Modification of Distal Shoe- A Systematic Review & Meta Analysis

Abstract

Introduction: In the pediatric patients the premature loss of second primary molar will culminate in malocclusion of the permanent teeth by the space loss.  This space has to be guarded with the help of the appliance that can prevent the permanent first molar from migration into the free space.  The Distal Shoe Space Maintainer is indicated in such situation to avoid space loss. But there may be situations that will require some modifications in the conventional design. Hence in our study we intend to review the various modifications in the Distal Shoe Space Maintainer and their functional implications. 

Materials and Methods: We conducted the search for the data from the online sources like the “EMBASE”, “Pubmed”, “Scopus” and other sources. The articles for the past 20 years were searched for the parameters Distal Shoe Space Maintainer, modified Distal Shoe Space Maintainer, space maintainers, space loss.  The primary outcome variable was the effectiveness of the modified distal shoe space for the space maintenance after the eruption of lower first permanent molar in the oral cavity. The gingival responses and patient compliance were taken as the secondary outcomes. The data extraction was based on the PICOS guidelines. We also assessed the quality of the study using the quality assessment score.

Results: Out of the 27 articles only 6 articles were finalized. Inadequate data is available from these 6 articles. The efficiency of these modifications, gingival responses were inconclusive.  Three studies only stated the patient compliance.

Conclusion: The success of the distal shoe and its gingival response is inconclusive. There were many clinical aspects that were not thoroughly described in the studies about these modifications. We can propose that further well designed studies be conducted to establish the performance of these modifications in the distal shoe and help clinicians with its application.