{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T06:35:53Z","timestamp":1780641353711,"version":"3.54.1"},"reference-count":14,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2025,12,3]],"date-time":"2025-12-03T00:00:00Z","timestamp":1764720000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background: Premature loss of the second primary molars can result in arch space loss and later malocclusion. Distal shoe space maintainers (SMs) are used to guide the eruption of the permanent first molars, although their clinical effectiveness remains under-evaluated. Objective: We aimed to assess the clinical effectiveness and complication profile of distal shoe SMs in paediatric patients following premature loss of second primary molars. Methods: A PRISMA-compliant systematic review was conducted, with protocol registered in PROSPERO (CRD420251101518). Searches in PubMed, Scopus, Web of Science, Embase, and Cochrane Library identified clinical studies evaluating distal shoe appliances in children aged \u22646 years. Risk of bias was assessed using ROBINS-I and JBI tools. Results: Six clinical studies comprising 67 patients were included. Overall eruption success was 95.5% (64\/67), with minor complications occurring in 25.4% of cases. Modified designs demonstrated fewer complications, although sample size was limited. Due to heterogeneity of methods and outcomes across studies, results are reported as descriptive metrics rather than inferential estimates. Conclusions: Distal shoe space maintainers are effective in promoting eruption of the first permanent molar with an acceptable complication profile. Their success depends heavily on technical execution and case selection. Further prospective studies with larger cohorts are required to validate optimal procedural parameters.<\/jats:p>","DOI":"10.3390\/children12121642","type":"journal-article","created":{"date-parts":[[2025,12,3]],"date-time":"2025-12-03T08:44:28Z","timestamp":1764751468000},"page":"1642","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Effectiveness of Distal Shoe Space Maintainers for First Permanent Molar Eruption: A Systematic Review"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5722-0547","authenticated-orcid":false,"given":"Laura","family":"Marqu\u00e9s-Mart\u00ednez","sequence":"first","affiliation":[{"name":"Dentistry Department, Medicine and Health Science Faculty, Catholic University of Valencia, 46001 Valencia, Spain"},{"name":"Stomatology Department, University of Valencia, 46010 Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carla","family":"Esteve-Ferre","sequence":"additional","affiliation":[{"name":"Dentistry Department, Medicine and Health Science Faculty, Catholic University of Valencia, 46001 Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lidia","family":"Gal\u00e1n-L\u00f3pez","sequence":"additional","affiliation":[{"name":"Dentistry Department, Medicine and Health Science Faculty, Catholic University of Valencia, 46001 Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan Ignacio","family":"Aura-Tormos","sequence":"additional","affiliation":[{"name":"Stomatology Department, University of Valencia, 46010 Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8841-7975","authenticated-orcid":false,"given":"Clara","family":"Guinot-Barona","sequence":"additional","affiliation":[{"name":"Dentistry Department, Medicine and Health Science Faculty, Catholic University of Valencia, 46001 Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8864-3702","authenticated-orcid":false,"given":"Esther","family":"Garc\u00eda-Miralles","sequence":"additional","affiliation":[{"name":"Stomatology Department, University of Valencia, 46010 Valencia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,3]]},"reference":[{"key":"ref_1","unstructured":"McDonald, R.E., and Avery, D.R. (2022). Dentistry for the Child and Adolescent, Elsevier. [11th ed.]."},{"key":"ref_2","first-page":"155","article-title":"Efficacy of distal shoe space maintainers in guiding first permanent molar eruption: A retrospective cohort study","volume":"34","author":"Alghamdi","year":"2022","journal-title":"Saudi Dent. J."},{"key":"ref_3","first-page":"ZC62","article-title":"Distal shoe appliance: A clinical study in space management","volume":"11","author":"Suvetha","year":"2017","journal-title":"J. Clin. Diagn. Res."},{"key":"ref_4","first-page":"43","article-title":"Clinical Application of Distal Shoe Space Maintainer in Primary Dentition: A Case Report","volume":"33","author":"Lin","year":"2022","journal-title":"Taiwan J. Oral Maxillofac. Surg."},{"key":"ref_5","first-page":"280","article-title":"Distal shoe complications: A 10-year retrospective study","volume":"41","author":"Rosenberg","year":"2017","journal-title":"J. Clin. Pediatr. 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Synth."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"i4919","DOI":"10.1136\/bmj.i4919","article-title":"ROBINS-I: A tool for assessing risk of bias in non-randomised studies of interventions","volume":"355","author":"Sterne","year":"2016","journal-title":"BMJ"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"226","DOI":"10.4103\/jisppd.jisppd_86_24","article-title":"Spatial and angular alterations in the dental arch after premature loss of primary molars: Immediate and 9-month computed tomography evaluation","volume":"42","author":"Kundra","year":"2024","journal-title":"J. Indian. Soc. Pedod. Prev. Dent."},{"key":"ref_12","first-page":"92","article-title":"Clinical management of premature loss of primary molars: A modified distal shoe space maintainer","volume":"28","year":"2016","journal-title":"Saudi Dent. J."},{"key":"ref_13","first-page":"93","article-title":"Distal Shoe Appliance in Space Management: Case Report","volume":"8","author":"Erdemci","year":"2020","journal-title":"J. Pediatr. Dent."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"l4898","DOI":"10.1136\/bmj.l4898","article-title":"RoB 2: A revised tool for assessing risk of bias in randomised trials","volume":"366","author":"Sterne","year":"2019","journal-title":"BMJ"}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/12\/12\/1642\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,3]],"date-time":"2025-12-03T09:20:25Z","timestamp":1764753625000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/12\/12\/1642"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,3]]},"references-count":14,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["children12121642"],"URL":"https:\/\/doi.org\/10.3390\/children12121642","relation":{},"ISSN":["2227-9067"],"issn-type":[{"value":"2227-9067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,3]]}}}