Saving Space

October 12th, 2009 by Mark Mutschler

Baby teeth are useful for many things:

• chewing on things (not always a good thing)
• eating
• talking
• smiling
• guiding permanent teeth into proper position
• saving space for permanent teeth

It is a rare day in my pediatric dentistry practice when I do not have to think about the space available for permanent teeth to grow in properly.  Sometimes I have to extract teeth to make room then hold the space open with a metal space maintainer.

Other times, infection causes a baby tooth to come out early and a space maintainer is needed to make sure there is room available for the permanent tooth to come in.

Holding this space is important to avoid orthodontic problems or possible extraction of permanent teeth.

There are several types of space maintainers:

• Band-loop space maintainers – The most common space maintainer, it is most useful for replacing a single tooth.  They consist of a metal band around a tooth next to the missing one and a wire is soldered to the band that rests against the tooth on the other side of the missing one.

• Distal shoe space maintainers – These have a band around the closest tooth to the missing one.   A bar extends back and digs into the gums to guide permanent tooth eruption.  I avoid these whenever possible.

• Lower lingual arches (LLA) - Also very common, are used to hold space open for more than one missing tooth or to help keep the lower incisors straight.  Bands are placed on molars on both sides of the mouth then a wire extends from one side to the other inside the front teeth.

• Upper lingual arches – These are just like the lower lingual arches but on the top.  They also help keep the upper incisors straight after early orthodontic treatment.

• Nance appliances – metal bands on upper molars connect to a plastic pad that pushes against the top of the mouth.  They tend to get icky after a while so I just don’t use them.

• Trans-palatal arches – metal bands on molars connect to each other with a wire that goes directly across the top of the mouth.  These are useful for keeping molars in position without getting in the way of the front teeth.

• W-arches – these have metal molar bands with a wire that rests against the inside of the back teeth and a large loop in the palate area.  These are useful for widening the upper dental arch.

Each of these have different uses and each doctor has their favorites.

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