International Journal of Oral Health Dentistry 2022;8(4):340–342 Content available at: https://www.ipinnovative.com/open-access-journals International Journal of Oral Health Dentistry Journal homepage: www.ijohd.org Case Report Modified Willet appliance: A case report Himanshu Aeran 1 , Shalu Majreti 2, *, Avantika Tuli 2 , Nitin Khanduri 2 1 Dept. of Prosthodontics & Crown and Bridge, Seema Dental College & Hospital, Rishikesh, Uttarakhand, India 2 Dept. of Pediatric & Preventive Dentistry, Seema Dental College & Hospital, Rishikesh, Uttarakhand, India ARTICLE INFO Article history: Received 15-10-2022 Accepted 24-11-2022 Available online 19-12-2022 Keywords: Willet appliance Molar ABSTRACT The preservation of deciduous teeth is essential until normal exfoliation. It plays an important role in preventive and interventional dentistry. Early loss of a deciduous tooth or teeth can have various consequences. Space maintainer of the intra-alveolar kind is advised when the deciduous second molar is lost before the eruption of the first permanent molar. This report discusses a modified Willet appliance in cases where loss of primary deciduous first and second molar occur prior to eruption of permanent mandibular first molar. This is an Open Access (OA) journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms. For reprints contact: reprint@ipinnovative.com 1. Introduction The willet appliance, that guides the young’s permanent first molar into place, is one of the most beneficial techniques that pediatric dentists can employ when a primary second molar is prematurely lost. Gerber pioneered the distal shoe space maintainer, which Croll further improved. Its indications and contraindications were thoroughly explored by Hicks, who favored the production of a cast gold device, however the clinically acceptable appliances were the ones which were soldered to stainless steel crowns or bands. Brill described chairside manufacturing of a distal shoe space maintainer to be supplied immediately after extraction, which had a high success rate if the patient co-operated. 1 There are various conditions that make the willet appliance ineffective. Abutments to anchor a cemented device may be missing if numerous teeth are removed. Poor oral hygiene or an inadequate level of patient and parent’s involvement significantly diminishes the likelihood of a satisfactory clinical outcome. Certain medical diseases, including blood disorders, immunodeficiency, congenital * Corresponding author. E-mail address: majretishalu22@gmail.com (S. Majreti). heart defects, rheumatic fever, hyperglycemia, and systemic debilitation, may exclude its use. In cases where distal shoe appliance usage is contraindicated, there are two treatment options 1. Permit the tooth to emerge and then reclaim space. 2. Use a removable or fixed appliance that does not penetrate the tissue to apply more pressure to the ridge that is mesial to the unerupted permanent molar. 2 Carroll and Jones described three examples in which a removable or fixed pressure gadget was employed to guide the erupting permanent molar. 3 The goal of this case report is to discuss the clinical care of severe caries on mandibular primary molars with a modified Willet appliance. 2. Case Report A 5-year old male patient reported to department of Pediatric and Preventive dentistry with a chief complaint of pain in the left lower back tooth region. Clinical examination revealed deep occlusal caries w.r.t 75, 84 and deep proximal caries w.r.t 74 (Figure 1). Intraoral periapical radiograph showed furcal radiolucency and external root https://doi.org/10.18231/j.ijohd.2022.065 2395-4914/© 2022 Innovative Publication, All rights reserved. 340