Lower Lingual Holding Appliance (LLHA) | Lower Space Maintainer Poway, CA

A space maintainer or a lingual holding arch is commonly used to maintain space for prematurely lost baby teeth. This prevents the permanent molars (adult teeth in the back) that grow in first from drifting forward and potentially blocking the eruption of the permanent teeth. Generally speaking, if the permanent tooth is not expected to erupt (grow in) within the 6 months following the loss of the baby tooth, space maintenance is necessary.

The appliance can also be used for treatment of minor crowding of the lower front teeth. The idea is to place the space maintainer prior to the loss of baby molars. Usually, when primary teeth are lost, nearly 2 mm of extra space per side is available due to the difference in size between a larger baby tooth and the smaller succeeding permanent tooth. If the space is not preserved, the permanent molars drift forward into the extra space and the front teeth remain crowded. By placing a space maintainer, the permanent molars cannot drift forward and instead, the crooked front teeth can drift back into the extra space, allowing them to somewhat straighten out spontaneously over time. This technique is only appropriate if there are no concerns for eruption of the second molars.

Initial placement

Lower lingual holding arch is custom designed for each individual patient, and as such, requires three different appointments for its installation:

  • The first appointment takes no longer than 5 minutes and can be done at the same time as the consultation appointment if desired. Separators or small rubber bands are placed between the lower back teeth. They are used to make space between those teeth and allow for the band fitting at the second appointment. It is important to avoid flossing the areas with the separators. As they begin to move, the back teeth will be sore for a few days.
  • The second appointment consists of a band fitting around the molar (back) teeth, and taking the mold of the lower dental arch. The mold is used to design and custom make the appliance for each individual patient.
  • The third appointment is the delivery appointment, meaning the space maintainer is ready to be cemented in the patient’s mouth. It is also time to educate the patient or parent on how to take care of the appliance.

Activations

Parents often confuse a space maintainer with an expander. Both appliances are commonly used in young patients but are not the same. A space maintainer is a passive appliance, keeping the space nature or treatment provided, whereas an expander is an active appliance, creating additional space when needed.

Being passive, a lower lingual holding arch does not need to be activated. However, the appliance needs to be checked periodically.

Hygiene

Patients are encouraged to clean the appliance with toothbrush and toothpaste, taking special care when brushing the bands.

Using a Waterpik may be helpful to rinse food particles that may get lodged between the wire connecting the bands and the teeth.

Helpful Tips

Cutting food into smaller pieces and avoiding sticky or hard food will help you eat more comfortably and avoid breakage of the appliance. Limit carbonated beverages (soda) as they have tendency to dissolve the cement holding the appliance in place and are more likely to cause dental cavities.

Have questions about lower lingual holding appliances in Poway, California? Reach out to Align Orthodontics at 858-487-0173. Schedule a visit with our orthodontist, Dr. Mirna Nguyen, today.