Space Maintainers UK — What They Are and When Children Need Them

What is a space maintainer and why is one needed?

Baby (primary) teeth act as natural guides that reserve space for the permanent teeth developing beneath the gum. If a primary tooth is lost significantly earlier than the expected eruption date of the adult tooth — through decay, trauma, or extraction — the neighbouring teeth can drift or tip into the gap. This reduces the space available for the permanent tooth, often causing it to erupt in the wrong position, become impacted, or require more complex orthodontic treatment later. A space maintainer is a custom-made appliance fitted by a dentist or orthodontist that holds the gap open until the permanent tooth is ready to erupt. It is a simple, preventative measure that can avoid much more involved treatment in the future.

Types of space maintainer

There are four main types used in the UK. A band and loop maintainer is the most common — a stainless steel band is cemented around the tooth adjacent to the gap, with a loop extending across the space to prevent the neighbouring tooth from drifting. It is used for a single missing tooth. A lingual arch is used when multiple lower primary molars have been lost early; a wire runs along the inside of the lower arch, anchored to bands on the back molars, preserving space across several teeth. A Nance appliance serves a similar purpose for the upper arch, with the wire connecting to a small acrylic pad that rests against the palate for stability. A distal shoe is a more specialised appliance used before the first permanent molar has erupted — it extends slightly below the gum line to guide the adult molar into the correct position. Removable space maintainers (similar to a partial denture) are occasionally used for older children but are less commonly prescribed because compliance can be poor.

NHS access and when a dentist refers

Space maintainers are available on the NHS, and the standard NHS charge for a course of treatment involving a space maintainer falls under Band 2 (currently £76.60 in England). A child's NHS dentist will assess whether a space maintainer is clinically appropriate following premature tooth loss. The key factors are how much root remains on the adjacent teeth, how far advanced the permanent tooth is, and whether the gap is already beginning to close. If the gap has already closed significantly, a space maintainer may not be sufficient and a referral to a specialist paediatric dentist or orthodontist may be needed instead. Children under 18 are not charged for NHS dental treatment, so space maintainers are free for those under 18.

How long does a space maintainer stay in?

A space maintainer remains in place until the permanent tooth has erupted sufficiently to hold the space on its own — this can range from a few months to two years depending on the child's age and stage of dental development. The dentist monitors progress at regular check-up appointments. Once the permanent tooth begins to break through the gum, the maintainer is removed. If the space maintainer becomes loose or breaks before then, the dentist should be contacted promptly as a gap left unprotected for even a short time can begin to close.

Cost — NHS vs private

For children under 18, space maintainers on the NHS are provided free of charge as part of routine NHS dental care. Adults requiring a space maintainer (for example following premature loss of a tooth before an implant) would pay the Band 2 NHS charge of £76.60 or private fees typically ranging from £150–£450 depending on the type and complexity. Privately placed space maintainers for children typically cost £200–£500. If a private specialist paediatric dentist is involved, fees are higher, often £350–£800 for more complex cases.

What happens if a space maintainer is not used?

Without intervention, the teeth bordering the gap will drift towards each other, sometimes within weeks. This can cause the permanent tooth to erupt ectopically (in the wrong position), become partially or fully impacted, or push adjacent teeth out of alignment. The long-term consequences often include more extensive and costly orthodontic treatment — potentially fixed braces, extractions, or even surgical exposure of impacted teeth. In some cases, early tooth loss and failure to maintain space contributes significantly to the severity of crowding that requires treatment in the teenage years. Prevention with a simple space maintainer is almost always preferable to the more complex correction needed later.

Useful related pages

This guide is for general information only. It is not a diagnosis, treatment plan, or substitute for advice from a registered dentist or orthodontist.