Space Maintainer Consent Form



  • When baby teeth (molars and canines) are lost prematurely, it is usually necessary to place a space maintainer in order to prevent teeth from shifting into the space created from the extracted tooth. If the space is not maintained, it can cause or increase crowding for permanent teeth.



    If a tooth is lost on one side of the jaw, a unilateral (one-sided) spacer called a band and loop is used.

    If teeth are lost on both sides of the upper or lower arch, a bilateral (two-sided) space maintainer is used. These are described as a nance for the upper teeth or a lower lingual arch for the lower teeth.

    Band and loop space maintainers can often be fabricated and cemented in one visit. Other types of space maintainers will require two visits to complete.

    Following the cementation of a space maintainer your child must visit our office every six months to make sure the spacer is fitting properly and to examine the rest of the teeth for future eruption. If you notice a tooth erupting in the area under the space maintainer or have any concerns please call to make an appointment.

    Your child should avoid sticky candies which could cause the space maintainer to become loose. Proper brushing and flossing is imperative while a space maintainer is in place. If teeth and gums are not properly cleaned, cavities and sore gums can easily develop.

    Potential benefits of a space maintainer:
    1. Helps to maintain current occlusion and prevents loss of space due to loss of a baby tooth before normal exfoliation.
    2. May lessen future orthodontic needs.
    Risks include but are not limited to the following:
    1. Increased risk for cavities if teeth and gums are not properly brushed and flossed.
    2. Need for future visits to recement and possibly remake the space maintainer if damaged or lost.
    I understand that a space maintainer does not guarantee that my child will not have crowding. My child may require future orthodontic treatment with or without a space maintainer.

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