Space management can minimize the development of crowding.
It involves the maintenance of space following the premature loss of primary molars.
Space Maintenance
The best space maintenance therapy is to preserve the primary molars until natural
exfoliation. Although dental health education and improved caries prevention have
lowered the number of children who develop malocclusion because of premature loss
of primary teeth, it is still one of the most common controllable causes of malocclusion.
Making the Space Maintainer
Each space maintainer is custom-made by a dentist or orthodontist. For a fixed space
maintainer, a metal band is placed around one of the teeth next to the space, and
impressions are made. The band is removed and sent to a dental laboratory with the
impressions. The lab creates the space maintainer and sends it back to your child's
dentist, who cements it in place at a second office visit. Sometimes, a space maintainer
can be made in the office in a single visit without impressions. To make a removable
space maintainer, impressions are made and sent to a lab, which makes the appliance.
Types of Space Maintainers:
Removable
Removable space maintainers have the shortcomings of all removable appliances. They
may be worn at the whim of the patient. May be broken. Easily lost when removed
by the patient. A removable space maintainer that is only worn at night is often
sufficient to hold space and prevent the mesial drift of permanent molars.
Fixed space maintainers
Fixed appliances have the advantage that they are worn continuously and do not require
patient cooperation in wearing them. It should be noted that the placement of a
fixed appliance in a child at high risk of caries may compromise teeth that are
banded, or even adjacent teeth. Band and loop appliance is typically used in cases
of unilateral loss. Nance appliance or lingual arch appliance can be used if the
loss is bilateral. Distal shoe appliance can be used if the first permanent molar
is not yet erupted, but are not widely used because of risks of infection.
