space maintenance

lecture given 11/9/2026

what are the objectives of pediatric space management?

arch length and occlusal discrepancies

identify the factors contributing to abnormal arch form development

effectively manage a condition of premature primary tooth loss

pediatric space management

an important responsibility of the general dentist and the pediatric dentist

inaequate space management can cause problems which are long lasting and severe

prompt and appropriate space management therapies help insure potimal lifelong dental health

premature loss of primary teeth may cause…

loss of arch length, resulting in crowding of the permanent dentition, impaction of permanent teeth, esthetic difficulties, and other problems

what is the purpose of a space maintainer?

preserve arch length following the premature loss of primary tooth

allow the permanent tooth to erupt unhindered into proper alignment and occlusion

what is the best space maintainer?

natural tooth

why is space management important?

adjacent and opposing teeth can change position

how can you determine the extent of change in position after a primary tooth is lost?

location of missing tooth

eruptive activity following loss of the tooth

eruptive forces consequences

as the arches continue to develop and permanent molars erupt, a powerful mesial force is exerted

if arch continuity has been interupted through the loss of a tooth, space closure occurs

this results in a decreased arch length

when should space maintenace be initiated?

whenever primary or permanent tooth loss will lead to drifting of adjacent or opposite teeth

necessary to prevent mesial migration of posterior teeth, particularly first permanent molars, and to inhibit lingual drifting of mandibular incisors

should be employed as soon as possible after tooth loss to minimize detrimental tooth space loss

t/f radiographs don’t really matter for space maintenance

false- they are essential

what is the ideal space maintainer?

preservation of space

eruption of adjacent and succedaneous teeth

normal osseous development

restoration of masticatory function

compatibility with soft tissues

economy of construction

resistance to distortion

allowance for adjustment or minor repair

t/f you can set a space maintainer and then forget about it

false- duh

why are anterior teeth primarily lost?

trauma and decay

why are posterior teeth primarily lost?

dental caries

teeth lost during primary dentition years will cause (earlier/later) than normal eruption of the succedaneous teeth

later

whether succedaneous tooth eruption is delayed or accelerated depends on…

timing- before or after age 8

root development and alveolar bone overlying the unerupted permanent tooth

what are the types of fixed maintainers

band and loop

lingual holding arch

nance appliance

distal shoe

band and loop

preserves space created by loss of one tooth in a single quadrant

a crown can be substituted for the band when full tooth coverage is desired

what are indications for band and loop?

in primary dentition

premature loss of first primary molar- to prevent mesial drift with the eruption of the first permanent molar

premature loss of primary canine- to stop lateral movement of incisors (midline shift)

once in mixed dentition, the band and loop that is holding the canine space should be replaced with…

bilateral fixed space maintainer to permit normal incisor eruption by allowing distolateral displacement of the primary canine during permanent incisor eruption

why should a band and loop be used in mixed dentition with premature loss of a maxillary first molar prior to eruption of permanent laterals?

prevents loss in arch dimension

does not interfere with eruption of permanent laterals

why should a band and loop be used in mixed dentition with premature loss of a mandibular first or second molar prior to eruption of permanent laterals?

prevents loss in arch dimension

does not interfere with permanent incisor eruption

replaced by LHA after eruption of the permanent lateral incisor(s)

when should a space maintainer be removed?

when tooth begins to erupt through bone- detected via radiograph

lingual holding arch

stabilizes the mandibular arch length by preventing mesial tipping of molars and lingual tipping of incisors

what are the requirements for lingual holding arch?

lower 6’s (permanent 1st molars)

lower 1’s (permanent central incisors)

lower 2’s (permanent lateral incisors)

what are the indications for a lingual holding arch?

premature loss of manidbular first primary molars after the eruption of permanent lateral incisors- prevents loss of dimension, permits distolateral repositioning of primary canine

premature loss of manidbular second primary molars after the eruption of permanent lateral incisors- prevents loss of arch dimensions, prevents mesial tipping of first permanent molar

nance appliance

designed to retain maxillary molar position

serves as a brace against the anterior wall of the palatal vault

what are the indications for a nance appliance?

in mixed dentition missing maxillary first primary molar- does not interfere with eruption of permanent laterals, prevents loss in arch dimension

in mixed dentition, premature loss of maxillary second molar- prevents loss in arch dimension

premature loss of more than one primary maxillary molar in the same quadrant

premature loss of bilateral primary molars

distal shoe space maintainer

used when early removal of 2 primary molar is required

main objective is to retain and guide the permanent first molar eruptive position

only used in primary dentition, only when 2nd primary molar is lost before the 1st permanent molar is erupted, NEEDS a radiograph

consists of a distal extension with both a horizontal and vertical component is cantilevered from first primary molar

vertical component of a distal shoe space maintainer

extends into the alveolar process to guide the eruption of the first permanent molar into normal position

what are the advantages of a distal shoe?

proved and efficient

prevents supraeruption of the opposing teeth

what are the disadvantages of distal shoe?

requires close follow up while in place (do not use on pts with history of poor appt attendance)

there is no allowance for inaccuracy in measurement of fabrication

anterior teeth space maintainer

appliance to replace missing maxillary anterior primary teeth

primary incisors should be replaced only out of esthetic concerns

removable space maintainers

acrylic resin space maintainers or modified hawley

multiple tooth replacement unilaterally or bilaterally

usually has wire attachments to improve appliance retention

can be unilateral but those are usually too small and present a choking hazard

what are drawbacks to removable space maintainers?

retention- canines do not have large undercuts for clasp engagement

compliance/tolerance

poor OH

in mixed dentition, what do you need to consider?

timing of permanent tooth eruption

timing of tooth loss

presence of succedaneous teeth

extent of crowding present