Complications of lower arch space maintainers in pediatric patients: a retrospective study

Space maintainers, including band and loop (BLSM) and lower lingual holding arch (LLHA) designs, preserve arch integrity in children. This study aimed to compare the clinical complications, patient comfort, and compliance between BLSM and LLHA appliances in children aged 6–12 years. This retrospective cohort study included 88 space maintainers (44 BLSM and 44 LLHA). Dental records were reviewed to identify pediatric patients who had received space maintainers within the last two years. The identified patients were subsequently contacted and invited for a clinical examination to assess the current condition of the space maintainers and potential complications, including debonding, soft tissue irritation, delayed removal, appliance fracture, and dislodgment. A validated questionnaire was used to assess their experience with the appliance. Children with LLHA were older (10.2 ± 1.3 years) than those with BLSM (8.1 ± 2.1 years) (p < 0.001). Complications occurred in 45.5% of appliances and were associated with LLHA and BLSM at similar rates. Based on bivariate analysis, LLHA was more often associated with transient speech disturbances (45.5%) than BLSM (9.1%) (p < 0.05). Pain was more frequent in the LLHA group (p < 0.05). Based on adjusted logistic regression, children with LLHA were more likely to report pain in the last month preceding the clinical examination of this study (OR = 3.2; 95% CI: 0.6–18.5) than those with BLSM, although this difference was not statistically significant (p = 0.195). LLHA showed a significant association with increased speech interference in the first month post-insertion, with an odds ratio of 5.8 (95% CI: 1.6–20.6; p = 0.007), compared to the BLSM. Adaptation of pediatric patients to LLHA and BLSM improved progressively over time. Both appliances demonstrated similar rates of clinical complications. Patients with LLHA experienced greater early speech difficulties than those with BLSM did. By prioritizing patient-centered outcomes, this study offers valuable insights for clinical decision-making and lays the groundwork for future robust prospective studies.