Background: In pediatric dentistry, multiple dental caries, trauma, and congenital anomalies often necessitate prosthetic rehabilitation. A removable space maintainer (RSM) is the only device capable of providing both proximal and vertical retention, serving as an effective prosthetic and functional solution. Advances in digital technology have established computer-aided design/computer-aided manufacturing (CAD-CAM) systems as reliable tools in pediatric dental treatment; however, their application in the fabrication of RSMs and pediatric dentures remains limited. Cases: We describe the cases of two pediatric patients in which RSMs were fabricated using subtractive manufacturing via a CAD-CAM system. The first patient was a boy with partial edentulous mandibular anterior teeth, whereas the other patient was a girl with a missing maxillary right lateral central incisor due to trauma. In both patients, the RSMs were successfully placed without requiring intraoral adjustments, and an excellent fit was achieved. Conclusions: The use of subtractive manufacturing for RSM fabrication offers several advantages, including clinical fit, efficiency, visualization, and esthetics. Nonetheless, further technical refinements are required to enhance fit accuracy.
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