Space Maintenance in Orthodontics

Space Maintenance

“What is space maintenance in orthodontics?”

Space maintenance is defined as “the measures or procedures that are brought into use due to premature loss of deciduous tooth/teeth, to prevent loss of arch development.”

Planning for Space Maintenance

For planning the space maintenance following are the considerations for the factors which influence the development of malocclusion:

• Abnormal oral musculature: Alteration in the position of the tongue and a strong mentalis muscle causes damage to occlusion after loss of the deciduous mandibular molar. This leads to the collapse of the mandibular arch and the distal drift of anterior teeth.
• Pernicious oral habits: Habits such as sucking habits, tongue thrusting alter the buccinator’s mechanism, which causes collapse of arch aftr premature loss of deciduous teeth.

Space maintainers in orthodontics

• Existing malocclusion: Due to early loss of deciduous tooth, there is an increase in severity of different types of malocclusion such as arch length discrepancy, Class 2 division 1 malocclusion.
• Stage of occlusal development: There is more space loss if the lost tooth is adjacent to the actively erupting tooth.

Factors Considered for Planning of Space Maintenance

Read And Learn More: Mandibular Growth, Functional Matrix Theory & Space Maintainers in Orthodontics

Time Elapsed Since Loss of Tooth

• Maximum loss of space occurs within 2 weeks to 6 months of the premature loss of deciduous tooth.
• It is recommended to fabricate the space maintainer before the extraction and to be inserted at the time of extraction.

“Understanding space maintenance: Types and uses explained”

Dental Age of the Patient

• Dental age is more important than the chronological age of the patient.
• Normally eruption of tooth occurs when ¾ of root development takes place. So space maintainers should be planned depending on formation of root of permanent successor.
• In cases with inadequate root completion space maintainers are indicated.

“Impact of removable space maintainers on dental alignment”

Amount of Bone Covering the Unerupted Tooth

• The developing premolars usually require 3-5 months to move through 1 mm of covering alveolar bone as observed on a bitewing radiograph.
• If thickness of bone over erupting tooth is more there is delay in tooth eruption while if bone covering the tooth get destroyed, there is speedily eruption of permanent tooth.
• Patients having thick overlying bone need space maintainers even if roots are fully developed.

Sequence of Teeth Eruption

• The status of the developing and erupting teeth adjacent to the space created by the premature loss of the deciduous tooth affect space closure.
• Two clinical conditions are of importance:
  • The fist one being premature loss of deciduous second molar. If the level of eruption of the second permanent molar is at a level higher than that of the second premolar, then there is a likelihood of permanent fist molar to tip mesially and impact the eruption of the second premolar.
  • The second scenario is that of premature loss of deciduous fist molar and an erupting permanent lateral incisor, which tends to distally ditch the deciduous canine thus effecting the eruption of permanent fist premolar. This also results in lingual inclination of the anteriors especially in the mandible thus resulting in the collapse of the anterior segment.

Space maintenance in pediatric dentistry

“Treatment options using space maintainers in orthodontics”

Congenitally Missing Teeth

It can be deal in two ways, fist one is maintain the space i.e. plan for replacement at later stage and second is allow the space to close.

Delay Eruption of Permanent Tooth

In patients where there is delay in permanent tooth eruption with a retained primary tooth, the primary tooth should be extracted, and space maintainer is provided. This leads to the permanent tooth to erupt in its normal position.

Time of Tooth Loss and Stage of Occlusion

• This factor should be well considered.
• For instance, if there is loss of deciduous second molar before eruption of the permanent first molar, this requires a special space maintainer, i.e. distal shoe space maintainer.