Early Tooth Loss & Space Maintainer
Dentists call baby teeth primary or deciduous teeth. They aren't just for chewing. One of a
baby tooth’s most important jobs is holding the place for permanent teeth until they erupt.
Each one also acts as a guide for the eruption of the permanent tooth that replaces it. If a
baby tooth is lost too early, the permanent tooth loses its guide. It can drift or erupt into the
wrong position in the mouth. Neighboring teeth also can drift or tilt into the space and
cause crowding. This means that there may not be enough space for the permanent tooth
to come in. Crooked or misaligned teeth can cause a range of problems, from interfering
with proper chewing to causing temporomandibular joint problems.
If your child loses a tooth prematurely, we may recommend a space
maintainer. A space maintainer is a plastic or metal device that holds
open the space left by the missing tooth. Your dentist will remove it once
the permanent teeth begin to erupt.
Primary teeth can be lost too early for several reasons:
- They can be knocked out in a fall or other accident.
- They may need to be extracted because of severe decay that causes infection.
- They may be missing at birth.
- Some diseases or conditions can lead to early tooth loss.
Types of Space Maintainers
A space maintainer is made of stainless steel and/or plastic.
It can be removable or fixed. Fixed space maintainers are cemented onto the teeth on either
side of the space in the child's mouth.
Removable space maintainer
A removable space maintainer looks like a retainer. It uses artificial
teeth or plastic blocks to fill in the space or spaces that need to
stay open. This type of space maintainer often is used when the
space is obvious to other people. Removable space maintainers
work well in older children who can reliably follow directions about caring for this appliance.
For children missing several teeth, a partial denture may be used instead of a space
maintainer. For example, children with a congenital disease called ectodermal dysplasia
often are missing multiple primary teeth. There are no permanent teeth to replace them. A
child with this condition will use a removable denture into adulthood. After that, the child
can receive dental implants or a bridge or continue to use a partial denture to replace the
The disadvantages of a removable appliance are that it may not be worn by the patient and
it is more susceptible to breakage or loss by the patient.
To reiterate, most clinicians prefer to place fixed space maintainers if possible.
Fixed space maintainers
There are several kinds of fixed space maintainers:
A band-and-loop maintainer is made of stainless steel wire. It is held in
place by a crown on the tooth next to the space or an orthodontic-type
band around one of the teeth next to the open space. A wire loop is
attached to the band or crown. It sticks out across the space where the
tooth is missing and just touches the tooth on the other side of the open
space. The wire loop holds the space open. This allows the permanent
tooth enough space to come into the mouth without crowding.
A lower wire known as a "lingual arch" is used when back teeth are lost
on both sides of the lower jaw. "Lingual" refers to the inside or tongue
side of the teeth. This type of space maintainer uses bands wrapped
around a tooth on either side of the mouth behind the missing teeth. A
wire connected to the bands runs along the inside of the bottom teeth,
just touching them. This will maintain the space on both sides.
Another type of fixed space maintainer is called a distal shoe appliance. It is inserted under
the gums. It is used when a child loses the baby tooth in front of a 6-year molar that has not
yet come into the mouth. The 6-year molar is also called the first permanent molar. Because
it 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. This keeps
the space from closing.
Distal shoe appliances must be checked often because the incoming tooth can easily
become blocked by the wire. The appliance may require adjustment to allow the tooth to
come in properly. As a result, most dentists will try to avoid using a distal shoe appliance.
Instead, they will try to keep the primary tooth in the mouth until the permanent tooth
underneath is ready to come in.
Are Space Maintainers Always Necessary?
Not every tooth that is lost too early requires a space maintainer. If one of the four upper
front teeth is lost early, the space will stay open on its own until the permanent tooth
Making the Space Maintainer
Some children may not be able to cooperate during the process of making the space
maintainer. Others may be at risk of injury if the space maintainer comes loose or breaks.
These include children with diseases that affect how they breathe or swallow, and children
who are very young. The ability to cooperate with the dentist is more important than a
child's age. Most young children can have space maintainers placed, if needed. Most of
them are able to cooperate during the process.
Each space maintainer is custom-made by a dentist or orthodontist.
For a fixed space maintainer
- A metal band is placed around one of the teeth next to the space, and impressions
- The band is also removed and sent to the dental
laboratory with the impressions.
- The laboratory to make a copy of the teeth to use in
making the space maintainer.
- The lab fabricates the space maintainer and sends it back
to your child's dentist.
- We cement it into place at a second office visit.
- Sometimes, a space maintainer can be made in the office in a single visit without
To make a removable space maintainer,
- We first make impressions.
- They are sent to a lab, which makes the appliance.
- We will deliver it on your Second Office visit.
Caring for Your Space Maintainer
The space maintainer may feel unusual at first. But after a few days, your child probably will
forget about it. A removable space maintainer with replacement teeth can affect speech
until your child gets used to it.
It's important for your child to brush regularly to keep the gum tissue healthy. A child with a
fixed space maintainer needs to avoid hard or sticky foods and chewy candy and gum. They
can loosen the band or get caught in the wire arm. If the space maintainer comes loose,
there is a risk of swallowing or inhaling it into the lung.
Finally, your child shouldn't push on the space maintainer with his or her tongue or fingers.
That could bend or loosen it.
Is Space Maintainer Follow Up Necessary?
If you do not take your child to the dentist regularly — at least every six months — a space
maintainer can cause problems. This especially can occur if your child does not brush well.
The gum tissue in the space can grow over the wire arm, increasing the risk of infection. If
that happens, your child's dentist may have to remove the gum tissue by surgery.
If the permanent tooth is about to erupt, we may decide not to use a space maintainer
unless your child needs braces and space is a critical issue. Your child's dentist will take X-
rays regularly to follow the progress of the incoming permanent. When the tooth is ready to
erupt, the space maintainer is removed.
If a permanent tooth is missing, the space maintainer will be used until your child's growth
is completed (age 16 to 18). Then a bridge, implant or removable partial denture is placed in
Please call 703-743-2324 for an appointment and visit us at Gainesville Dental Arts in