An intra alveolar type of space maintainer also known as willets distal shoe was given. A 12 month follow up was taken. Conclusion: In. Space maintainers are appliances used to maintain space or regain .. The only treatment alternative to the distal shoe space maintainer is a. Distal shoe space maintainer is a valuable part of the Paediatric Dentist’s armamentarium in those cases where the second primary molar is.

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The space maintainer was maintqiner by the child and his parents and was optimistic for the future of his dentition. Unfortunately patient did not turn up for follow up treatment and reported back to the department six months later with a swelling in the lower right back teeth region. Unsupervised Distal Shoe Appliance: The history as reported by the parents revealed that fracture of teeth occurred few days back while playing. The wire components were soldered to bands on both the sides.

Please review our privacy policy. This article has been cited by other articles in PMC. However, further clinical studies are needed to establish its feasibility and usefulness in paediatric dentistry. Guidelines Upcoming Special Issues. The vertical depth of intra-alveolar projection was calculated radiographically, and a cut was made in the cast and wire components were adapted using gauge wire.

Author information Maiintainer notes Copyright and License information Disclaimer. Preservation of the primary dentition until the normal time of exfoliation is one of the most important factor involved in preventive and interceptive dentistry.

Bilateral design of distal shoe was planned for unilateral loss of deciduous molars. So it is distaal to modify dustal conventional designs for comfort, co-operation and success in different paediatric patients [ 3 ]. An erupting tooth adjacent toan edentulous area has a greater potential for space loss than fully erupted ones, indicating that clinical slace should be considered [ 3 ].

Thus, it is required to modify the conventional designs according to the needs of the patient. Select your language of interest to view the total content in your interested language. This appliance is difficult to place into proper position passively contracting the mesial surface of the erupting permanent first molar while extending only 1mm below the mesial marginal ridge [ 9 disatl, 11 ].


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The primary second molar served as a guide on the working model for calculating the horizontal length of distal extension. Also there is evidence of an associated chronic inflammatory response [ 13 ].

Unsupervised Distal Shoe Appliance: A Case Report | OMICS International

The recall visits were planned after every two months to check the condition of the modified distal shoe appliance, supporting teeth and status of eruption of lower incisors. Agri and Aquaculture Journals Dr. Pediatr Dent Care 1: Primary dentition plays a vital role in developing speech, mastication, aesthetic, prevention of bad oral habits and eruption of permanent teeth [ 12 ].

Thus, a short term modified bilateral design of the distal shoe appliance was planned whose duration of use was subjected to closely watched eruption of permanent mandibular incisors both radiographically and clinically. Support Center Support Center. Arrested development of a permanent tooth. Case Report Open Access. The purpose of this case report was to present a side effect in a case of unsupervised distal shoe space maintainer which was placed in a child and not followed regularly. Other adverse effects of pre-mature extraction of primary molar are mesial migration of first permanent molar, increased overbite, increased crowding, impaction, occlusal impairment, arch asymmetry and disruption of eruption sequence.

Modified mmaintainer shoe appliance for the loss of a primary second molar: As there was premature eruption of right first and second premolar prior to the eruption of right first permanent molar and the first permanent molar showed signs of eruption, the modified distal shoe appliance was removed before the eruption of right first permanent molar.

Radiographic examination shows that the root of left mandibular first primary molar was completely resorbed and bone was not seen on the occlusal surface of both mandibular left premolars.

It was then decided to remove the modified distal shoe appliance and the patient was closely monitored during the recall visits.


Various treatment options have been suggested in case of premature loss of second primary molar before eruption of first permanent molar [ 89 ]. Intraoral periapical radiograph showing modified distal shoe ten months after insertion. Case Report A 4. Modification of distal shoe space maintainer was advocated because of inadequate abutments caused due to multiple loss of deciduous molars on right side. Find articles by Prasanna Kumar Bhat. Primary dentition plays a vital role in developing speech, mastication, aesthetic, prevention of bad oral habits and eruption of permanent teeth [1,2].

Considering the age of the child, position and developmental stage of both mandibular left premolars, it was decided to remove mandibular left first primary molar along with distal shoe appliance. Intraoral periapical radiograph showing modified distal shoe immediately after insertion. Band adaptations were made on lower left second deciduous molar and lower right deciduous canine. Eur Arch Pediatr Dent. As it is a bilateral appliance it is possible for it to create hindrance in the path of eruption of permanent mandibular incisors.

J Clin Pediatr Dent. To avoid these problems and reduce the need for prolonged orthodontic treatment, space maintainer should be advised. In the present case, the right first and second premolars showed hardly any root development showing signs of complete stoppage of root development.

Modified Distal Shoe Appliance for Premature Loss of Multiple Deciduous Molars: A Case Report

It consists of crown and an intra-alveolar distal extension which guide the eruption of permanent first molar. Due to lack of regular follow-up, in this case, space maintainer remained for the longer time in the mouth, causing hindrance in the eruption of second premolar from its intragingival extension.

Premature loss of the primary second molar prior to the eruption of the permanent first molar is often a challenging problem to the dentist in managing the developing dentition.