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A space maintainer is a common term for various dental appliances placed in either the upper or lower dental arch. These appliances preserve and maintain space for your child's teeth. They may be recommended by both general dentists and orthodontists. The type of space maintainer used often depends on the tooth's location and your child's specific needs.

There are several situations where space maintainers may be recommended:

• Dentists typically place them in children who have lost primary teeth prematurely (either through disease or trauma), so the child can retain the proper spacing between teeth until their permanent teeth emerge. This occurs most commonly in back teeth.
• They are also used for children who have congenitally missing permanent teeth (hypodontia).

Primary types of space maintainers

Space maintainers may be fixed (cemented) in the mouth or removable. They may be placed to prevent tooth movement on one side of the mouth (unilateral) or both sides (bilateral). This results in four primary types of space maintainers:

• Fixed space maintainer for one side of the mouth
• Fixed space maintainer for both sides of the mouth
• Removable space maintainer for one side of the mouth
• Removable space maintainer for both sides of the mouth

The benefits of space maintainers include:

• Preventing unwanted movement of teeth.
• Preserving space for permanent teeth that have not yet come in.
• Preserving the shape of the dental arch.
• Helping avoid some types of orthodontic treatment.

Space maintainers are typically prepared and placed in two separate appointments. The type of space maintainer used and the process to place it can vary depending on your child's specific situation. In general, these are the steps to place a space maintainer:

Before the procedure

• Health history: You will share information about your child that will help ensure that their dentist and their staff can provide safe and effective treatment and provide appropriate post-care guidance. Get important information here: Health history and current health status.
• Treatment review: Your dentist will review the procedure with you, including its risks, benefits, and options you may have. Understanding the process will lead to the best treatment outcome. Ask any questions you have before starting the procedure.

During the procedure

• Banding: If the primary tooth or teeth is/are already missing, and no loss of space has occurred, your child's dentist will fit stainless steel bands onto the adjacent teeth behind the space(s). These will be used to anchor the space maintainer.
• Impressions: Your child's dentist will take an impression of the dental arch with the band(s) in place.
  • The band(s) will then be removed and placed in the impression.
  • A cast of the teeth will be made from the impression.
  • After the cast hardens, your child's dentist will position a wire or wires onto the cast in such a way that they prevent the tooth or teeth from moving.
  • The dentist will solder the wires to the bands and then smooth and polish the soldered areas.

After the procedure

• Placing the maintainer: At the second dental appointment, the dentist will place the space maintainer (and cement it if using a fixed appliance).
• Follow-up care: Your dentist will give your child instructions on how to take care of their space maintainer. You should request a copy of the instructions to refer to later.

• Be sure to mention if your child is allergic to any metals. This helps your dentist determine the best material and type of space maintainer for your child's situation.
• It may be more difficult to clean the teeth and gums around a space maintainer. If the plaque is not removed, it's easier for tooth decay to develop. In addition to brushing and flossing, you may want to have your child use a floss threader, interdental brush, or water flosser to help keep the area properly clean.
• Without good oral hygiene, the gums around the space maintainer may become inflamed. In some cases, the gums may grow around the space maintainer and require surgical removal.
• Space maintainers may loosen or break. If a fixed space maintainer loosens, your child's dentist can generally recement it back into place.
• If you have a young child who needs a space maintainer, they may have difficulty cooperating with the impressions and cementation procedures necessary to place a space maintainer. Young children or those with special needs may require sedation. Sedating children has risks, which should be fully understood and carefully considered before undergoing treatment.
• The dentist may recommend frequent monitoring and adjustment of certain types of space maintainers to ensure the appliance does not prevent the normal movement of a permanent tooth coming in.
• Fixed space maintainers generally must be removed by a dentist at a later date. Keep your child's regular cleaning and exam appointments, as well as any recommended follow-up appointments that the dentist recommends. This is important to ensure the space maintainer is functioning as intended.

• Orthodontic treatment can successfully regain lost space, realign dental arches, and correct misaligned teeth. However, avoiding unnecessary orthodontics is one of the goals of using space maintainers.

If the space maintainer is for a child who has congenitally or otherwise missing permanent teeth, there may be better long-term solutions:

• Removable dentures may be an option if your child is missing multiple permanent teeth. These may not be recommended for younger children who are not fully capable of understanding the purpose of dentures or how to properly care for them. They may also not be recommended if your child's jaw is still developing.
• If your child's mouth's growth and development are complete (at the earliest age 16 to 18 depending on the individual), dental implants may be an option.

If the spacing between teeth is not properly maintained, they may drift or move. This can result in misaligned teeth or irregular development of the dental arches. It may also prevent permanent teeth from coming in properly.

• Why does my child need a space maintainer?
• What other options may also work for my child? What are the pros and cons of those options?
• How should my child take care of their space maintainer?
• How should my child take care of the area around his/her space maintainer?
• What should I do if a space maintainer becomes loose or breaks?
• When will the space maintainer no longer be needed?