Space Maintenance — ORE Part 1 MCQ

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ModeratePaediatric DentistrySpace MaintenanceORE Part 1

A 9-year-old has had a mandibular first permanent molar extracted. Following radiographic and orthodontic assessment, the treatment plan is to preserve mandibular arch length until definitive orthodontic treatment. Which space-maintaining appliance is most appropriate?

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Correct answer: E — Fixed lower lingual arch

The correct answer is **C. Fixed lower lingual arch**. The stated objective is preservation of mandibular arch length after loss of a lower first permanent molar. A lower lingual arch is a bilateral fixed appliance designed for the mandibular arch and can limit mesial movement of the posterior teeth while orthodontic management is planned. Extraction of a first permanent molar in a child requires orthodontic assessment: SDCEP notes that timing and second-molar development may permit eruption into the first-molar space, so a space maintainer should not be selected routinely without that assessment. Here, preservation has expressly been planned. A band-and-loop appliance is principally used for a local space after premature loss of a primary molar. Nance and transpalatal arches are maxillary appliances. A removable partial denture is not the usual fixed orthodontic method for maintaining lower arch length in this setting.

Reference: Scottish Dental Clinical Effectiveness Programme. Prevention and Management of Dental Caries in Children: Guidance in Brief, 3rd edition, section “Caries management in permanent teeth”, 2024. https://www.childcaries.sdcep.org.uk/media/5p4fv1sf/sdcep-prevention-and-management-of-dental-caries-in-children-3rd-edition-guidance-in-brief.pdf