It is commonly thought that the deciduous, or primary, teeth are solely meant for chewing. This is not true, in fact, they also serve to maintain space for the permanent teeth to erupt, and guide them during their eruption.
If the primary teeth are prematurely lost, the permanent teeth are left without a guide, and the permanent tooth might erupt at an abnormal position or angulation. Hence, it is imperative that in cases where the primary tooth has been lost, and there is significant time left in the eruption of a permanent successor, a dental appliance known as the space maintainer must be given to the child.
Causes of Early Loss of Primary Teeth
Although the primary teeth are secure enough to hold the place while the permanent ones erupt, their premature loss can occur in the following ways:
• Tooth loss due to a dento-facial injury causes while playing.
• Sometimes milk teeth have to be extracted earlier if they become severely carious.
• They may be absent at birth.
• In some medical and dental conditions, premature tooth loss can occur.
Indications for the Need of a Space Maintainer
Obviously, the foremost reason for prescribing a space maintainer to a child is in the case of the premature loss of a primary tooth. Another indication arises in case of absence of the natural tooth. In these cases, the adjacent teeth have a tendency to take up the space left by the missing tooth, and erupt at an improper position.
Types of Space Maintainers
There are two types of space maintaining orthodontic appliances, fixed and removable:
• Removable Space Maintainers –these look just like the orthodontic retainers, and possess a tooth or an acrylic block that sits onto the vacant area, and prevents the adjacent teeth from straying their path during eruption. These devices are reserved for relatively simple cases, or where the child is expected to follow the dentist’s instruction regarding the use of the appliance.
• Fixed Space Maintainers – these devices are fixed onto the adjacent teeth, using either an orthodontic band or a dental crown, in such a way that a loop of wire or a small chunk of acrylic protrudes out into the space created by the missing tooth. Since these devices are fixed to the adjacent teeth, issues regarding patient compliance are minimized, however, oral hygiene maintenance become difficult.
Two examples of fixed space maintainers via chelseapediatricdentistry.com
Is a Space Maintainer Always Necessary?
The simple answer is no. a space maintainer is required only when there is significant time left before the eruption of a permanent successor, or when precise calculations of tooth spaces are to be made in orthodontic cases. Otherwise, if the permanent tooth is about to erupt, your dentist may choose not to provide you with a space maintaining device.
Fabrication of a Space Maintainer
These devices are fabricated in a dental laboratory. The process starts when the dentist makes an impression of the teeth of the child, and then sends it to the laboratory, where diagnostic models are made from the impression. The method of making the prosthesis is different for the fixed and removable appliances. Once the space maintainer has been made, it is sent to the dental office, where it is inserted into the patient’s mouth. Removable space maintainers are usually made up of acrylics, while fixed ones may be made up of stainless steel or other dental alloys.
Care for the Appliance
The maintenance requirements of removable space maintainers are similar to those of acrylic dentures. They must be worn for the prescribed duration of time, and when not wearing, must be put in water to avoid distortion and degradation.
In case of fixed appliances, special efforts must be made to keep up a good oral hygiene, otherwise there are high chances of dental infections.
Duration of Treatment
Space maintainers must be worn by the child until the tooth erupts, or in case of a missing permanent tooth, a dental prosthesis such as an implant or a dental bridge is placed into the space. Talk to your dentist if you or a child may be in need of one. He or she can help you make the best decision for optimum oral care.