Deciduous teeth extraction may be necessary when there are non- restorable decays or extensive infections related with decays. Space maintainers are appliances that should be prepared for protecting arc length in early deciduous tooth loss.
In early loss of posterior teeth, the missing tooth causes movement or tipping of adjacent teeth to this area. As a result of this situation, arc length which is necessary for permanent teeth will be shortened and the place becomes narrow where premolar and canine teeth should be. Related with this narrowing, premolar and canine teeth may be impacted or crowding may occur. In a situation like these, orthodontic treatment will be necessary for children who may never have orthodontic treatment need normally.
Intervention Time After Early Loss of Deciduous Tooth
After loss of deciduous tooth maximum movement occurs between the first 2. Week and 6. months. When wound healing is completed between 1 week-10 days subsequently from tooth extraction, space maintainer should be prepared by an impression of mouth. However, it should be kept in mind that there is no need to prepare a space maintainer for children before the age of 3-4, between canine teeth when anterior teeth are missing because there is no lack of space.
When deciding to prepare space maintainer, the bone level on developing premolar teeth is evaluated from x-rays. It takes minimum 6 months for those teeth to resorbe 1 mm bone and move.
Dental age is more important than chronologic age of the patient when the need for considering space maintainer. Dental age, calcification and eruption time of crowns, roots of teeth are related with their order. Usually teeth erupt when they completed 3/4 of their root. When there is a bone loss without having 3/4 of root, it shouldn’t be trusted that the eruption will speed up so space maintainer should be prepared.
For deciding to prepare space maintainer, panoramic x-rays should be taken because they are more extensive and both 2 dental arcs can be observed. Root growth of permanent non- erupted tooth and the bone over it can be evaluated from – rays and thus sufficient data can be obtained about dental age of the
child, the decision to prepare space maintainer should be given based on this data.
Placing space maintainer appliance and follow ups are affected from the relationship between both patient- doctor and parent- doctor. Parents should be told that if existing situation is not treated then it may lead occlusion problems in the future. At the same time, follow ups of space maintainers are very important. They should be checked with 4-6 monthly intervals. If space maintainer loosens, the same one can be cemented again when the patient comes for control.
Band-Loop Space Maintainer
They can be applied double sided in upper or lower jaw for single tooth loss. It’s application and usage is very easy for patient. It can be removed easily when permanent tooth starts eruption. Those space maintainers don’t require adaptation period for children.
Lingual arc is applied when there is bilateral teeth loss. It’s usage is very easy because it is a fixed maintainer and there is no need patient adaptation. The advantage is it protects place of more than one tooth.
It is used when there are more then one missing tooth. Nance appliance seats on palatinal vault and supported by molar teeth with the help of an acrilic button. Therefore, it prevents movement of molar teeth to front side by getting supported from palatinal vault. It’s usage is easy because it is fixed appliance.
Trans Palatal Arc (TPA)
It is used when there are more than one missing tooth. By getting supported from molar teeth, it prevents movement to extraction cavity. It is a fixed prothesis.
Space Maintainers for Missing Deciduous Teeth
Sometimes, one or few missing of deciduous incisor tooth may occur due to trauma or extensive decays. A band is placed on deciduous molar teeth and acrilic teeth are placed over a metal bar extending through incisor area . Thus, lost speech and phonations will be gained for small children. Additionally, it positively effects the child aesthetically. It facilitates eruption of permanent teeth by stimulating the edantulous area.