A 10-year-old has a full complement of maxillary teeth; the right permanent canine is unerupted and the left permanent canine has just begun to emerge with only the cusp tip visible. What space maintenance is indicated?

Correct answer: B. No space maintainer is indicated

• A. A DISTAL SHOE guides the erupting first permanent molar when the second primary molar is lost BEFORE that molar erupts. It is entirely inapplicable at age 10 with permanent molars already in place.
• B. CORRECT. NO space maintainer is indicated. Space maintenance addresses PREMATURE LOSS of a primary tooth before its successor is ready to erupt. Here nothing has been lost prematurely — the arch is complete, and the canines are simply in the normal process of eruption, with maxillary canines typically emerging between ages 11 and 12. Slight asymmetry in eruption timing between contralateral teeth is a normal variation. The correct management is observation and periodic monitoring.
• C. A NANCE appliance maintains maxillary arch length bilaterally after posterior primary tooth loss, using an acrylic button against the anterior palate. There is no bilateral posterior space loss to maintain here.
• D. A BAND AND LOOP maintains the space of a single lost primary molar. No primary molar has been lost.

Note: Space maintainer selection: BAND AND LOOP — single primary molar lost, unilateral. NANCE or TRANSPALATAL ARCH — maxillary bilateral. LINGUAL ARCH — mandibular bilateral (only after permanent incisors erupt). DISTAL SHOE — second primary molar lost before the first permanent molar erupts. Do not place appliances for normal eruption variation — but DO monitor canine position by palpation.