Effect of treatment with dental space maintainers after the early extraction of the second primary molar: a systematic review

BACKGROUND: Early loss of second primary molars may lead to different malocclusions, mainly caused by the mesial migration of the first permanent molar. To prevent space loss in the dental arch, different types of space maintainers (SM) are used. OBJECTIVES: The main objective of this systematic review is to examine the evidence in the literature regarding the effect of SM, including the clinical effect, risk of developing caries and periodontal disease, patient satisfaction, and cost-effectiveness after the premature loss of the second primary molar in children. SEARCH METHODS: The present systematic review was made according to PRISMA. The literature search was performed using four databases (last search 30/8/2022): PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, and Web of Science. SELECTION CRITERIA: The studies included were randomized controlled trials, economic evaluations, and non-randomized clinical studies with a defined control group. DATA COLLECTION AND ANALYSIS: Data collected by the two authors were in regard to reports, studies, participants, research designs, and interventions. The assessment of the risk of bias was made using the ROBINSON-I tool. RESULTS: The search yielded 1058 articles after the removal of duplicates. Two studies were included in the final review with a moderate risk of bias, and measured space changes in the dental arch and the periodontal status of patients treated with SM. The main results indicate that treatment with SM can preserve arch length, but also cause an increase in plaque accumulation and other periodontal parameters. However, there is an overall lack of scientific evidence regarding the effect of the treatment. LIMITATIONS: No studies that fulfilled the eligibility criteria were found on cost-effectiveness, risk of caries development, and patient satisfaction. CONCLUSIONS: The scientific evidence is lacking regarding the clinical effect, cost effect, and side-effects such as caries and periodontal disease when using SM in children with a premature loss of the second primary molar. REGISTRATION: PROSPERO Registration (CRD 42021290130).