Space Maintenance in the Primary Dentition: Custom Made and Prefabricated

  • Meenakshi S. Kher
  • Ashwin Rao


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.


Space maintainer Space maintenance Preventive orthodontics Band and loop Distal shoe Prefabricated space maintainers Primary teeth Intra-alveolar space maintainer Space loss Reverse band and loop Crown and loop Reverse crown and loop 


  1. 1.
    Bhujel N, Duggal MS, Saini P, Day PF. The effect of premature extraction of primary teeth on the subsequent need for orthodontic treatment. Eur Arch Paediatr Dent. 2016;17(6):423–34.CrossRefGoogle Scholar
  2. 2.
    Christensen JR, Fields HW Jr. Space maintenance in the primary dentition. In: Casamassimo P, Fields H, Mctigue D, Nowak A, editors. Pediatric dentistry: infancy through adolescence. 5th ed. St. Louis, MO: Elsevier; 2013. p. 379–84.Google Scholar
  3. 3.
    Christensen JR, Henry W, Fields HW. Treatment planning and management of orthodontic problems. In: Casamassimo P, Fields H, Mctigue D, Nowak A, editors. Pediatric dentistry: infancy through adolescence. 5th ed. St. Louis, MO: Elsevier; 2013. p. 526–7.Google Scholar
  4. 4.
    Laing E, Ashley P, Naini FB, Gill DS. Space maintenance. Int J Paediatr Dent. 2009;19(3):155–62. Scholar
  5. 5.
    TunisonW F-MC, Elbadrawy H, Nassar U, El-Bialy T. Dental arch space changes following premature loss of primary first molars: a systematic review. Pediatr Dent. 2008;30:297–302.Google Scholar
  6. 6.
    Lin YTJ, Lin YT. Long-term space changes after premature loss of a primary maxillary first molar. J Dent Sci. 2017;12:44–8.CrossRefGoogle Scholar
  7. 7.
    Kumari P, Kumari R. Loss of space and changes in the dental arch after premature loss of the lower primary molar: a longitudinal study. J Indian Soc Pedod Prev Dent. 2006;24:90–6.CrossRefGoogle Scholar
  8. 8.
    Durward CS. Space maintenance in the primary and mixed dentition. Ann R Australas Coll Dent Surg. 2000;15:203–5.PubMedGoogle Scholar
  9. 9.
    Fields HW, Proffit WR. Moderate non skeletal problems in preadolescent children: preventive and interceptive treatment in family practice. In: Proffit WR, Fields HW, Sarver DM, editors. Contemporary orthodontics. 5th ed. St. Louis, MO: Mosby; 2013. p. 429–33.Google Scholar
  10. 10.
    Randall RC. Preformed metal crowns for primary and permanent molar teeth: review of the literature. Pediatr Dent. 2002;24(5):489–500.PubMedGoogle Scholar
  11. 11.
    Ekstrand KR, Christiansen J, Christiansen ME. Time and duration of eruption of first and second permanent molars: a longitudinal investigation. Community Dent Oral Epidemiol. 2003;31(5):344–50.CrossRefGoogle Scholar
  12. 12.
    Brill WA. The distal shoe space maintainer chairside fabrication and clinical performance. Pediatr Dent. 2002;24(6):561–5.PubMedGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Meenakshi S. Kher
    • 1
  • Ashwin Rao
    • 2
  1. 1.Happy Tooth Clinic for KidsMumbaiIndia
  2. 2.MCODS Mangalore, Manipal Academy of Higher EducationManipalIndia

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