Management of premature loss of primary maxillary first molar using crown and loop space maintainer in a 6-year-old patient: A case report

Premature loss of a primary molar due to extensive caries can reduce the available arch space for its permanent successor and predispose the child to future malocclusion. A fixed space maintainer is therefore indicated to preserve the space until the permanent tooth erupts. This report describes the management of an 8-year-old boy who presented with a deep carious lesion in the maxillary right first primary molar (tooth 54), with clinical and radiographic findings of pulp necrosis and furcation involvement together with root resorption of more than half the root length. Space analysis using the Moyers prediction method revealed an arch length deficiency of 2.4 mm in the maxilla, indicating the need for space maintenance. Tooth 54 was extracted under local infiltration anaesthesia, and a fixed crown and loop space maintainer was fabricated using a stainless steel crown cemented on tooth 55 with a soldered loop extending to the mesial surface of tooth 53. Treatment was completed over three visits: extraction and impression, crown try-in with impression for loop fabrication, and final cementation. At insertion, the appliance was stable, well retained, and did not interfere with occlusion. This case demonstrates that a crown and loop space maintainer is an effective, well-tolerated appliance for preserving arch space following premature loss of a primary molar in a paediatric patient.