Space Maintainers

A space maintainer is a small appliance that keeps open the gap left by a baby tooth lost too early, until the adult tooth underneath comes through. Most often it is simply a thin band fitted around a neighbouring tooth, with a single wire loop extending from it; sometimes it is a small plate that your child puts in and takes out. It has one job, which is to wait: to stop the gap from closing.

This page is mainly for parents whose child has had a baby molar taken out because of decay or an abscess, and who are asking, "What happens if we just leave the gap?"

Why does losing a baby tooth early lead to crowding?

Teeth tend to drift towards any space in the mouth. When a baby molar is extracted early, the teeth behind it — especially the first permanent molar, which comes through at around the age of six — slowly tip forwards and narrow the gap. The tooth in the opposite jaw can also grow down or up into the space. Most of the space is lost in the first few months after the extraction, which is why timing matters.

When the adult tooth waiting underneath is ready to erupt, it finds no room. It either comes through at an angle, off to one side, or stays buried in the bone. A few millimetres of lost space come back later as crowding and longer orthodontic treatment.

Does every early loss need a space maintainer?

No, and we say so plainly at the examination. A few things decide it:

• Which tooth was lost. Space loss is marked when a baby molar at the back is lost. When a baby front tooth is lost early, there is usually no meaningful drift once the baby canines are through.
• How close the adult tooth is. If the X-ray shows the tooth underneath is about to erupt, there is no point fitting an appliance for a few months.
• Whether there is an adult tooth to come. If the adult tooth is congenitally missing, the question is no longer one of holding space; it becomes a long-term orthodontic plan.
• Whether the space has already been lost. If the gap has already closed, a space maintainer comes too late; at that point a separate plan to regain the space is needed.

Whenever possible, the real space maintainer is the baby tooth itself. Even a baby tooth whose decay has reached the nerve can often be saved with baby tooth treatment; we only discuss a space maintainer when extraction genuinely cannot be avoided.

Fixed or removable?

	Fixed space maintainer	Removable space maintainer
Design	A band and wire cemented to the neighbouring tooth; for both sides, a wire arch running along the palate or the tongue side of the teeth	An acrylic plate, with an artificial tooth on it if needed
Suited to	Loss of one or two baby molars	Loss of several teeth; front teeth, where appearance and speech are a concern
Child's cooperation	Not needed — it stays in the mouth all the time	Needed; it does nothing during the hours it is not worn
Adapting to growth	Assessed at check-ups	Can be adjusted, or remade if necessary

One special case: if the second baby molar is lost before the six-year molar behind it has come through, a guiding type of space maintainer that reaches under the gum may be needed to lead that tooth into the right position. This option is planned for the same appointment as the extraction.

How is it fitted, and how can you prepare your child?

A fixed space maintainer usually needs two short appointments. At the first, a band of the right size is chosen for the neighbouring tooth and an impression or intraoral scan is taken; the appliance is then made in the laboratory. At the second, it is seated and cemented to the tooth. These steps usually do not need any local anaesthetic; your child will feel tightness and pressure, and the taste of the impression material can be unpleasant for a few minutes.

A simple explanation is enough, such as "We're going to fit a little guard that keeps your new tooth's place safe until it arrives." For the first few days the tongue keeps exploring the wire and speech may feel a little odd; most children are used to it within a week.

How long does it stay in?

Until the adult tooth underneath starts to come through. Depending on which tooth was lost and at what age, that can be anything from a few months to a few years. During this time we check it every 3–6 months: whether the appliance is in place and intact, the condition of the gum and, with an X-ray, how the adult tooth is progressing. Once the adult tooth appears, we remove the space maintainer; it is a simple procedure that takes a few minutes.

Meanwhile, the other baby teeth in the mouth keep changing. If the neighbouring tooth carrying the band is itself a baby tooth and starts to wobble, we may need to redesign the appliance for the new situation.

What should you watch for at home while it is fitted?

• Chewing gum, toffee and sticky sweets can loosen the band; keep away from them during this period.
• The edge of the band near the gum is a corner where food collects; check that area yourself at the evening brush.
• Do not let your child play with the wire with a finger or the tongue; a bent wire can dig into the cheek.
• If the appliance comes loose, breaks or falls out, keep it and have it seen without waiting for the next check-up — by a local dentist if you are not in İzmir; space can start to close in the meantime.
• A removable plate is brushed after meals and kept in its case when it is not being worn. Plates wrapped in a napkin usually end up in the bin.

What does the cost depend on?

The cost depends on whether the appliance covers one side or both, whether a fixed or removable type is chosen, and the laboratory work involved. After the examination and X-ray at our clinic in Bayraklı, İzmir, you receive a written, itemised quote together with the treatment plan.