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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Maintwiner Dent Care 1: 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. 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.

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

dpace To avoid these problems and reduce the need for prolonged orthodontic treatment, space maintainer should be advised. Conclusion The modified distal shoe appliance is time efficient, more stable, better accepted by the child and meets all the criteria for proper space maintainer. In the present case reported here, there was a premature eruption of right first and second premolars prior to the eruption of right permanent first molar.

Modified distal shoe appliance, Premature loss of multiple deciduous molars. National Center for Biotechnology InformationU. Can’t read the image?

Space Maintainers & Regaining

However poor retention and patient compliance are the major drawbacks with this appliance [ 6 ]. For this a regular follow-up should be stressed after placement of space maintainer. 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.


Especially primary molars are very important in development of occlusion and guidance for the eruption of permanent molar. Case Report A 4. 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 [ 911 ]. Photograph after restoration of central incisors.

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Space Maintainers: Types Of Space Maintainers

In the present case, the right maintainef and second premolars showed hardly any root development showing signs of complete stoppage of root development. All the permanent incisors, first molars, maxillary first premolars and mandibular right second premolar were erupted. Visit for more related articles at Neonatal and Pediatric Medicine.

J Clin Pediatr Dent. Treatment planning for the distal shoe space maintainer. Photograph showing fracture of both maxillary central incisors. J Am Dent Assoc. The erupted lower right first and second premolar were hypoplastic with brownish discoloration of enamel, severe pitting and irregularities of crown and hardly showed any root development. Apart from the eruption disturbance, other abnormalities that may rise from periapical lesions associated with primary dentition include enamel hypoplasia, Turners Hypoplasia ; displacement and rotation of the tooth, partial or complete stoppage of root growth of the succeeding permanent tooth.

The distal shoe space maintainer remains an acceptable standard of care, with an extension subgingivally to a location mesial to the unerupted first permanent molar [ 5 ]. The patient had not visited the dentist for a long period of time and so the distal shoe space maintainer was still present even after eruption of permanent first molar.


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 ].

Prasanna Kumar Bhat1 Navin H. Select your language of spacce to view the total content in your interested language. It was then decided to remove the modified distal shoe appliance and the patient was closely monitored during the recall visits.

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

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. No treatment was currently advised for enamel hypoplasia and the patient is under regular follow up for future treatment.

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

Conventional design poses a variety of problems in cases of multiple loss of lower primary molars prior to eruption of first permanent molar. Find articles by Niharika Rai. This patient does not had any such problem and so distal shoe space maintainer was given after extraction of left mandibular second primary molar at the distwl of five years.