Abstract
This review aims to present updated evidence on different modifications of distal shoe space maintainers, which will aid in optimizing patient outcomes and standardizing procedures. Distal shoe space maintainer therapy is needed to prevent space loss and guide the eruption of the permanent first molar when the primary second molar is lost prematurely before the eruption of the permanent first molar. Studies assessing the efficacy of different distal shoe space maintainer adjustments in children with mixed dentition were found through a thorough search of electronic databases. Data extraction and screening were carried out by two separate reviewers. Nine case reports evaluating nine children in the mixed dentition phase, ages three to six, were included in the qualitative synthesis. In cases of bilateral primary molar loss, the distal shoe space maintainer, an effective tool for both preventive and interceptive treatment, is a reliable way to keep space. This review will provide clinicians with an essential, evidence-based resource to optimize distal shoe therapy, leading to better long-term oral health for children. In pediatric dentistry, ensuring effective treatment with minimal discomfort is essential for patient cooperation and efficient care. The distal shoe space maintainer supports this goal by guiding proper eruption of permanent teeth, especially after premature loss of primary molars. It plays a key role in preserving arch length and preventing future malocclusion, aligning with preventive and interceptive orthodontic principles.