Modified Distal Shoe Appliance for Bilateral Early Loss of Primary Molars: Report of Four Cases

Introduction: Space maintenance in primary dentition in patients with early loss of several primary molars is a clinical challenge for pedodontists. In these cases, the conventional distal shoe appliance cannot be used and the efficacy of removable appliances is questionable. Thus, appliances with special designs providing increased patient acceptance and optimal efficacy are required in these cases. Case Reports: In this article, we report the successful use of modified distal shoe appliance in a number of patients who suffered from a bilateral early loss of primary molars. In this design, a fixed bilateral appliance was fabricated and incorporated with a distal extension of a conventional distal shoe appliance. A removable appliance was replaced the modified distal shoe appliance as soon as the first permanent molars erupt. Conclusion: The use of a modified distal shoe appliance seems to be a good choice for space maintenance in patients with bilateral loss of primary molars.