Orthotreatment with Space Maintainers


What are Ortho-Spacers and Why are They Used?

Ortho-spacers (or “space maintainers”) are temporary dental appliances used to maintain a separation between teeth in the jaw. Normally, teeth are arranged side by each, and each tooth is fixed in place by the teeth adjacent to it. However, the mouth is actually a dynamic place, with change happening all the time. At no time in life is natural change in the mouth more dramatic than in the mouths of children.

In the first few years of life primary teeth arrive (or “erupt”), develop, and leave the mouth, to be followed in turn by secondary teeth. These changes are a very clever way of ensuring that the growing jaws of a child are populated by appropriately sized teeth, with new teeth arriving to fill the spaces in expanding jaws.

Generally, the place vacated by a lost primary tooth is soon filled by its successor, and the gap is filled. At times however, a tooth is lost before its secondary replacement is ready to arrive. In those cases, the teeth adjacent to the tooth that has been lost can shift into the void, and narrow the opening for the new tooth to fit.

To prevent this crowding from happening, an ortho-spacer can be used as a placeholder, in the literal sense of the term. The ortho-spacer will hold the place open for the incoming tooth to fill, even if there might be a delay in the arrival of the new tooth.

Why Might the Arrival of Secondary Teeth be Mistimed?

Sometimes the delay between the loss of a primary tooth and the arrival of a secondary tooth can be simply as result of a child’s individual development, although this is rare as the loss of a primary tooth is usually caused by the arrival of its secondary replacement.

More usually, premature loss of a primary tooth results from either tooth decay or trauma. These events can cause a gap in the teeth that will need to be held open pending the arrival of the secondary tooth.

Types of Ortho-Spacers

Many variations of ortho-spacers exist, depending on their location, material, permanence, and design.

Removable / fixed: removable ortho-spacers are taken from the mouth regularly for cleaning or sleeping; fixed ortho-spacers remain in place until the secondary tooth arrives to fill the gap. Fixed ortho-spacers are usually preferable for children as they stay in place and are less likely to be removed, damaged, or lost by a child. Removable ortho-spacers can also present a choking hazard for young children.

Unilateral / bilateral: unilateral ortho-spacers are located on just one side of the mouth; bilateral ortho-spacers are located on two sides, and have a wirework construction joining the two sides of the mouth. Bilateral ortho-spacers usually maintain two spaces located symmetrically on the left and right sides of the jaw.

Designs of Ortho-Spacers

Band and loop ortho-spacer

Usually cemented in place, and used on one side of the mouth, the band and loop ortho-spacer consists of a metal band encircling an “abutment tooth” (that is, a tooth adjacent to the space to be maintained). The band is connected to a metal loop that bridges the gap between the abutment tooth and the tooth on the far side of the gap.

Crown and loop ortho-spacer

Like the band and loop ortho-spacer, the crown and loop ortho-spacer is cemented in place, and used on one side of the mouth. The crown and loop ortho-spacer consists of a tooth crown on an abutment tooth with the crown connected to a metal loop that bridges the gap between the abutment tooth and the tooth on the far side of the gap.

Sometimes a band and loop ortho-spacer is put over a crown, making a hybrid form of space maintainer.

Your Dentist Can Help

Ortho-spacers are not always needed when a gap opens between teeth. Your dentist will assess the need based on the location in the mouth of the missing tooth, the age of the child, the expected duration of the gap, the timing of incoming teeth, and other factors. However, when appropriate, space maintainers are effective in helping primary teeth transition successfully to their secondary replacements, possibly preventing further more extensive orthodontic work in the future.

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