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Space Maintenance: The Right Appliance at the Right Time by Josh Wren, DMD

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One of the most common questions asked on the Dentaltown pediatric dentistry message boards is, "Do I need to place a space maintainer here? If I do need a space maintainer, which one do I need?" My goal of this article is to address those two questions.

Ask any orthodontist the following question: "Is it easier to put the teeth where they need to be if you have the space available, or is it easier to create the space first then put the teeth where they need to go?" The following examples are general examples only. There are often other variables that can influence the use of a particular space maintainer.









Another indication for a wire Nance and lower lingual holding arch is when the patient has anterior crowding and the "e space" needs to be saved to help alleviate the crowding. In the mandibular arch, an LLHA can often alleviate up to 6mm of anterior crowding.

This is due to the size difference between the second primary molar and second permanent premolar. If that space is not maintained and anterior crowding exists, the options become much more limited. For example: distalization of six-year molars, proclinating the incisors, reducing proximal surfaces, etc.

Space maintenance is an important, often overlooked, component of prevention. I urge the practitioners reading this article to strongly consider incorporating space maintenance into your practices. And in the mid-late dentition, a close look at a space analysis may reveal that your crowded patient needs nothing more than a bilateral space maintainer.



Dr. Josh Wren owns Wren Pediatric Dentistry in Brandon, Mississippi. He founded Pediatric Dental Seminars, which educates dentists on all aspects of clinical pediatric dentistry. Wren's areas of interest include prevention, pulpal therapy, full-coverage crowns, orthodontic therapy, and emerging concepts in pediatric dentistry.


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