Survival rate of different fixed posterior space maintainers used in Paediatric Dentistry – A systematic review

Abstract

PurposeSpace Maintainers have long been used for the management of space loss in primary and mixed dentition, but there is a need to have an evidence based approach when selecting the most appropriate space maintainer for space management in children. This systematic review aimed to assess the survival rate of space maintainers in children.MethodsA systematic literature search was conducted until October 2017 using PubMed, Scopus, and The Cochrane Central Register of Controlled Trials databases to identify peer- reviewed papers published in English. Search keywords and MeSH headings include “primary dentition” and “Fixed Space maintainers”. The inclusion criteria were clinical studies conducted in children less than 12 years of age, who required unilateral or bilateral fixed space maintainer. Retrieved papers were evaluated by four reviewers independently to assess suitability for inclusion in the systematic review and the final decision was made by consensus. Qualities of the included studies were assessed using Quality of Reporting of Observational Longitudinal Research by Oxford Academics and data were extracted for analysis.ResultsThe search identified a total of 39 papers for screening after removal of duplicate articles. Among the retrieved studies, 23 papers did not satisfy the study inclusion criteria. Consequently, 16 full text articles were retrieved and reviewed. Finally, those 11 papers which fulfilled all the inclusion criteria were selected and reviewed systematically. Most of the clinical trials were assessed as having moderate and low risk of bias.ConclusionThere is a wide variation in the survival rate of metal based and resin based space maintainers and also within the metal based space maintainers. There is an inadequate evidence to recommend one best fixed space maintainer due to lack of properly designed studies. Hence, clinical trial comparing different types of metal based space maintainer and resin based space maintainer with longer duration of follow-up must be performed to evaluate its survival rate.

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

“…With regard to the BL-SM failure, the key reasons were cement failure, solder breakage, and the emergence of soft tissue lesions associated with the devices [4], [5]. Another common cause of BL-SM failure is bending of the metal loops and embedding in the gingival tissues, leading to gingival irritation or overgrowth [5].…”

“…The FRC-SM has several advantages over the BL-SM. It has greater esthetic appeal compared to stainless steel, is minimally invasive, does not impinge on soft tissue, is easily removable, and more readily accepted by pediatric patients [1], [4]. The FRC-SM exhibits high durability and is comparable in physical strength to the stainless steel BL-SM [6].…”

“…Moreover, they found longer survival periods for devices placed in the maxilla than for those placed in the mandible [12]. This could be explained as occlusal trauma is more prevalent in the mandible than in the maxilla [1], [4]. Additionally, they found that FRC-SMs for one tooth lost survived longer than those for two teeth lost [12].…”

“…The effects of masticatory forces and the degree of clearance between the fiber and the opposing tooth, especially when the fiber is bonded to the functional side of an abutment tooth, should be taken into consideration during the placement of a FRC-SM [4].…”

“…The conventional stainless steel band-and-loop space maintainer (BL-SM) is a non-invasive fixed device that is commonly used for such a purpose [3]. 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].…”