We recommend space maintainers when primary (baby) molar teeth are lost prematurely (e.g. because of large, unfixable cavities) or are congenitally missing. The goal of space maintainers is to prevent movement of the adjacent permanent first molars (which erupts in the oral cavity at around six years of age) and loss of space for (permanent) bicuspids and permanent canines. If the permanent first molars are not held in their proper position, they can drift forward and prevent the bicuspid teeth from being able to move into the mouth on their normal path. The first bicuspids can also move forward and block the normal pathway of movement of the permanent canines into the mouth.
We most commonly use fixed space maintainers which include the band and loop, the lingual holding arch, the Trans-Palatal Arch (TPA) and the distal shoe. We select the proper space maintainer depending on the number of missing teeth and their position in the dental arch. The term fixed means the device is cemented (glued) into place with dental cement and is not meant to be removable by the patient. This makes them more reliable at effectively achieving their goal. It also means they must be removed by us at some point.
We may alternatively prescribe removable partial dentures as space maintainers (less commonly used) if several teeth are missing and the child's appearance is affected.