Total views : 444

The use of Distal Shoe Space Maintainer in Pediatric Dentistry; A Systematic Review


  • Pediatric Dentistry Department, Cairo University, Egypt
  • Dental Biomaterial Department, Ain Shams University,, Egypt


Objectives: Early loss of a second deciduous molar before the eruption of first permanent molar can lead to space deficiency in the dental arch. The Distal Shoe Space Maintainer (DSSM) is indicated in such situation to avoid space loss. We sought to assess the efficacy and safety of this appliance. Methods/Statistical Analysis: We performed a comprehensive search on PUBMED, Cochrane libraries, LILACS and EMBASE. Our primary outcome measure was the effectiveness of space maintenance. Other outcome measures were the gingival response and patient’s tolerance to DSSM. We also assessed the design and quality of each study. Findings: Six articles which met our inclusion criteria were analyzed. Insufficient information was given in the studies regarding the efficacy in space maintenance or gingival response to the DSSM. The appliance was well tolerated by patients in 4 studies. Application/Improvement: Neither the efficacy of DSSM nor the gingival response to it has been investigated in the available studies. There is evidence that patients tolerate the DSSM well.The studies were shown to be of poor design and quality.


Distal Shoe Space Maintainer, Space Management Malocclusion.

Full Text:

 |  (PDF views: 517)


  • An SY, Shim YS, Park SY. Aesthetic rehabilitation in maxillary anterior tooth with early childhood caries using ZIRKIZ® Crown: Long-term follow-up. Indian Journal of Science and Technology. 2015 Oct; 1-5.
  • Kupietzky A. Clinical technique: Removable appliance therapy for space maintenance following early loss of primary molars. European Archives of Paediatric Dentistry.2007; 8(1):30-4.
  • Pinkham JR, Casamassimo PS, Tigue MDJ, Fields HW, Nowak AJ. Pediatric dentistry: Infancy through adolescence.Elsevier Saunders. 2005; 63146.
  • Dean JA, Avery DR, Donald MRE. Dentistry for the child and adolescent. Riverport Lane. 2016; 3251.
  • Cochrane Handbook for Systematic Reviews of Interventions.2014. Available from:
  • Gegenheimer R, Donly KJ. Distal shoe: A cost-effective maintainer for primary second molars. Pediatric Dentistry.1992; 14(4):268-9.
  • Kirshenblatt S, Kulkarni GV. Complications of surgical extraction of ankylosed primary teeth and distal shoe space maintainers. Journal of Dentric Childist (Children ). 2011; 78(1):57-61.
  • Nouri MR, Kennedy DB. Optimal fit of chairside-fabricated distal shoe space maintainer. European Academy of Paediatric Dentistry. 2013;14(5):351-4.
  • Brill WA. The distal shoe space maintainer chairside fabrication and clinical performance. Pediatric Dentistry.2002; 24(6):561-5.
  • Bhat PK, Idris M, Christopher P, Rai N. Modified distal shoe appliance for premature loss of multiple deciduous molars: A case report. Journal of Clinical Diagnostic Research.2014; 8(8):43-5.
  • Agarwal R, Chaudhry K, Yeluri R, Singh C, Munshi AK. Alternative approach to management of early loss of second primary molar: A clinical case report. Journal of California Dental Association . 2014; 42(5):327-30.
  • Dhindsa A, Pandit IK. Modified Willet’s appliance for bilateral loss of multiple deciduous molars: A case report.Journal of Indian Social Pedodtric Prevention Dental. 2008; 26(3):132-5.
  • Gujjar KR, Indushekar KR, Amith HV, Sharma SL. Modified distal shoe appliance-fabrication and clinical performance.Journal of Dentric Childist. 2012; 79(3):185-8.
  • Dhull KS, Bhojraj N, Yadav S, Prabhakaran SD. Modified distal shoe appliance for the loss of a primary second molar: A case report. Quintessence Int. 2011; 42(10):829-33.


  • There are currently no refbacks.

Creative Commons License
This work is licensed under a Creative Commons Attribution 3.0 License.