International Journal of Clinical Pediatric Dentistry

Register      Login

VOLUME 15 , ISSUE 6 ( November-December, 2022 ) > List of Articles


Comparative Evaluation of Fixed Functional Cantilever Space Maintainer and Fixed Nonfunctional Space Maintainer: A Randomized Controlled Trial

Savitha Sathyaprasad, Monika Godilli Krishnareddy, Vinisha Vinod, Nikhil Das, R Ramesh, Irfana Ilyas

Keywords : Esthetics, Pediatric prosthesis, Space maintainer

Citation Information : Sathyaprasad S, Krishnareddy MG, Vinod V, Das N, Ramesh R, Ilyas I. Comparative Evaluation of Fixed Functional Cantilever Space Maintainer and Fixed Nonfunctional Space Maintainer: A Randomized Controlled Trial. Int J Clin Pediatr Dent 2022; 15 (6):750-760.

DOI: 10.5005/jp-journals-10005-2478

License: CC BY-NC 4.0

Published Online: 14-02-2023

Copyright Statement:  Copyright © 2022; The Author(s).


Background and objectives: Effective way to prevent mesial drift after the early loss of primary first molars is by inserting a durable space maintainer. Several space maintainers are available; fixed nonfunctional (FNF) space maintainer (crown and loop) is commonly used when abutment teeth need full-coronal restoration. Disadvantages of crown and loop space maintainer are nonfunctional, nonesthetic, and fracture of solder loop. To overcome this drawback, new design of fixed functional cantilever (FFC) space maintainer (crown and pontic) using bis-acrly composite resin. The study evaluated the longevity and acceptance of an FFC and compared it with a FNF space maintainer. Materials and methods: A total of 20 healthy children, aged 6–9 years, were selected having bilateral premature loss of lower deciduous first molars. FFC space maintainer in one quadrant and FNF space maintainer in the other was cemented. The subject's acceptance of treatment was checked using a visual analog scale after the treatment completion. Criteria for complication leading to the failure was assessed in both the designs in the 3rd, 6th, and 9th month. Cumulative success longevity was obtained at a 9 month evaluation. Results: Patient acceptability was greater in group I (FFC) in comparison to group II (FNF). In group I, fracture of the crown and pontic was the common complication leading to failure, followed by attrition of the crown and loss of material due to abrasion. In group II, fracture of the solder joint was the common complication leading to failure, followed by slippage of the loop gingivally and cement loss. The longevity of groups I and II were 70 and 85%, respectively. Conclusion: FFC can be considered a viable alternative to conventional FNF space maintainers.

PDF Share
  1. American Academy of Pediatric Dentistry Clinical Affairs Committee-Developing Dentition Subcommittee, American Academy of Pediatric Dentistry Council on Clinical Affairs. Guideline on management of the developing dentition and occlusion in pediatric dentistry. Pediatr Dent 2005–2006;27(7 Suppl):143–155.
  2. King NM, Anthonappa RP, Itthagarun A. The importance of the primary dentition to children - part 2: effects of treating carious teeth by extraction. Hong Kong Pract 2007;29(3):101–107.
  3. Cardoso L, Zemburski C, Fernandes DS. Evaluation of prevalence of precocious loss of desiduous molars. Braz Res Pediatr Dent Integr Clin 2005;5:17–22.
  4. Northway WM, Wainright RL, Demirjian A. Effects of premature loss of deciduous molars. Angl Orthod 1984;54(4):295–329. DOI: 10.1043/0003-3219(1984)054<0295:EOPLOD>2.0.CO;2
  5. Padma Kumari B, Retnakumari N. Loss of space and changes in the dental arch after premature loss of the lower primary molar: a longitudinal study. J Indian Soc Pedod Prev Dent 2006;24(2):90–96. DOI: 10.4103/0970-4388.26023
  6. Jayachandar D, Gurunathan D, Jeevanandan G. Prevalence of early loss of primary molars among children aged 5-10 years in Chennai: a cross-sectional study. J Indian Soc Pedod Prev Dent 2019;37(2):115–119. DOI: 10.4103/1319-2442.261340
  7. Monte-Santo AS, Viana SVC, Moreira KMS, et al. Prevalence of early loss of primary molar and its impact in schoolchildren's quality of life. Int J Paediatr Dent 2018;28(6):595–601. DOI: 10.1111/ipd.12416
  8. Laing E, Ashley P, Naini FB, et al. Space maintenance. Int J Paediatr Dent 2009;19(3):155–162. DOI: 10.1111/j.1365-263X.2008.00951.x
  9. Raviteja NVK, Prasad MG. Clinical evaluation of Ghana Shyam's TEFF (telescopically expanding fixed functional) space maintainer versus conventional band and loop space maintainer. Pesqui Bras Odontopediatria Clín Integr 2020;(20).
  10. Qudeimat MA, Sasa IS. Clinical success and longevity of band and loop compared to crown and loop space maintainers. Eur Arch Paediatr Dent 2015;16(5):391–396. DOI: 10.1007/s40368-015-0183-y
  11. Tunc ES, Bayrak S, Tuloglu N, et al. Evaluation of survival of 3 different fixed space maintainers. Pediatr Dent 2012;34(4):e97–e102.
  12. Kazmi SMR, Iqbal Z, Muneer MU, et al. Different pontic design for porcelain fused to metal fixed dental prosthesis: contemporary guidelines and practice by general dental practitioners. Eur J Dent 2018;12(3):375–379. DOI: 10.4103/ejd.ejd_232_18
  13. Alt V, Hannig M, Wöstmann B, et al. Fracture strength of temporary fixed partial dentures: CAD/CAM versus directly fabricated restorations. Dent Mater 2011;27(4):339–347. DOI: 10.1016/
  14. Takamizawa T, Barkmeier WW, Tsujimoto A, et al. Mechanical properties and simulated wear of provisional resin materials. Oper Dent 2015;40(6):603–613. DOI: 10.2341/14-132-L.1
  15. Croll TP, Johnson R. The stainless steel crown, welded sheath, and wire loop for posterior space maintenance. Pediatr Dent 1980;2(1):56–58.
  16. Rapp R, Demiroz I. A new design for space maintainers replacing prematurely lost first primary molars. Pediatr Dent 1983;5(2):131–134.
  17. Garg A, Samadi F, Jaiswal JN, et al. ‘Metal to resin’: a comparative evaluation of conventional band and loop space maintainer with the fiber reinforced composite resin space maintainer in children. J Indian Soc Pedod Prev Dent 2014;32(2):111–116. DOI: 10.4103/0970-4388.130783
  18. Suresh PB, Mani G. Most frequently extracted primary tooth in mandibular arch of children - a retrospective study. Indian J Forensic Med Toxicol 2020;14(4):4794–4802. DOI: 10.37506/ijfmt.v14i4.12390
  19. Zameer M, Dawood T, Basheer SN, et al. Clinical technique: space maintenance following the premature loss of primary molars using innovative fixed unilateral space maintainers (smart appliances). Int J Dent Oral Sci 2020;7(12):968–971.
  20. Jaai R, Jasmin W. Space regainers - a review. European J Biomed Pharm Sci 2018;5(7):212–217.
  21. Artun J, Marstrander PB. Clinical efficiency of two different types of direct bonded space maintainers. ASDC J Dent Child 1983;50(3):197–204.
  22. Owen DG. The incidence and nature of space closure following the premature extraction of deciduous teeth: a literature study. Am J Orthod 1971;59(1):37–49. DOI: 10.1016/0002-9416(71)90214-4
  23. Setia V, Pandit IK, Srivastava N, et al. Space maintainers in dentistry: Past to present. J Clin Diagn Res 2013;7(10):2402–2405. DOI: 10.7860/JCDR/2013/6604.3539
  24. Choonara SA. Orthodontic space maintenance–a review of current concepts and methods. J Dent Assoc S Afr 2005;60(3):113–117.
  25. Arikan F, Eronat N, Candan Ü, et al. Periodontal conditions associated with space maintainers following two different dental health education techniques. J Clin Pediatr Dent 2007;31(4):229–234. DOI: 10.17796/jcpd.31.4.9588m43n027t560n
  26. Wright GZ, Kennedy DB. Space control in the primary and mixed dentitions. Dent Clin North Am 1978;22(4):579–601.
  27. Bell RA, Dean JA, McDonald RE, Avery DR. Management of the developing occlusion. McDonald and Avery's dentistry for the child and adolescent. 9th ed. Maryland Heights: Mosby Elsevier. 2011:550–613.
  28. Stein RS. Pontic-residual ridge relationship: a research report. J Prosthet Dent 1966;16(2):251–285. DOI: 10.1016/0022-3913(66)90080-1
  29. Zareen N, Gounder R. Pontic Design Considerations and their Complications in General Population. Int J Pharm Sci Rev Res 2016;40(1):304–306.
  30. Himmel R, Pilo R, Assif D, et al. The cantilever fixed partial denture–a literature review. J Prosthet Dent 1992;67(4):484–487. DOI: 10.1016/0022-3913(92)90077-n
  31. Rueggeberg FA. From vulcanite to vinyl, a history of resins in restorative dentistry. J Prosthet Dent 2002;87(4):364–379. DOI: 10.1067/mpr.2002.123400
  32. Haselton DR, Diaz-Arnold AM, Vargas MA. Flexural strength of provisional crown and fixed partial denture resins. J prosthet Dent 2002;87(2):225–228. DOI: 10.1067/mpr.2002.121406
  33. Lang R, Rosentritt M, Behr M, et al. Fracture resistance of PMMA and resin matrix composite-based interim FPD materials. Int J Prosthodont 2003;16(4):381–384.
  34. Sideridou ID, Karabela MM, Vouvoudi ECh. Physical properties of current dental nanohybrid and nanofill light-cured resin composites. Dent Mater 2011;27(6):598–607. DOI: 10.1016/
  35. Balkenhol M, Mautner MC, Ferger P, et al. Mechanical properties of provisional crown and bridge materials: chemical-curing versus dual-curing systems. J Dent 2008;36(1):15–20. DOI: 10.1016/j.jdent.2007.10.001
  36. Nejatidanesh F, Lotfi HR, Savabi O. Marginal accuracy of interim restorations fabricated from four interim autopolymerizing resins. J Prosthet Dent 2006;95(5):364–367. DOI: 10.1016/j.prosdent.2006.02.030
  37. Haselton DR, Diaz-Arnold AM, Dawson DV. Color stability of provisional crown and fixed partial denture resins. J prosthet dent 2005;93(1):70–75. DOI: 10.1016/j.prosdent.2004.09.025
  38. Givens EJ Jr, Neiva G, Yaman P, et al. Marginal adaptation and color stability of four provisional materials. J Prosthodont 2008;17(2):97–101. DOI: 10.1111/j.1532-849X.2007.00256.x
  39. Drummond JL, Botsis J, Zhao D, et al. Fracture properties of aged and post-processed dental composites. Eur J Oral Sci 1998;106(2 Pt 1):661–666. DOI: 10.1046/j.0909-8836.1998.eos106208.x
  40. Gegauff AG, Wilkerson JJ. Fracture toughness testing of visible light-and chemical-initiated provisional restoration resins. Int J Prosthodont 1995;8(1):62–68.
  41. Gegauff AG, Pryor HG. Fracture toughness of provisional resins for fixed prosthodontics. J Prosthet Dent 1987;58(1):23–29. DOI: 10.1016/s0022-3913(87)80137-3
  42. Wu W, Toth EE, Moffa JF, et al. Materials science subsurface damage layer of in vivo worn dental composite restorations. J Dent Res 1984;63(5):675–680. DOI: 10.1177/00220345840630051401
  43. Fathian M, Kennedy DB, Nouri RM, et al. Laboratory-made space maintainers: a 7-year retrospective study from private pediatric dental practice. Pediatric Dent 2007;29(6):500–506.
  44. Sasa IS, Hasan AA, Qudeimat MA. Longevity of band and loop space maintainers using glass ionomer cement: a prospective study. Eur Arch Paediatr Dent 2009;10(1):6–10. DOI: 10.1007/BF03262659
  45. Johnsen DC. Space observation following loss of the mandibular first primary molars in mixed dentition. ASDC j Dent Child 1980;47(1):24–27.
  46. Croll TP. Prevention of gingival submergence of fixed unilateral space maintainers. ASDC j Dent Child 1982;49(1):48–51.
  47. Rathnam A, Madan N, Madan N. The language of pain: A short study. Contemp Clin Dent 2010;1(3):142–145. DOI: 10.4103/0976-237X.72778
  48. Hojat M, Louis DZ, Maxwell K, et al. A brief instrument to measure patients’ overall satisfaction with primary care physicians. Fam Med 2011;43(6):412–417.
  49. Brill WA. The distal shoe space maintainer: chairside fabrication and clinical performance. Pediatr Dent 2002;24(6):561–565.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.