Space maintenance controversies in pediatric dentistry—a scoping review

Space maintainers (SMs) serve as a key component in interceptive orthodontics, helping to avoid the need for more invasive treatments later on. This scoping review aims to assess the necessity and the controversy of using space maintainers, by comparing and analysing the dental and occlusion outcomes of children who received SMs with those who did not receive any treatment following the early loss of primary teeth. Databases such as PubMed, Science Direct, Wiley and ProQuest were examined using the PCC framework (Population, Concept, Context), following specific eligibility criteria. Titles and abstracts were screened, and full-text articles were critically assessed followed by the construction of the data charting table. A total of 901 were screened, and 17 relevant articles were included. The findings suggested that SMs could be effective in maintaining arch integrity and preventing future malocclusions. However, the literature revealed several key gaps and controversies in the use of SMs, particularly in terms of long-term effectiveness, patient compliance, cost and the occurrence of potential complications. The findings of this review seem to be helpful for clinicians in deciding when the SM is necessary versus when the natural closure is expected; also in optimising patient outcomes and reducing unnecessary treatments by incorporating these findings into their practice making more educated individualized treatment decisions, and using a risk-based strategy; as well as in improving parental counselling and patient education, which help increase compliance, especially when it comes to removable appliances. However, the disparities in study designs, inadequate long-term data and unclear therapeutic guidelines might complicate evidence-based decision-making. To address these gaps, the focus on longitudinal, standardized clinical trials that assess the true efficacy of SMs over time, studies that compare the effectiveness of fixed versus removable SMs, and patient compliance variables are recommended for future research.