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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However it appeared that intragingival extension of distal shoe appliance was obstructing the eruption of mandibular second premolar Figure 3.

Space Maintainers & Regaining

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. Photograph after eruption of premolars.

One such appliance was presented by Willett called distal shoe space maintainer with distal extension which goes intra-gingivally to guide the eruption of permanent first molar [ 10 ].

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.

The distal shoe space maintainer chairside fabrication and clinical performance.

Holding space to allow the teeth to erupt and to prevent impactions is valuable [ 2 ]. Guidelines Upcoming Special Issues. Photograph showing distal shoe on the left and erupting second premolar on the right. Failure of the tooth germ to develop as a sequelae to periapical or inter-radicular infection of the primary tooth is uncommon but has been reported [ 10 ].


Pulp therapy was carried out on lower left primary first and second molars and upper left primary first molar,followed spafe stainless steel crown. Developmental arrest of permanent tooth germs following pulpal infection of deciduous teeth. Thus, a short term modified bilateral design of the dista shoe appliance was planned whose duration of use was subjected to closely watched eruption of permanent mandibular incisors both radiographically and clinically.

Intraoral periapical radiograph showing modified dhoe shoe ten months after insertion. The distal shoe space maintainer remains an acceptable standard of care, with an extension subgingivally ddistal a location mesial to the unerupted first permanent molar [ 5 ]. Select your language of interest to view the total content in your interested language. Treatment planning for the distal shoe space maintainer. Find articles by Niharika Rai. For this a regular follow-up should be stressed after placement of space maintainer.

The present case showed hypoplastic crown with brownish discoloration of maintainsr, severe pitting and irregularities of crown in relation to right second premolar.

Modification of distal shoe space maintainer was advocated because of inadequate maijtainer caused due to multiple loss of deciduous molars on right side. Thus the modified distal shoe appliance was removed before the eruption of right permanent first molar.

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

Dental caries is one of the most common reason for the premature loss of primary teeth [ 1 ]. 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.

Other contraindications includes blood dyscrasias, juvenile diabetes, low resistance to infection, congenital heart disease, history of rheumatic fever and generalized debilitation [ 79 ]. Thus, it is required to modify the conventional designs according to the needs of the patient.


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. In the present case, the right first and second premolars showed hardly any root development showing signs of complete stoppage of root development. Agri and Aquaculture Journals Dr. This was due to the lack of regular radiographic examination and follow-up.

J Clin Pediatr Dent. Eur Arch Pediatr Dent. Photograph showing fracture of both maxillary central incisors. But this type of design has certain disadvantages such as non-functional, difficulty in fabrication and cannot be given in uncooperative patients [ 7 ].

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.

However, further clinical studies are needed to establish its feasibility and usefulness in paediatric dentistry. This patient does not had any such problem and so distal shoe space maintainer was given after spzce of left mandibular second primary molar at the age of five years.

Find articles by Pradeep Christopher. Dent Clin N Amer. However poor retention and patient compliance are the major drawbacks with this appliance [ 6 ].

So whenever restoration in primary molar is not possible and extraction is the choice, there is always a risk of losing space resulting in malocclusion.