Methods of space maintenance for premature loss of a primary molar: a review

Abstract

AimThis critical appraisal attempts to answer the question: What is the best method of space maintenance (SM) following premature loss of a primary molar in children under 12 years old?MethodsA search to identify studies relevant to the PICO was conducted. Single case reports and studies prior to 1986 were excluded. The principles of GRADE were followed to appraise the evidence.Results20 studies were identified, which evaluated 2265 space maintainers (SMs). Two studies were graded high quality, four moderate, eight low, and six very low. All studies reported on longevity outcomes and most on adverse effects.ConclusionsThere was no strong evidence favouring a particular SM, the following recommendations were made: (a) strong recommendations: In cases where rubber dam cannot be used clinicians should not use Glass Fibre Reinforced Composite Resin (GFRCR) SMs. (b) Weak recommendations: Crown and Loop SMs are recommended for loss of primary first molars; GFRCR SMs (placed under rubber dam) are recommended for loss of primary second molars. Bilateral SMs may have questionable efficacy and their use where there is loss of multiple molars in the same quadrant should be weighed against the risk of unwanted tooth movements, loss of a removable SM or no space maintenance at all.

Fiber-reinforced Composite Space Maintainers: A Literature Review of their Survival Rate

“…Therefore, placing a space maintaining device would stabilize the arch dimensions and reduce or eliminate these undesirable consequences. Additionally, it can help prevent the need for future extensive fixed orthodontic treatment in mild to moderate crowding cases [1].…”

“…On the other hand, when assessing if a space maintainer is needed, it is very important to consider the clinical situation and multiple factors for each case [1], [2], [10]. These considerations are presented in the American Academy of Pediatric Dentistry (AAPD) guidelines [10].…”

“…Currently, the most commonly used fixed space maintainer is the conventional stainless steel BL-SM [1], [3]. Although the fabrication of a BL-SM is relatively simple, achieving a good fit of the band around the anchor tooth is sometimes difficult.…”

“…Early loss of a posterior primary tooth would result in space loss and compromised dentition [1]. The placement of an effective space maintainer upon premature tooth loss could reduce future occlusal discrepancies such as malocclusion [2].…”

“…It was reported that the survival rate of BL-SMs, in many cases, is often low and insufficient time for the permanent tooth to erupt [4], [5]. Common reasons for the failure of these BL-SMs include fracturing, bending, or debonding of their components under occlusal forces [1], [4].…”