Primary (baby) teeth do not only provide chewing function; they also stimulate jawbone development and serve as a “physiological guide” for the permanent teeth that will come from underneath. When a primary tooth must be extracted before its physiological shedding age due to deep decay or trauma, the neighboring teeth quickly shift towards this extraction gap (mesialization). This situation narrows the area where the permanent tooth will erupt, causing the tooth to remain impacted in the jawbone or to erupt ectopically (at a wrong angle). Passive appliances placed in the extraction gap to prevent this biomechanical chaos are called Space Maintainers. In our clinic, custom-designed space maintainers are the most vital preventive medical application that protects the child from complex, long, and costly future orthodontic (brace/aligner) treatments.
Among parents, there is a very dangerous misconception regarding oral and dental health passed down from generation to generation: “It’s going to fall out anyway, let’s just pull out the aching baby tooth.” However, in modern pediatric dentistry (Pedodontics), extracting a primary tooth early is never the end of a treatment process; on the contrary, it is the beginning of much more complex orthodontic problems.
Extracting a tooth that is too damaged to be saved with Baby Tooth Treatments (filling or root canal treatment) due to decay may be a medical necessity. However, leaving that gap to its fate is a major clinical mistake. Here are the scientific facts parents should know about space maintainers, the cornerstone of Pediatric Orthodontics.
1. What Happens in the Jaw When a Baby Tooth is Extracted? (Biomechanical Facts)
Teeth in our mouth are in a dynamic balance and by nature always tend to move towards the midline (forward). Especially the permanent “1st Molar”, which erupts around age 6, is the keystone of the jaw. If the primary molar in front of this tooth is extracted early, that massive 6-year-old molar quickly tips forward, closing the extraction gap. The permanent premolar preparing to emerge from underneath cannot find space; it either remains completely impacted in the jawbone or erupts crookedly towards the palate.
Space maintainers at this point say “stop” by creating a physical barrier to neighboring teeth and preserve the original length of the dental arch (curve).
2. Types of Space Maintainers for Needs
The type of appliance to be used according to your child’s age, jaw development stage, and the number of teeth lost is determined after a detailed radiological analysis:
Fixed Space Maintainers: Generally applied for single-sided and single tooth deficiencies. They are produced from biocompatible medical alloys. They are fixed to the tooth with special dental cements and cannot be removed by the child.
Lingual Arch / Nance Appliance: If there is early tooth loss on both sides of the jaw, these are more comprehensive appliances that pass from behind the teeth and stabilize multiple teeth.
Removable Space Maintainers (Pedodontic Prostheses): Preferred especially in cases where multiple molars or front incisors are lost early. By adding “artificial child teeth” to these appliances, which children can put on and take off, aesthetic and speech functions are also protected.
3. Is the Impression and Application Process Painful? (Digital Comfort)
Making a space maintainer is one of the most comfortable procedures in pedodontics. No abrasion or cutting is done on the teeth, and there is no pain. There is no need for any injection (needle) in the child’s mouth.
Instead of traditional, nauseating doughy impression materials, Digital Intraoral Scanners are used in our clinic. The child’s mouth is scanned in 3D in seconds with a small camera. With this digital data, an appliance providing a millimetric fit to the child’s teeth is prepared and placed on the tooth painlessly.
4. Why is Space Maintainer Maintenance Important?
The area around fixed space maintainers is prone to plaque accumulation. The child must pay maximum attention to oral hygiene; otherwise, cavities may start in the healthy teeth the space maintainer rests on. In addition, to prevent the appliance from breaking or its adhesive from dissolving, caramel, Turkish delight, jelly beans, and extremely hard foods (ice, hard-shelled nuts, etc.) must be strictly avoided.
Comparison: Scientific Approach to Early Extraction
Clinical Parameter
If Space Maintainer is Applied
If Extraction Gap is Neglected
Eruption of Permanent Tooth
Guaranteed to erupt in its natural, anatomical, and correct position.
Eruption area closes, so it stays impacted in the bone or erupts crowded.
Orthodontic Result
No brace/aligner treatment needed in the future, or the process is very light.
Severe crowding starts, definitely requires long-term Pediatric Orthodontics.
Jaw Joint (TMJ)
Chewing force is distributed equally, joint health is protected.
One-sided chewing starts due to the gap, jaw asymmetry and joint pain occur.
Cost and Time
An elective, simple, short-term, and quite economical medical investment.
Brace treatments are complex and high-cost procedures lasting years.
Frequently Asked Questions (FAQ)
Exactly how long should the space maintainer stay in the mouth?
This period is different for every child. The space maintainer continues its duty until the tip of the permanent tooth coming from underneath appears on the gum surface. When the permanent tooth starts to erupt, the appliance is painlessly removed by the dentist in a few seconds.
What should be done if the appliance falls off or becomes loose?
If the child eats hard or sticky food, the adhesive of the fixed space maintainer may dissolve. If the appliance is not broken, there is no need to panic; the appliance should be washed, put in a clean box, and brought to the clinic as soon as possible.
The tooth was extracted months ago, are we too late for a space maintainer?
It is difficult to understand how much the extraction gap has closed by eye. A radiological (x-ray) examination is absolutely necessary for this. If the gap is not completely closed or in a state where it can be opened again with a simple apparatus, it is not too late.
The Precaution Taken Today is the Perfect Smile of the Future
A simple space maintainer apparatus is the smartest and most protective medical investment that prevents your child from undergoing years of challenging orthodontic treatments in the future.
Antalya Pediatric Dentist Prof. Dr. Behiye Bolgül graduated from Dicle University Faculty of Dentistry as the top student in 1995. She started her doctorate in the Department of Pedodontics at the same university in 1996 and completed it in 2001, receiving the title of Pedodontist
