes in?
- Is there already crowding or a significant lack of space in the mouth?
- Is there a permanent tooth under the lost tooth at all, or is it congenitally missing?
When is a space maintainer needed, and when is it not?
Situations where a space maintainer is often considered
- Early loss of the second baby molar: The six-year molar (the first permanent molar) right behind it tends to drift forward into the gap. This is one of the situations where space loss is most pronounced.
- Early loss of the first baby molar: The gap can narrow, especially if the tooth was lost before the canines and premolars come in.
- A long wait until the permanent tooth comes in: If the X-ray shows the permanent tooth is still deep and its root development is at an early stage, the space needs to be held open for a long time.
Situations where a space maintainer may not be needed
- If the permanent tooth is about to come in: If root development is well advanced and very little bone is left over the tooth, it is expected to come in soon; monitoring may be chosen instead of an appliance.
- Loss of baby front teeth: Early loss of the baby incisors usually does not lead to significant space loss. If there are concerns about appearance or speech, a removable appliance can be considered separately.
- If the permanent tooth is congenitally missing: In this case, a long-term plan is needed instead of a standard space maintainer; whether the space should be kept for a future implant or closed orthodontically is decided together with the orthodontist. We explain this decision process in adulthood on our missing teeth page.
- If there is extra space in the mouth: If there are natural gaps between the teeth, a small amount of drift may not cause a problem.
What types of space maintainers are there?
Space maintainers fall into two main groups: fixed (bonded to the teeth) and removable (put in and taken out). The choice depends on how many teeth were lost, which jaw they are in, the child's age and how cooperative the child is.
Commonly used types of space maintainers
| Type | How it is held in place | Common use |
|---|---|---|
| Band and loop | Cemented to the neighboring molar with a band | Loss of a single baby molar |
| Crown and loop | Attached via a crown placed on the neighboring tooth | Single tooth loss when the neighboring tooth also needs a crown |
| Lingual arch | A wire attached to the molars on both sides, running along the inner surface of the lower front teeth | Loss on both sides or of several teeth in the lower jaw |
| Nance appliance / palatal arch | A wire attached to the upper molars, resting against the palate | Loss on both sides or of several teeth in the upper jaw |
| Distal shoe | A fixed appliance with a guide piece extending into the gum | Loss of the second baby molar before the six-year molar has come in; requires close follow-up |
| Removable space maintainer | An acrylic plate that is put in and taken out | Loss of several teeth, concerns about appearance in the front; requires the child's cooperation |
Which type is suitable is determined after the exam and X-ray evaluation.
Fixed space maintainers are often preferred for single tooth loss because they do not depend on the child's cooperation. Removable space maintainers can be considered when several teeth are lost and when appearance in the front matters; however, if they are not worn consistently, they cannot do their job. For an overview of other types of appliances, take a look at our orthodontic appliances page.
How is a space maintainer fitted, and what will your child feel?
- Taking records: An intraoral scan or impression is taken. If a band will be used, a band of the right size is selected for the molar.
- Fabrication: The appliance is custom-made; this process usually takes a few days.
- Fitting: A fixed space maintainer is attached to the tooth surface with a special dental cement. The procedure usually does not require numbing and is quick.
- Getting used to it: In the first days, the tongue may keep probing the appliance, and your child may feel that something is slightly foreign. For most children, this feeling fades within a few days.
What do you need to watch for with care at home?
- Sticky foods such as caramel, chewing gum and Turkish delight can loosen a fixed space maintainer; they should be avoided.
- Habits such as chewing ice, hard candy and biting pencils can bend or break the appliance.
- The area around the band is prone to decay; careful brushing twice a day with fluoride toothpaste and cleaning the edges of the band are important. Young children need a parent's help with brushing.
- Your child should not play with the wire loop of the appliance with a finger or the tongue.
- A removable space maintainer should be worn for as long as the orthodontist specifies and kept in its case when taken out.
- If the appliance is loose, has come off, is broken or is poking the gum, let the clinic know without waiting for the next check-up. Do not throw away an appliance that has come out; bring it to the clinic.
How often are check-ups, and when is the space maintainer removed?
After the space maintainer is fitted, check-ups are usually every few months. At check-ups, the orthodontist assesses whether the appliance is in place and intact, the tooth surface and gum around the band and how the permanent tooth is coming in; X-rays are taken when needed. The space maintainer is removed when the permanent tooth starts to show through the gum or is close to coming in. This timing matters: if the appliance stays in longer than necessary, it can block the permanent tooth from coming in or change its direction. Removal is usually a quick and simple procedure.
What can happen if a space maintainer is not fitted?
When a space maintainer is needed but not used, the outcome is not the same in every child; in some children the gap narrows only slightly, while in others significant space loss develops. Possible consequences include the neighboring teeth tilting or drifting into the gap; the permanent tooth not finding room and coming in crowded, rotated or out of line with the gum; in some cases, the permanent tooth becoming impacted; and the opposing tooth in the other jaw overerupting into the gap. Regaining space once it has been lost often requires longer and more extensive treatment than keeping the space open from the start. That is why, even when an appliance is not recommended, it is important to monitor the space at the intervals the orthodontist sets.
What can be done if space has already been lost?
If the gap has narrowed, in some children the teeth that have drifted can be moved back with appliances designed to regain space. However, not all space loss can be regained this way; some children may need comprehensive orthodontic treatment later on. Space loss is usually assessed not on its own but together with other findings such as a narrow jaw or crowding. That is why, for children who have lost baby teeth early, it is also useful to assess their overall orthodontic situation during the mixed dentition stage. You can find what can be done at this stage on our early orthodontic treatment page, and how a narrow jaw is managed on our palatal expansion treatment page.
How is the evaluation done at the clinic?
At Funda Sarıkaya Oral and Dental Health Polyclinic, the space situation in children who have lost baby teeth early is assessed by Funda Pekyılmaz Sarıkaya, specialist orthodontist (Uzm. Dt.), through an exam and the necessary X-rays. If a space maintainer is not needed, a monitoring schedule is discussed with the family; if it is, the suitable type and check-up plan are discussed. Opening hours of Monday–Saturday, 09:00–20:00 make it easier to schedule appointments outside school hours. Bringing any previous X-rays and the date of the extraction with you to the exam makes the assessment easier.