Space Maintenance in the Primary Dentition: Custom Made and Prefabricated

Abstract

The premature loss of a primary molar can lead to space and arch length loss leading to the need for future complex orthodontic treatment. The detrimental effects of premature loss of molars are greatest in the primary dentition. Passive space maintainers in the primary dentition not only prevent these unfavorable outcomes but are easy to place for the operator and comfortable for the little child. Their presence in a clinician's armamentarium obviates the need for heroic attempts at salvaging primary molars with poor prognosis. Endodontic treatment procedures in such primary molars can compromise the health of the developing permanent tooth bud and are extremely challenging for the child to undergo and for the clinician to perform. This chapter discusses in depth through step-by-step clinical photographs and long-term follow-ups the stages in the fabrication of the band and loop, reverse crown and loop, and the distal shoe space maintainers. Both the custom-made and prefabricated chairside varieties are discussed so as to suit the individual clinician's circumstances and preferences. A discussion of the indications, rationale, and clinical tips helps the clinician make an informed decision of whether a space maintainer is required and which design is best for a given clinical situation.