Primary teeth are important for chewing, speech, aesthetics, and maintaining the space for permanent teeth to erupt.
Early childhood caries can lead to an early loss of the primary teeth.
Regular dental checkups will reduce the risk of dental caries and its progression to the point that the tooth needs to be extracted.
Early loss of primary teeth may cause tipping of adjacent teeth and cause space loss which may lead to crowding of the permanent teeth and possible need for orthodontic treatment later in life.
Healthy teeth are the best space maintainers and they should be maintained until the natural exfoliation time.
However, sometimes tooth extraction is inevitable.
When do we have to extract a primary tooth:
- Caries reaching the furcation of the tooth
- Caries onto the root surface
- Tooth can’t be restored anymore
- Caries has caused a severe infection that can damage the permanent tooth or cause the spread of the infection in the body
Consequences of Tooth Loss or Tooth Extraction
The consequence of the loss of teeth can lead to a reduced arch length which can have the following consequences:
- Ectopic eruption
- Midline discrepancy
What is a Space Maintainer?
A space maintainer can be a fixed or removable appliance that is used to maintain the space in the arch, once a primary tooth has been lost prematurely until the permanent tooth is ready to erupt.
According to the Royal College of Surgeons of England if an anterior tooth is lost prematurely there is minimum space loss and no space maintainer is required.
If the first primary molar is lost before the age of 7.5 as shown in a study by Ronnerman in 1974 there is a higher chance of space loss and a space maintainer may be indicated. If the primary molar is lost after the age of 7.5 space loss is minimum and a space maintainer is usually not required.
Second primary molars are the most important teeth in maintaining the space and early loss of this tooth can have a significant space loss, especially in the upper jaw.
This page provides information about dental treatments specific to children. Regarding Dental treatments for adults refer Brisbane Dentists Pure Dentistry.
What are the Different Types of Space Maintainers?
There are two types of space maintainers for children, removable and fixed.
Fixed Space Maintainers
Fixed space maintainers are fixed or cemented onto the adjacent teeth.
Band and Loop Space Maintainers
Band and loop Can be used unilaterally or bilaterally and usually used to maintain space for 1 missing tooth.
Crown and Loop Space Maintainer
Crown and loop is similar to the band and loop but is used when the abutment tooth needs a stainless steel crown.
Lower Lingual Arch Space Maintainers
This fixed appliance is used when there are multiple missing teeth bilaterally and sometimes unilaterally in the lower arch to hold the space for the permanent teeth to erupt.
The anterior permanent teeth need to have erupted to be able to use this appliance.
Transpalatal Arch (TPA) Space Maintainers
Originally described by Robert Goshgarian in 1972, TPA is used in the upper arch to hold the space for the permanent dentition to erupt. It can also be used to expand the arch to gain some more space for a crowded arch.
Nance appliance Space Maintainers
This is a maxillary custom-made fixed appliance developed by H.N. Nance in 1947. It is similar to TPA but the bar extends behind the upper anterior teeth and rests on the palate. This gives the appliance more anchorage and prevents the upper molars from drifting forward.
Removable Space Maintainers
Removable appliances can be used as a space maintainer. These appliances are not recommended often. They will rely on patient compliance and in young children, it may be difficult to convenience them to wear the appliance at all times. There is more risk of the appliance being lost or broken. Smaller removable appliances have the risk of being inhaled or swallowed.
Which Space Maintainer is Best for Children?
The band and loop is a commonly used space maintainer appliance for single unit spaces, partly due to its durability. A study by Muawia A.Qudeimat and A. Fayle in 1998 has reported that the band and loop space maintainers lasted the longest out of all the appliances, with a mean survival time of 13 months.
Any of the mentioned appliances may be used depending on the patient. Some factors that are considered before choosing a space maintainer are:
- Age of the child
- When the primary tooth was lost prematurely
- How many primary teeth are missing?
- Any other abnormalities associated with the bite
Not every child that loses a primary tooth early will require a space maintainer
What are the Contraindications of using a Space Maintainer for Children?
- Poor oral hygiene
- High caries risk
- Irregular attendance, as the gingival tissues may grow over the space maintainer, necessitating surgical removal of the appliance
What Happens if a Space Maintainer is not Used?
The answer to this question depends on many factors such as the child’s age and type of tooth that has been lost.
The most common effect of a premature loss of the primary molars is the loss of arch length which means the available space for the permanent teeth is reduced. In a study by Lin and Chang, it was reported that most of the space loss following the loss of primary molars is due to the distal (backward) movement of the primary canine in the mandible. Lin and Lin reported the dame finding in 2007 in the maxilla.
What can a Dentist do to Help?
Anticipatory guidance from a dentist from an early age can prevent caries. The importance of oral hygiene and diet can be discussed from an early age reducing caries risk early on in life.
Special tests to evaluate the saliva flow and amount of S.Mutan bacteria in the saliva that play a major role in caries. The result of these tests can help the dentist plan a long-term preventive plan for patients to help reduce caries risk.
By regular check-ups, a dentist can make sure all the small cavities are managed to prevent any gross break down of the teeth that may lead to the need for early extraction of the primary tooth.
If an extraction is necessary, dentists can assess the tooth being lost prematurely and plan for a space maintainer, if needed, to be placed in the correct time to minimize the space loss.
Following the insertion of the space maintainer, the dentist will continue to monitor the space maintainer for any adjustments if required and to make sure it is not interfering with the eruption of the permanent tooth. The space maintainer will need to be removed at the correct time.