New Bilateral Rigid Extended Mandibular Distal Shoe Fixed Appliance for Space Maintenance of Premature Bilateral Loss of All Lower Posterior Primary Molars

It is about a new technique using bilateral rigid extended distal shoe space maintainer, indirectly prepared in the dental lab, with band support on both lower canines and lingual arch in-between for stability. A 5.4 years old female child was referred to Paediatric Dentistry Unit, for advanced behaviour management. Treatment plan included complete dental rehabilitation under GA, Orthodontic Band selection on lower primary canines and lower alginate impression were possibly made on the dental chair prior to GA. In the Dental Lab, the bilateral rigid extended distal shoe was prepared, later on, in the Operating Theatre and as final part of the procedure, the fixed appliance was inserted and cemented in place after extraction of all the lower posterior primary teeth and following radiographic confirmation. Clinical and Radiographic Monthly follow up of the case post-operatively, showed no complication and the patient adapted functionally well to the appliance till the bilateral eruption of the lower first permanent molars in place. This New Technique is feasible for both planned and unplanned loss of all primary posterior teeth bilaterally, and can be done for also the upper arch with some minor difference placement of the supporting wire palatally in-between the parallel bilateral distal extensions behind the canines (Orthodontic Bands or SSC with facial window) to avoid interference with the occlusion palatally.