The right room for manoeuvre

Did you know primary or deciduous (baby) teeth act as a marker for the eruption of the
permanent tooth replacing it? If a baby tooth is lost too early; knocked out in a fall,
extracted because of severe decay or missing at birth, the permanent tooth can drift or
erupt into the wrong position in the mouth. Neighbouring teeth also can move into the
space. This means that there may not be enough space for the permanent tooth to come
in, and if untreated could result in the necessary removal of healthy permanent teeth in
children and adults. When it comes to adults the premature loss of permanent teeth can
lead to unsightly ‘gapping’ of the other teeth as they tilt into the space and teeth become loose.

Types of space maintainers

Removable: A removable space maintainer looks like a retainer. It uses artificial teeth or plastic blocks to fill in the space that needs to stay open. This type is often used when the space is obvious to other people and works well in older children who can reliably maintain care for the appliance

Fixed:​ Fixed space maintainers are cemented onto the teeth on either side of the space in the child’s mouth.

There are several kinds of fixed space maintainers:

  • A band-and-loop maintainer, made of stainless steel wire and 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.
  • A ‘distal shoe’ appliance is inserted under the gums and used when a child loses the baby tooth in front of a 6-year molar that has not yet come. The 6-year molar is also called the first permanent molar. A distal shoe appliance has a metal wire that is inserted slightly under the gum. This keeps the space from closing. This appliance must be checked often because the incoming tooth can become blocked by the wire.

All under one roof

At Wells Orthodontics each space maintainer is custom-made in our laboratory. For a fixed space maintainer, a metal band is placed around one of the teeth next to the space, and impressions are made from which the space maintainer is created. It is then cemented into place and can all happen in one visit. To make a removable space maintainer, we take impressions from which the lab then makes the appliance and you return for fitting.

Caring for your space maintainer

The space maintainer may feel unusual at first. But after a few days, it will be forgotten about. A removable space maintainer with replacement teeth can affect speech until you become accustomed to it. It’s important to brush regularly to keep the gum tissue healthy. Patients with a fixed space maintainer need to avoid hard or sticky foods and gum, which can loosen the band or get caught in the wire arm. Avoid pushing on the space maintainer as it could bend or come loose. If the space maintainer comes loose, there is a risk of swallowing it. At Wells Orthodontics you will be given clear guidelines and we will always be at hand for advice or if you need to come in the unlikely event you experience any problems.

Please consider…

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. If the permanent tooth is about to erupt, it may be decided not to use a space maintainer unless a child needs braces and space is a critical issue. 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.

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Contact us for more information

TEL: 01749 675 825