Space Maintainers: Treatment, Cost and Side Effects

Usually, kids lose their temporary or milk teeth around the ages of six to seven. However, sometimes there can be a premature loss of one or more of these teeth, either due to accidents, or decay. In this situation, the adult or permanent tooth won't be ready to grow. A space maintainer maintains the empty space to prevent the surrounding teeth to grow in a way that impedes the eruption of future adult tooth. There are many types of space maintainers. Single tooth space maintainers are wrapped around a neighboring tooth and use a metal loop to 'maintain' space, whereas bilateral space maintainers are attached to both sides of the mouth. Distal shoe space maintainers are usually used for unerupted molar teeth and are more complicated because the end of the metal is inserted into the gum line. Removable space maintainers can be removed, while fixed space maintainers cannot. Some people argue removable space maintainers are dangerous as they may get dislodged an could be a choking hazard. The advantages of fixed space maintainers outnumber the advantages of removable space maintainers, however, in some situations, it is required for a removable space maintainer. It is most optimal to insert a space maintainer at most six months after loss of the tooth, as that is when space closure begins to occur. If there is bone covering the crown, it can be predicted that eruption will not occur for many more months. However, if this bone is destroyed, eruption is accelerated. Ideally, space maintainers should maintain the entire mesio-distal space created by a lost tooth, restore the function as far as possible and prevent over-eruption of opposing teeth, cheap and simple in construction, and strong enough to not break easily.

Space maintainers are of many different types and can be constructed differently and be used in different parts of the mouth. Space maintainers work on one principle, 'maintaining' space left behind by the premature loss of a baby tooth to prevent surrounding teeth growing in a way that impedes the eruption of the future permanent tooth. space maintainer generally consists of a metal or plastic guide plane along which the permanent molar erupts. It must be removable if the primary first and second molars are missing, as the length and span are incorporated in a partial denture. There must be careful measurement and positioning to ensure the purpose of the space maintainer is fulfilled. Usually, a radiograph is taken to show the structure of the teeth. Then, it is decided which type of space maintainer to use, depending on the structure of the surrounding teeth. For example, in situations where both lower primary molars have been lost, a bilateral band and loop would be most suited to the situation. A child will probably take a few days to get used to the space maintainer and will need to clean it regularly to keep the gum tissue healthy and free of dental plaque. Chewy foods should be avoided, as they can get caught on the appliance.

Like previously mentioned, there can be a premature loss of temporary teeth, due to reasons like caries, trauma, ectopic eruption, abnormal root resorption and herditary syndromes. If this is not acted upon early, it is extremely expensive to fix it in the future. Excessive forces are used while biting, and this, added to the fact that the teeth are already weak due to tooth decay, can cause in this loss of temporary teeth. Malocclusion, or the mal-alignment of the jaw and teeth, can also lead to this. In such scenario spce maintainers are needed and thus such patients are eligible for the treatment.

Losing your 1st incisors or 1st canines don't require space maintainers, as in the first case there is no decrease in intracanine dimensions if loss after eruption of canines, and in the second case there is common loss due to ectopic eruption of permanent lateral incisors. Some people confuse spacers with space maintainers. However, they are very different things. People who don't have enough space between their teeth to allow the bands of braces to fit comfortably around them are not eligible for using space maintainers, they need spacers. Space maintainers do the opposite, they ensure open space created by the premature loss of a temporary tooth is not encroached by the growth of nearby teeth, to ensure proper eruption of future teeth.

A lot of people have claimed that using removable space maintainers is extremely hazardous, as it could potentially get dislodged, and choke a child. The appliances can also get broken and lost. It also leads to plaque accumulation if not cleaned regularly by the user. It could also cause interference with the eruption of the future tooth, and potentially even slow down its growth. Undesirable tooth movement could also be caused. It can be very uncomfortable and maybe even painful for a child to use a space maintainer, and it will take a child several days to get used to it.

After getting a space maintainer, sugary and chewy food should be avoided, and the area should be specially cleaned to avoid any plaque buildup. After the eruption of the permanent tooth, the space maintainer can be removed. There will be follow up appointments for x-rays to check if the treatment has been successful. The maintainer needs adjustment from time to time and needs immediate attention if damaged.

Generally, it takes children a few days to get used to the unconfort and sometimes pain of space maintainers.

In India, space maintainers are very expensive. They can cost from 15000 to 25000 rupees. After including the price for the regular cleaning of the teeth and other follow up appointments, this price drastically increases.

Space maintainers can successfully permanently fix the problem of surrounding teeth growing in the wrong way to impede the growth of the future tooth permanently, until the permanent tooth starts to erupt, which automatically fixes the problem.

Generally, band and loop space maintainers are used. However, there are also several disadvantages. These disadvantages include disentigration of cement, inability to prevent rotation or tipping of adjacent teeth, and increased laboratory time. There are many proposals for alternatives for the conventional band and loop method. Some alternatives include the Fiber reinforced composite loop space maintainer. Using glass fiber-reinforced composite resins as a material is also another alternative. It is better tolerated by the patient, and less time consuming.