First of all, place the space maintainer in the mouth for a trial fit before you attempt cementation. It should fit like it does on the cast. Check to make sure that the wire of a band and loop space maintainer is in light contact with the tooth which is mesial to the edentulous space. With the wire in contact, you are sure tipping will not occur. In the case of a Nance Appliance, check to make sure that the acrylic button is in very gentle contact with the palatal tissue.

Also check for large voids or spaces between the band and the tooth. If any are present, carefully use an instrument to push (burnish) the band to the surface of the tooth. In some cases, this step can be accomplished on the cast.

Finally, make sure the child can occlude normally before you cement the space maintainer. It is a major interruption to be forced to remove a space maintainer after it has been cemented because it interferes with chewing.

In the case of unilateral space maintainers and children who have extremely vigorous gag reflexes, you will want to consider running floss through the wire loop so that the space maintainer cannot be swallowed. A unilateral space maintainer possibly could be lost down the throat of a gagging, choking child without the protection of the floss.