There are numerous types of space maintainers.

They range from the very simple to those with numerous bands and wires. They can be constructed differently and used in different parts of the mouth. As we will cover later, some even have parts extending into the tissue. We feel the best way to make sense of the numerous types and subtypes of space maintainers is to start by classifying them broadly into four categories. They can be fixed or removable, and they can be unilateral or bilateral. A removable space maintainer, of course, can be removed. A fixed space maintainer is fixed (i.e., held) to a tooth or to more than one tooth. Fixation usually is done by cementing the space maintenance appliance in place. Unilateral space maintainers are fixed to one side of the mouth and bilateral space maintainers are fixed to both sides of the mouth. Fixed space maintainers can be unilateral or bilateral. Space maintainers also can be placed on the mandibular or maxillary arch. Consequently, we could have a maxillary removable bilateral space maintainer, or a mandibular fixed unilateral right side space maintainer, and so forth. There are numerous variations on these basic themes. For example, some space maintainers are used for missing anterior teeth and some are used to preserve space for posterior unerupted teeth. The following pages will show the various types of space maintainers.

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This photograph shows an example of a fixed bilateral space maintainer. The patient is four years of age. The appliance is cemented on the two second primary molars. Fixed bilateral space maintainers on the mandibular arch often are called lingual arch space maintainers. Mandibular fixed bilateral space appliances generally are preferred by clinicians over removable space maintainers. Fixed appliances are easier to maintain and they are less likely to be removed, damaged, or lost by the child.

Distal shoe space maintainers are discussed in the chapter on pediatric pulp therapy, particularly in terms of the importance of saving pulpally compromised second primary molars prior to the eruption of the first permanent molars. This is principally because of the technical difficulties associated with the placement of distal shoe space maintainers. The point we make repeatedly in discussions concerning pulp therapy is that it is best to save second primary molars using primary endodontic therapy (i.e., pulpectomy) when first permanent molars have not yet erupted. Most experienced clinicians prefer to avoid distal shoe space maintainers. However, one approach which may cause the process to be easier is to make distal shoe space maintenance a one appointment procedure. Most space maintainer protocol involves two appointments: the first appointment for extraction and impression taking, and the second appointment for placement and cementation of the appliance. In the case of distal shoe space maintainers, this means an additional local anesthetic experience for the child and a surgical incision immediately mesial to the first permanent molar so the distal shoe can be imbedded in tissue. The distal shoe space maintainer can be placed at the time of extraction of the second primary molar. If this approach is used, the impression must be taken and the appliance constructed prior to extraction of

e.e. it also is desirable to replace the distal shoe space maintainer with an appliance which is banded to the permanent molar once the permanent molar erupts. when distal shoe space maintainers are not used.. Consequently. They are placed at the time of the extraction appointment (i. Of course.the primary tooth.e. a one appointment procedure is involved). Although they are not customized for the patient. Using a preformed space maintainer certainly is preferable to not using a space maintainer at all. Consequently. . preformed space maintainers are not customized (i. Unfortunately. The advantage is not having to go back at a later time and surgically make an incision for insertion of the distal shoe into the tissue so the distal shoe segment can abut against the permanent molar. placement of distal shoe space maintainers can be planned as one appointment or two appointment procedures.. prefabricated) distal shoe space maintainers also can be used. using a preformed space maintainer is acceptable in many situations.. distal shoe space maintainers sometimes are not used when a child's behavior makes it unlikely that placement of the appliance at a second appointment would be successful. Of course. Preformed (i. and the choice of approach is left to the discretion of the clinician. As mentioned earlier in the chapter. using the distal shoe space maintainer and a subsequent band and loop appliance really involves several appointments. the development of space problems results. fitted) for the individual patient.

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