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Orthodontists are always worrying about space. When we are lucky, and this is most of the time, there is just the right amount of space for the top teeth and the bottom teeth to come together properly when all the teeth touch and are nice and straight.
The primary baby teeth are important for chewing and biting and speaking and especially for maintaining the space needed for the future permanent adult teeth.
Luckily, missing front teeth do not seem to have as much trouble with space loss as missing back teeth. A gap-toothed grin in a kid is much cuter than in an adult!
But when a primary molar is lost by infection or trauma, the gingival gum fibers and the angle of the jaws closing together make for a strong tendency for the adjacent teeth to move into the newly open space. In other words, the space will be lost.
While initially the loss of a primary tooth does not seem like such a terrible thing, the future consequences could be the loss of a permanent tooth, extensive and expensive orthodontic appliances, and even an uncomfortable bite that causes abnormal wear on the poorly positioned teeth.
We routinely make a small appliance that spans the gap to keep the the space open. This is called a band-loop space maintainer. It is made with a metal orthodontic band with a wire stretching across the missing tooth’s space.
Adults need to have an artificial tooth made to replace missing permanent teeth because the teeth on the other jaw can over erupt. Children are growing so much and their adult teeth will come in soon enough that this is usually not a problem for them. An artificial tooth is not needed.
If more than one tooth is missing, a better way to save the space is to use an appliance that goes from a permanent tooth on one side to one on the other side of the mouth. These are called a lower lingual arch to replace bottom teeth or a transpalatal arch to replace upper teeth.
If teeth are crowded, sometimes teeth must be extracted to make room for the others to line up. Often a lower lingual arch or transpalatal arch can keep the room that remains, and even stretch the space.
Taking care of them is easy with only minor restrictions of not playing with them and keeping them clean. These appliances will stay in place until the permanent teeth erupt. Usually braces are needed after all the permanent teeth erupt but the treatment will be easier.
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