Title In Patients With Mixed Dentition and First Primary Molar Tooth Loss, Loss of Space Is Not Clinically Significant for the Use of Space Maintainers
Clinical Question In patients with mixed dentition that have premature loss of primary first molars, is inserting a space maintainer more beneficial for the permanent occlusion compared to not having a space maintainer?
Clinical Bottom Line In patients with mixed dentition and premature loss of primary first molars, there is a statistically significant loss of space but its clinical significance is controversial. The use of a space maintainer might be questionable in a well-spaced arch with solid intercuspidation. This is supported by a systematic review of controlled studies that evaluated dental arch space problems arising as a result of premature loss of primary maxillary first molar.
Best Evidence  
PubMed ID Author / Year Patient Group Study type
(level of evidence)
18767508Tunison/200779 studies reviewed; only 3 studies selected Systematic review of observational studies
Key resultsThree articles were selected based on the methodology criteria. The combination of studies report a loss of 1.5 mm in the mandibular arch and 1.0 mm in the maxillary arch after the early loss of a primary first molar. Although these results are statistically significant, the authors question the clinical significance of the space lost.
Evidence Search premature loss primary molar AND dental arch space
Comments on
The Evidence
Validity: A systematic review of the available evidence was performed, and out of the 79 articles, 76 were excluded due to lack of information or a low score on their methodology. Three articles met the selection criteria but evidence was insufficient for a meta-analysis. The sample size and methodology of available articles is limited. Perspective: Based on the systematic review and existing reports further studies with larger sample size and longer follow up period are required.
Applicability Careful evaluation of a patient’s individual space needs, compliance and dental development are necessary to determine the need for a space maintainer. After the early extraction of a primary first molar the loss of few millimeters in a well-aligned arch might not be significant but it can be a decision-maker in a patient with an arch length discrepancy that would benefit from every millimeter saved.
Specialty (Orthodontics) (Pediatric Dentistry)
Keywords Loss of space, premature tooth loss, mixed dentition, tooth migration, space management, space maintainer
ID# 3244
Date of submission 05/03/2017
E-mail gonzalezsuar@livemail.uthscsa.edu
Author Ana M. Gonzalez
Co-author(s) e-mail
Faculty mentor Maria Jose Cervantes, DDS
Faculty mentor e-mail
Basic Science Rationale
(Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)
None available
Comments and Evidence-Based Updates on the CAT
None available