If your child’s tooth has come out too soon because of decay or an accident, it is important to maintain the space to prevent future space loss and dental problems when permanent teeth begin to come in. Without the use of a space maintainer, the teeth that surround the open space can shift, impeding the permanent tooth’s eruption. When that happens, the need for orthodontic treatment may become greater.
Types of Fixed Space Maintainers
Space maintainers utilize orthodontic bands and stainless steel wire to create a design that is fixed (cemented) in the mouth to best preserve space. They can be unilateral (on one side of the mouth), or bilateral (utilizing both sides of the mouth). Space maintainers can seem “big” in a child’s mouth initially, but with encouragement and patience they soon hardly notice the “spacer” is there.
A unilateral spacer, or band and loop, is used when a first primary molar is lost and the permanent molars have not come in yet. A band goes around the tooth behind the tooth that was lost early, and a wire loop attached to the band extends to the tooth in front of the tooth that was lost. A band and loop can become obsolete if the baby tooth the loop is resting against is lost before the tooth that space is being saved for comes in. In this case, a bilateral spacer anchored off of permanent molars is utilized. A lingual arch is used on the lower teeth and a Nance on the upper teeth to maintain space when the permanent molars have erupted. A lingual arch and Nance are also handy if teeth on both sides of the arch have been lost early. For a lingual arch, a wire is attached to bands on the permanent molars and runs along the tongue side of all the remaining teeth creating an arch shape, thus the reason for its name. For a Nance, wires are attached to bands on the permanent molars that lead to an acrylic button that rests on the front part of the hard palate.
In the case of a lost second primary molar prior to the eruption of the first permanent molar, a distal shoe may be recommended. Because the first permanent molar has not come in yet, there is no tooth to hold a band-and-loop space maintainer in place. A distal shoe appliance has a metal wire that is inserted slightly under the gum which will guide the permanent molar into its proper position and preserve proper space.
If your child ends up having a spacer, we always check and maintain them at their regular dental visits. When we see the tooth or teeth beginning to come in that the spacer was saving space for, we can then easily remove the spacer.
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