Space maintainers are essential in pediatric dentistry because they help preserve the correct spacing among the dental arch resulting from the premature loss of primary teeth, thereby avoiding unwanted dental movements and misalignments. The importance of space maintainers becomes apparent when they prevent malocclusions and orthodontic issues that might occur due to premature loss of primary teeth. This preventive strategy is especially important during the transitional period between primary and permanent dentition as it lays the foundation for appropriate occlusion and alignment22.
Recent advancements in space maintenance technology, like as the use of 3D printing, have rendered previous approaches obsolete. 3D printing creates accurate and patient-specific equipment, allowing for bespoke solutions for particular dental problems while also improving accuracy and efficiency. This technological integration is consistent with the larger trend of digital dentistry, which involves the use of digital impressions and computer-aided design (CAD) for precise mapping of the oral environment, resulting in highly personalized space maintainers that not only improve effectiveness but also promote patient comfort and acceptance23.
Furthermore, the recent incorporation of advanced materials in 3D printing for space maintainers, such as biocompatible and durable resins, contributes to the evolution of dental interventions. Those advancements address limitations associated with traditional materials and ensure improved strength and longevity. They represent a progressive shift toward more customized, precise, and technologically advanced approaches to space maintenance in pediatric dentistry, ultimately improving the standard of care and treatment outcomes for young patients during critical periods of dental development15,16,23,24.
The therapeutic efficacy and survival time of several forms of space maintainers (SMs) have been investigated by researchers. SMs have a broad range of effectiveness rates, ranging from 92 to 27%, according to previous studies25,26,27. The effectiveness of 3D-BLSM has not been widely studied. Band and loop SMs (BL SMs) are often used for conserving space after early loss of primary teeth due to their historically high success rates over long durations18,27,28. As a result, the current findings shed light on the comparison between C-BLSM and the most contemporary 3D-BLSM, evaluating its clinical performance and influence on oral hygiene.
The success rate of C-BLSM was determined to be 92% as Tahririan et al.25 reported in their study. Other trials found similar success rates, such as 90%27, 86.7%26, and 84.6%29. In a long-term investigation, Sasa et al.30, observed a much lower success rate of 42.5%. The survival rate for C-BLSM in the current study at the end of the 9-month evaluation was 51.6%.
In the current study, significant variations are put forward over time when contrasting C-BLSM to 3D-BLSM. While the 3-month survival rates from both types of maintainers were comparable (87.1% for 3D-BLSM vs. 67.7% for C-BLSM). The evaluations indicated considerably higher survival rates for 3D-BLSM (83.9% after 6 months and 77.4% after 9 months) compared to C-BLSM (54.8% after 6 months and 51.6% after 9 months). These findings indicate 3D-BLSM’s greater long-term durability in retaining space within the dental arch as compared to regular C-BLSM. The survival rate of space maintainers is critical since it is directly related to the efficacy and success of the execution31.
The substantially increased survival rate observed among 3D-BLSM in our study can be credited to 3D printing technology’s distinct benefits. 3D printing’s personalization enables exact adaptation to unique patient anatomy, potentially minimizing soft tissue pain and interference with adjoining teeth. Furthermore, 3D printing material properties like as enhanced durability and biocompatibility eventually result in a stronger device that is less susceptible to fractures. The fabrication precision of 3D printing may result in less plaque retention on smoother surfaces, minimizing the risk of dental cavities and gingival discomfort. Patient-specific design components, made feasible by 3D printing, improve appliance operation, and sophisticated layer-by-layer production procedures lead to a structurally better device. Furthermore, the better biocompatibility of 3D printing materials encourages a more favorable tissue response, minimizing the risk of soft tissue irritation and boosting overall patient comfort and acceptance32,33,34,35.
The current research findings have important therapeutic significance in pediatric dentistry, providing insight into the effectiveness of conventional band and loop space maintainers in comparison to their 3D-printed equivalents. Dentists may now customize treatment plans based on patient-specific criteria, taking into account the benefits and downsides of each type of space maintainer. This evidence-based decision-making is critical for selecting a space maintainer after the loss of primary teeth, thereby improving patient care quality. Furthermore, the study’s examination of patient comfort and acceptability associated with both traditional and 3D-printed space maintainers emphasizes the importance of a patient-centered approach in treatment planning to inquire about the incorporation of innovative technologies into clinical practice.
Because meticulous clinical trials on 3D-BLSM have not yet been conducted, a direct comparison of the success rates identified in our investigation with the available literature is not possible. Particularly, Pawar18 provided the first academic paper on this kind of SM as a case report on a 7-year-old kid with no detected constraints during clinical observations at the 3-month follow-up. Following the case report by Khanna et al.19, additional short-term follow-ups were provided to attend justifiable results. Considering the least number of literature on the effectiveness and long-term efficacy of 3D-BLSM, more extensive clinical studies are required.
In our study, a substantial difference in the impact of SMs on oral hygiene was observed between the two groups. Importantly, regardless of the type of fixed SM, our data revealed a rise in the abutment tooth’s gingival index (GI) values, consistent with the findings of Arikan et al.36 who discovered that GI levels increased considerably in the first and third months when compared to original data. Similarly, Hosseinipour et al.’s37 study on the influence of fixed SMs on oral hygiene showed a significant increase in GI scores after six months of treatment. Contrastly, our study found that patients’ general GI scores decreased, possibly due to the Hawthorne effect38, in which participants adjust their behavior when they are aware that they are being watched. Oral hygiene stimulus during control check-ups, using plaque-revealing technologies, can be employed to offset negative impacts on the periodontal health of abutment teeth39.
Remarkably, based on the Likert-scale responses, a change in patient opinion was found at the 6-month follow-up. In contrast, the 3D BLSM group showed a statistically significant increase (29%) in “agree” responses, but the C-BLSM group showed a statistically significant rise (14.50%) in “strongly disagree” responses. This discrepancy suggests a brief decline in C-BLSM satisfaction at this intermediate stage which needs to be further investigated. Interestingly, after nine months, this difference disappeared, supporting the results of Rana et al., while results during this period indicated that both modalities provide similar long-term happiness. The 3D BLSM’s ability to provide a respectable substitute for the well-established C-BLSM approach is intriguing11.
The current findings can help dentists customize treatments based on patient preferences to improve treatment compliance and outcomes. In resource-constrained environments, decision-making should be guided by an assessment of the economic consequences of traditional and 3D-printed space maintainers. Education programs need to be promoted to practitioners to integrate innovative technology such as 3D printing in dentistry. Furthermore, the current findings help long-term treatment planning in pediatric dentistry, allowing for methods that can result in both well-performed immediate and long-term outcomes.
This current study promotes interdisciplinary teamwork, especially among patients who have several oral problems. It emphasizes the importance of evidence-based, patient-centered decision-making in enhancing the quality of treatment for young children who have lost their primary teeth. While the study’s hypotheses are consistent with the observed results, further research, particularly the biomechanical one, is required to completely understand the underlying processes from the improved survival rate of 3D-BLSM revealed in our study.
This current study had a potentially limited sample size, which impacts generalizability and thus needs bigger and more varied cohorts in future research. The lack of biomechanical evaluations indicates the need for further investigation of mechanical variables that influence device performance. Variations in operator expertise in manufacture and placement might add confounding effects, prompting attention in future studies. Moreover, longitudinal studies in pediatric dentistry should be conducted in the future to determine the long-term efficacy and survival rates of 3D-printed space maintainers. Biomechanical studies that investigate structural characteristics and forces involved can provide insights into device performance. Comparative studies with a larger and more varied patient population will improve external validity, and investigating patient-reported outcomes like comfort and satisfaction will lead to a more comprehensive knowledge of the space maintainer’s function. Furthermore, healthcare decision-makers and practitioners must investigate the cost-effectiveness and economic consequences of both types of space maintainers.
Besides sample size, this study does not address the variability of operator experience in production and placement, which may affect aspects like as comfort and fit. Therefore, a more diversified cohort is necessary for thorough insights. Limitations found in this study are expected to be addressed in future research.
