26 - Space Maintenance in the Primary Dentition

Abstract

Management of premature tooth loss in the primary dentition requires careful thought by the clinician, because the consequences of proper or improper space maintenance may influence dental development well into adolescence. Early loss of primary teeth may compromise the eruption of succedaneous teeth if there is a reduction in the arch length. On the other hand, timely intervention may save space for the eruption of the permanent dentition. The key to space maintenance in the primary dentition is in knowing which problems to treat. Premature tooth loss in this age group is best thought of in terms of anterior (incisors and canines) and posterior (molars) teeth. The causes and treatment of missing teeth differ in these two regions. Anterior tooth loss is due primarily to trauma and tooth decay. Children in this age group are still developing gross motor skills so injuries to the primary incisors are common. In addition, despite efforts at promoting preventive care, a number of children still suffer from early childhood caries. These decay patterns result in both anterior and posterior tooth loss. The majority of posterior tooth loss is due to dental caries; rarely are primary molars lost to trauma. If no space loss has occurred immediately after tooth loss, space maintenance is appropriate because the permanent successor will not erupt for several years. If space loss has occurred, a comprehensive evaluation is required to determine whether space regaining or no treatment is indicated.