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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September 19, ; Accepted Date: October 20, ; Published Date: Pediatr Dent Care 1: This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Visit for more related articles at Neonatal and Pediatric Medicine. Primary dentition plays a vital role in developing speech, mastication, aesthetic, prevention of bad oral habits and eruption of permanent teeth [1,2]. Especially primary molars are very important in development of occlusion and guidance for the eruption of permanent molar.
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. 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.
Primary dentition plays a vital role in developing speech, mastication, aesthetic, prevention of bad oral habits and eruption of permanent teeth [ 12 ]. 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 [ 2 – 5 ]. To avoid these problems and reduce distaal need for prolonged orthodontic treatment, space maintainer should be advised.
Various treatment options have been suggested in case of premature loss of second primary molar before eruption of first permanent molar [ maintianer9 ]. 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 ].
The purpose of this case report was to present a side effect in a case of maintainsr distal shoe space maintainer which was placed in a child and not followed regularly.
A 10 year female child reported to the dental department with the chief complaint of pain maintziner the upper front teeth. On intraoral examination it was found that both upper central incisors were fractured Figure 1. All the permanent incisors, first molars, maxillary first premolars and mandibular right second premolar were erupted.
Whereas, distal shoe space maintainer was present on the mandibular left side Figure 2. The history as reported by the parents revealed that fracture of teeth occurred few days back while playing.
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. Didtal it appeared that intragingival extension of distal shoe appliance was obstructing the eruption of mandibular second premolar Figure 3. Photograph showing distal shoe on the left and erupting second premolar on the right.
Modified Distal Shoe Appliance for Premature Loss of Multiple Deciduous Molars: A Case Report
Radiograph showing obstruction of second premolar from eruption by the intra-alveolar extension. 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.
Extraction and removal of distal shoe space maintainer was done under local anaesthesia lidocaine with adrenaline 1: In the maxillary central incisors pulp treatment were done followed by composite build-up in maxillary right central incisor and fragment reattachment in maxillary left central incisor Figure 4. Periodic recall appointment was advised to monitor the eruption of mandibular left second premolar.
It was found that after a follow-up of one year eight months left mandibular second premolar had erupted Figure 5.
The distal shoe space maintainer chairside fabrication and clinical performance.
Distal shoe space maintainer maintains the space for the eruption of second premolar and at the same time guide the eruption of wpace first molar. It consists of crown and an intra-alveolar distal extension which guide the eruption of permanent first molar. Other contraindications includes blood dyscrasias, juvenile diabetes, low resistance to infection, congenital heart disease, history of rheumatic fever and generalized debilitation [ 79 ].
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 age of five years. 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 ]. Also gingival extension of the distal shoe may damage the developing tooth bud, which may cause displacement of tooth [ 12 ].
Another disadvantage of this appliance is that, the gingival tissue around the intra-alveolar extension never becomes distaal lined with epithelium, thus maintaining an open wound in the oral cavity [ 13 ]. Also there is evidence of an associated chronic inflammatory response [ 13 ]. But in this patient no clinical problem was evident even after having the appliance for such a long period.
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.
Patient and the parents were completely unaware msintainer the problem caused by the appliance on the eruption of succedaneous second premolar. 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. Probably to the best of our knowledge this is the first report in which the adverse effect of distal shoe space maintainer on the eruption of succedaneous second premolar spxce highlighted.
This was shke to the lack of regular radiographic examination and follow-up. After removal of the space maintainer, patient was regularly followed and it was found that on this side second premolar had completely erupted after one year eight months, although on the contralateral side it was present when first time patient reported to us. Distal shoe space maintainer is advised in case of early loss of second primary molar before eruption of first permanent molar. This appliance should be changed with band and loop space maintainer after eruption of permanent first molar to avoid any adverse effect on the second premolar, as seen in this case.
For this a regular follow-up should be stressed after placement of space maintainer. Ann Jose ankara disal. Please leave a message, we will get back you shortly. Home Publications Conferences Register Contact. Guidelines Upcoming Special Issues. Case Report Shof Access. Unsupervised Distal Shoe Appliance: Distl 28, Citation: Photograph showing fracture of both maxillary central incisors.
Photograph after restoration of central incisors. Photograph after eruption of premolars. Select your language of interest to view the total content in your interested language. Can’t read the image?
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