Occasionally a child's tooth will come out too soon because of an accident or tooth decay. When this happens, it is essential to maintain the original spacing to avoid space loss and dental problems in the future. When the permanent teeth come in, the original spacing should be intact and waiting for them. When children suffer tooth loss, we use space maintainers so that the teeth alongside the open space don't shift and block the permanent tooth's eruption. Without this precaution, the child may need orthodontic treatment.
Space maintainers come in different materials such as stainless steel, plastic, or a combination of the two. They also come in two different styles, removable or fixed, cemented to the adjacent teeth.
The removable maintainer looks like a retainer and has plastic blocks to take up the space where the missing tooth was previously. If your child is more grown-up and can dependably follow instructions, a removable space maintainer might be the best option.
Fixed maintainers are available in several designs
A band-and-loop space maintainer is constructed of stainless-steel wire and affixed by a crown or a band attached to the tooth alongside the space. We attach this wire to the adjacent tooth's crown, and it rests up against the side of the tooth on the other end of the gap.
We use a lingual arch exclusively for the lower teeth where the back teeth on both sides are missing. A stainless-steel wire is inserted under the lingual (tongue) of the arch. It is affixed to the first tooth positioned in the front of the empty space. The lingual arch stops the front teeth from moving back into the existing gap.
If a child loses a second primary molar before the presentation of the first permanent molar, we might recommend a distal shoe. We would choose the distal shoe because the permanent molar has not erupted yet. Without that molar, there is no tooth available to which we can attach a band-and-loop maintainer. The distal shoe procedure uses a stainless-steel wire placed just under the gum line and maintains the space for the secondary molar.
We have four rules governing the care of your child's space maintainer: