Some researchers have contested the indiscriminant use of space maintainers and suggested that tooth migration to the space left by the extraction depends on factors such as whether the tooth was lost or extracted, whether the extracted tooth was a first or second deciduous molar, the dental arch involved, the formation stage of the permanent successor, the occlusal relationship of the permanent molars, and the tooth eruption sequence in the patient. Our article discussed the needs of a rigorous assessment of whether it is really necessary to use a space maintainer in patients with premature loss of deciduous molars to avoid overtreatment.

The follow-up period was discussed as 1 difficulty of the study. Over the months of the study, the children began to lose other teeth. Such tooth loss could result in changes in physiologic and occlusal status, leading to a sample diversity that would hinder the evaluation of the results. Others articles also offer a discerning sample selection. Obtaining scientific evidence for this specific area is complex and laborious, because of difficulties in composing the sample. The conclusions are suggestions to guide clinical practice but do not preclude a rigorous routine follow-up of children with malocclusions and the premature loss of primary molars.

The literature has confirmed that severe malocclusion and the loss of several teeth have severe consequences for the function of the stomatognathic system. In such cases, patients can undergo rehabilitation and orthodontic or orthopedic treatment rather than merely space maintenance therapy, which was not the object of our study.

Patients with malocclusion and bilateral tooth loss can receive an indication for the maintenance of arch perimeter and, consequently, the need for space maintainers. Our study was limited to the investigation of conditions related to unilateral tooth loss, with the contralateral hemi-arch as the control, allowing the same physiologic status for both sides and the probability of comparing the 2 hemi-perimeters in the same arch with no modifying agents.