Space Maintenance

While normally transverse and A-P changes don’t offer relief to lower anterior crowding AFTER incisors are erupted, Leeway space is potentially available for crowding relief prior to exfoliation of buccal segment primary teeth and before the late mesial shift of the permanent molars.

Early Orthodontic/Pediatric Dental Care

In the past, patients were told to wait until ALL the baby teeth were lost to seek an orthodontic opinion. We let crowding develop & waited until growth was complete. We used headgears to distalize teeth, we reacted to growth & removed teeth in 50% of cases.

  • Today we know better. We know that the front baby teeth are smaller than the front permanent teeth.
  • This discrepancy has the affect of creating crowding in the anterior segment when children are 6-8 years old.
  • In addition, we know that the “back baby molars” are bigger than the permanent teeth that replace them.
  • We call this discrepancy “E” space because the 2nd baby molars are referred to as “E’s”. By saving this amount of posterior space we can often unravel the anterior crowding into the extra “back” space. We save this extra space with space maintainers and we expand upper arches to create more space. We take out teeth 15-20% of cases.

By creating an early plan for your child, we can :

  • reduce the need for extractions
  • guide the permanent teeth to erupt into a more optimal position
  • reduce the need for more difficult, comprehensive care.

Space maintenance

A palatal expander can increase transverse dimension and maintain the anterior/posterior “E” space at the same time. . . .both allows for more optimal eruption of the permanent teeth.

In this case, the lower cuspids continued their mesial inclination of development. Both cuspids were extracted by an oral surgeon. Early intervention with extraction of baby teeth and space maintenance could have allowed for more optimal eruption of the cuspids.
Lower cuspids are presenting with a mesial inclination in their eruption path. Teeth with the wrong eruption paths can continue to turn if an easier eruption path is not created.
When teeth are identified erupting as ” impactions” (not having enough space), or ectopically (in the wrong position). . . .they should be watched for extraction of primary teeth. Extraction of primary teeth can create an environment for permanent teeth to erupt in a more optimal position.

The upper primary cuspids and 1st primary molars were extracted to create a pathway for the “wandering” cuspids to erupt. Timely extractions resulted in favorable positioning.

Crowding was developing with “blocked out upper cuspids”, small laterals & mesially inclined lower cuspids. Extraction of baby teeth to create a larger “parking space” resulted in a better eruption path and favorable positioning of teeth.

Sometimes timely removal of primary teeth to create a better eruption path can be quite dramatic. In this case the upper permanent cuspids were given space by extracting primary cuspids and 1st primary molars. A simple “nance” space maintainer was utilized to hold arch length while the permanent cuspids erupted nicely.