Space Maintenance

Abstract

A normal healthy primary dentition is of utmost value to the general well-being of a growing child. If this is not maintained, difficulties may develop that will prevail for a lifetime. In considering the construction of a space maintainer to restore a loss in the continuity of the dental arch, the dentist should avail himself of all diagnostic aids at his disposal in formulating the proper mode of therapy. Due consideration should be given to the fundamentals of growth and development, the existing occlusion of the patient, the condition of supporting structures, and the variable factor of heredity as it influences the particular case in question. It has been concluded that in the upper primary anterior dentition, space maintenance is not necessary because of normal physiologic growth. The exception would be for phonetic and esthetic reasons. The space should be preserved if a permanent upper anterior tooth is lost. In the lower anterior segment the space should be retained to prevent a collapse of the arch. In the posterior segment of the arch it is more essential to place a retainer in the second primary molar area than for the first primary molar. The lower second primary molar is particularly important. A space maintainer should approximate or fulfill the following requirements: (1) preserve and retain the original space for the permanent successor, (2) restore function, (3) prevent or inhibit elongation of opposing dentition, (4) require minimum preparation of abutment teeth, (5) avoid interfering with normal physiologic growth and development, and (6) be readily cleaned by the patient. In maintenance of space for the permanent successors it is essential to fabricate carefully an appliance that is in harmony with the balance of the stomatognathic system and conforms to basic biomechanical principles.