Molar Distalization Techniques

MOLAR DISTALIZATION
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INTRODUCTION
• In the early 90’s, non compliance therapies in various
forms have become more prominent than everbefore.
One of the non compliance therapies and fairly recent
concept is the MOLARDISTALIZATION which has been
effectively used in the correction of malocclusion.
• Advances in mechanotherapy and changes in treatment
concepts have reduced orminimized the need for
extraction in severe discrepancies. Various techniques
are currently employed in non extraction therapy in the
treatment of a malocclusion.

• After early cephalometric studies have showed that little or
no distal movement of upper molars was produced by class
II elastic treatment of that era, the head gear was
reintroduced as a means of moving the upper molars back.
• patient compliance plays a major role in success of head
gear therapy
• an appliance system independent of the patient
cooperation was the need of the hour and then evolved the
molar distalizers.

HISTORY
• The extraction/non extraction debate from the Angle era to
the present day orthodontics does not define an absolute
indication for a specific treatment plan.
• Angle strongly believed in retaining teeth provided by nature
and molding the facial form through occlusion.
• Angle’s unweilding allegiance to non extraction therapy was
based on his own specific knowledge dentofacial growth and
development and to the concepts of facial beauty harmony.

• Case argued for therapeutic extractions in orthodontia based
on the fact that inherited inharmonious in contiguous
structure over which we have no control makes it impossible
for us to place all the teeth in the arch without fulfilling the
designs of an inherited deformity.
• groupism among orthodontists all over the world was to take
peculiar turn in the form of Angle’s disciples like CHARLES
TWEED and RAYMOND BEGG, supporting the need for
extractions in orthodontics.

• the dogma was “if in doubt extract” which led to blind
extractions of the premolars resulting in ‘dishe d in face s’.
• Gradually the awareness of soft tissue profile and function
occlusal concepts were introduced into orthodontics which put
the mind of the orthodontist into thinking twice before an
extraction.

• Now we are at a soft spot to decide, to extract or not to
extract and the dogma is “when in doubt do not extract”.
• Presently with the swing of pendulum towards the non
extraction protocol
• Molar distalization is a boon in the hands of the orthodontist.
It is important to understand the indications, the
biomechanical concepts and the contra indications of the
Molar distalization appliance system.

• Magnitude of forces and moments
• Moment to force ratio
• Constancy of forces and moments
• Bracket friction
• Ease of fabrication
• Cost
Burstone

INDICATIONS
• In the non extraction treatment of class II malocclusion.
• In low angle cases.
• In class I skeletal pattern cases.
• In patients with mild arch length discrepancy.
• In cases where upper permanent first molars have moved mesially due
to early loss of deciduous molars.
• In patients where second molar extractions are planned or has not yet
erupted.

CONTRAINDICATIONS
• In high angle cases.
• In class II and class III skeletal pattern
• Skeletal and dental open bite.
• Severe arch length discrepancy cases.

CLASSIFICATION
EXTRA ORAL
Head gears –
(i) Cervical pull
(ii) Combination pull
(iii) Kloehn.
INTRA ORAL
Removable appliances
Fixed appliances –
Buccaly acting
Palatally acting

DISTALIZINGAPPLIANCES

TUBEPLATES
• This appliance was developed by Alain Benauwt in the year 1972.
•This appliance has a
stationary part and a movable
part. They are held together
by a long horse shoe shaped
wire, which moves the
movable part by virtue of the
elasticity of the wire. Each
end is inserted into the tube,
one with fixed part of the
appliance. www.indiandentalacademy.com

ADVANTAGES
• The appliance is said to have a good retention as the
movable part also contributes to the retention.
• Unwanted displacement of teeth is minimized due to the
clasp as it avoids molar rotation.
• Possible to add an extra oral appliance to support and
reinforce stationary part. Progressive expansion of the arch
is also possible by changing the angulation of the tube in
relation to saggital plane.
• Repair is easy.

DISADVANTAGE
• Construction is very delicate, since the two wires
holding the movable part should do so without
binding.

THECETLIN APPLIANCE
• developed by Cetlin in 1982
• extra oral force in the form of headgear and an intra oral
force in the form of a removable appliance.
• To overcome the disadvantages caused due to the tipping
of molars, the Cetlin appliance utilizes a removable
appliance intra orally to tip the crowns distally and then an
extra oral force to upright the roots. So the intra oral
remarkable appliance can be called the crown mover while
extra oral force, the root mover.

ANCHORAGE
• The anchorage for removable appliance is by proper
adaptation to the palate an acrylic shield around the four
maxillary incisors and a modified Adams clasp on the first
premolars.
THEEXTRAORALFORCE
• The extra oral appliance is a headgear which is inserted
into the molar tube. The headgear is usually cervical or a
high pull, depending on the usual consideration of skeletal
pattern.

THE APPLIANCE
• The removable appliance is worn 24 hours a
day. The appliance also contains a bite plane
to disengage the molars (to aid rapid Molar
Movements).

THECRICKETTAPPLIANCE
• WEST in 1984
• The Crickett’s appliance embraces the essential features of
the quad Helix. But replaces the palatal and lingual bars of
upper and lower appliances with a quad and bi-helix
respectively

• The Crickett’s lingual arms are
embedded to provide an adjustable
spring action directed to lingual
surfaces of all teeth, without the
need for further soldering.
• The buccal arms are retained for
attachment of elastics and for ease
of insertion and removal of the
appliance.
• Upper palatal and lower lingual
main frames are constructed from
0.032” yellow and 0.038” blue
elgiloy respectively.
• The cribs, clasps and occlusal rests
from 0.028” blue elgiloy. The lingual
arms from 0.030” yellow elgiloy and
buccal arms from 0.045” blue
elgiloy.
Crickett appliance
Activated appliance

ADVANTAGE
The crickett is an effective appliance for variety of tooth
movements including distalization of molars.
DISADVANTAGE
The major limitation of this appliance is when intrusion of
anterior teeth has to be performed.

REPELLING MAGNETS
• This was developed by Gianelly in the year 1989.
• method of distalizing the molar is by the use of modified
nance appliance with the use of repelling magnets.

• The modified nance appliance is cemented on the first premolar to
encourage the distal drift of the second premolar that occurs normally as
first molars are moved posteriorly
• The acrylic palatal button extends anteriorly to the incisor segment by
means of a 0.045” wire soldered to the lingual aspect of the premolars.
• The acrylic component is placed both against the palatal vault and the
incisors.
• Bilateral distal extensions (0.045” wire) with loops at the end are soldered
to the labial aspect of premolar bands so that the loops approximate the
molar tubes.

• The modified nance appliance serves 2 functions:
• Activation of the Magnets
• This is by tying a 0.4” ligature wire through the
loop and extended anteriorly to encircle a tie back
hook mesial to the magnets. When tightened, the
magnets are held in contact.
• To Contain the Reaction Force Arising From the
Magnets

ACTIVATION
 The magnets were activated by tightening of 0.014” ligature wire to bring the
magnets into contact.
 The reactivation was done once in a week.
 The manufacturers of the magnets recommend activation once in 3 weeks as this
is more practical.
 Force exerted by magnet is 299-225gm. This dropped significantly as space
opened.
ADVANTAGE
 The advantage of this appliance system is that
 No patient cooperation is necessary to obtain molar movement.
 During the time of the magnet use, no treatment is performed on the lower arch,
so that it could serve as a reference point for assessment of movement occurring
in maxillary arch.

DISADVANTAGE
• Forces exerted by magnets drops significantly as
spaces are opened.
• Discomfort to the patient.

MODIFICATION
• In the year 1991, Takami introduced a Molar
distalization system using two opposing magnets for
each maxillary quadrant.

APPLIANCE DESIGN
• The mesial magnet of each pair is mounted so that it can move freely along a
sectional wire.
• A sliding yoke with ligation hooks mesial to the mesial magnet bring the magnets
together to activate the magnetic force.
• The distal end of the molar distalization system terminates in a 3-pronged fork
with middle prong inserted into headgear tube. The other two prongs are tied or
ligated to secure the MDS to molar tube..

ACTIVATION
• The magnets are activated by bringing the magnets together and ligating
them to the hook. The magnets produce a force of 8 Oz which causes
distal movement of molars. The movement separates the magnets and
hence reactivation by placing magnets back to contact is done every two
weeks.
ADVANTAGE
• The molar distalization observed in his study was entirely a bodily
movement with very slight distal tipping.
• It was observed that magnetic force causes erythrocytes to become a
1/3rd thinner and longer; therefore even if capillaries in the periodontal
ligament of root are compressed by strong orthodontic force, the blood
flow will still be smooth.

DISADVANTAGE
• Labial movement of the anterior teeth was observed despite
the use of a nance holding arch.
• Initial discomfort to the patient because of the size of
magnets.
• Using repelling force, orthodontic force decreased by 50%
to 70% with every 0.5mm - 1.0mm of movement hence
frequent reactivation was required every two weeks.

MOLARDISTALIZATION USINGSUPER
ELASTIC NITIWIRE
• This was introduced by Locatelli and Bednarin the year
1992.
• Maxillary molars are moved distally using a super elastic
nickel titanium wire with shape memory (Neosentalloy).

APPLIANCE DESIGN
• On a 100 gm Neosentalloy wire with
regular arch form 3 marks are marked
on each side at the distal wing of the 1st
premolar bracket, 5- 7 mm distal to
opening of the molar tube and between
the lateral incisors and canines
• Crimp a stop at each of the posterior
marks and add hooks for inter maxillary
elastics between lateral incisors and
canine.
• Insert the wire into the molar tube till the
posterior tube abuts the tube. To place
the wire through the first pre molar grab
the anterior stop and gently force the
wire distally so that the stop abuts the
distal wing of the premolar bracket.
since the wire is 5-7 mm longer than the
available space, the excess will be
deflected gingivally into muccobuccal
fold.

• As the wire returns to its original shape, it exerts a 100 gm
distal force against the molars and a mesial reaction force on
premolars. There is also tendency for the premolars to move
buccaly.
• Anchorage can be controlled by placing 100-150 gm class II
elastics at the hook between canine and lateral.

ADVANTAGES
• This method moves the molars distally by 1-2 mm per month
with little loss of anchorage.
• Neosentalloy is easy to insert even after all the teeth have
been bracketed or banded.
DISADVANTAGES
• Once the second molars are erupted, distal movement of
first molars usually take more time.
• If the first molars do not move by atleast 1mm / month, a 200
gm 0.018 X 0.025 Neosentalloy wire can be placed with
increase in force, therby increasing the chances of loss of
anchorage.

MODIFICATION
• To overcome the disadvantages of the conventional
design, Giancotti and Cozza in the year 1998
introduced a new system using the Neosentalloy.
NITI DOUBLE LOOPSYSTEM
• This new system was employed in simultaneous
distalization of the 1st and 2nd molars

.
APPLIANCE DESIGN
• The mandibular first and second molars
and second bicuspids are banded and
remaining teeth are bonded. Lip bumper is
given to prevent any extrusion from the use
of class II elastics.
• Maxillary molars and bicuspids are banded
and anterior teeth bonded.
• An 80 gm Neosentalloy arch wire is placed
on the maxillary arch and marked distal to
the first premolar bracket and 5mm distal to
the first molar tube. Stops are then crimped
in the arch wire.
Nickel Titanium double loop system

• Two sectional Niti arch wires (on either side) are prepared
by crimping stops distal and mesial of the IInd premolar
bracket and 5 mm distal to each second molar tube.
• Uprighting springs are inserted into vertical slot of the 1st
premolar and class II elastics are placed between
mandibular 1st molar and maxillary canine bracket.

ADVANTAGES
• Minimal patient cooperation
• Ideal for simultaneous first and second molar distalization
• Second Molars move easier distally compared to first molar
because of their different anatomical shape of the roots and
lack of posterior obstacles.
• Because of the stretching of transeptal fibers, an 80 gm Niti
wire is used instead of 100 gm or 200 gm.

PENDULUMAPPLIANCE
• This was developed by James Hilger in the year 1992.
• a hybrid that uses a large nance acrylic button in the
palate for anchorage, along with .032 TMA spring that
deliver continuous force to the inner first molar without
affecting the palatal button.
• a broad swinging or pendulum of force from the midline of
palate to the upper molars.

• The right and left pendulum springs
formed from 0.032” TMA wire, consist
of a recurved molar insertion wire, a
small horizontal adjustment loop, a
closed helix and a loop for retention
in the acrylic button.
• Springs are extended as close to the
centre of the palatal button as
possible to maximize their range of
motion, to allow for easier insertion
into the lingual sheaths and to reduce
forces to an acceptable range.
Pendulum appliance
• Springs are mounted as close as possible to the distal aspect of nance
button which permits access to acrylic for polishing.
• Lingual sheath should be 0.36” so that 0.32” wire fits loosely

• Anterior part of appliance can be retained in many ways. Initially it was by
pulling occlusally bonded rests on the deciduous molar or premolar.
• This was not stable; the most stable method was banding of first premolar,
solder a retaining wire and use this teeth as major anterior anchorage.
• Nance button should be made as large as possible to prevent any tissue
impingement. It should extend about 5m from teeth to allow adequate
hygiene.
• Jack Screw is incorporated into the nance button if expansion is required.
Screw is activated about one-quarter turn every three days. This appliance
is called Pend-X.

PREACTIVATION AND PLACEMENT

• Patient recalled every 3 weeks.
• Activation of spring done by holding the helix with plier and pushing the spring
distally toward midline and then reinserted.
• After distalization the molar is stabilized.
• Molars can be stabilized in any of the four ways
1. Nance portion is removed and full fixed appliance is bonded. Upper utility arch hold
molar back with incisors as anchorage. The buccal segments are retraced using
elastomeric chain.
2. Smaller easier to clean nance button is placed after removal of pendulum appliance.
3. Whole arch bonded and arch wire placed with omega loops placed mesial to molar
tube.
4. Headgear.

ADVANTAGE
• Use of 0.032 TMA springs delivers continuous force to the
upper first Molar without affecting the palatal button.
• Activation can be done before appliance placement.
DISADVANTAGE
• Pure bodily movement of the molar is not seen, tendency
towards cross bite.

M-PENDULUM
• In 1999, Schuzzo, Pisani and Takemoto, introduced a
modification to this appliance called the M-
PENDULUMappliance.
• This modification ensured a bodily movement of
molar crowns and roots.

• Horizontal loop is inverted
MESIALLY. This allows bodily
movement of both roots and crown
of the Molars.
• Once distal movement is occurred,
loop is opened an activated which
produces a buccal and distal
uprighting of root.
• The inverted loop should not be
activated until spring has deactivated
following each phase of distalization.
• A passive fit of the distal end of
spring with no distal force applied to
the Molar Crowns will allow
backward tipping of Molar roots.
M-PENDULUM

ADVANTAGES
• True bodily molar movement
• Minimal dependence on patient compliance.
• Less need for reactivation.
• Ease of fabrication.

MODIFIEDPENDULUMAPPLIANCEWITH
REMOVABLEARMS
• Pisani and Takemoto along with Vecchia in the year 2000
introduced this particular modification to the appliance.

• Double over 7mm – 9mm length of 0.032
TMA wire to form bayonets. Attach each
bayonet to an M-PENDULUM arm either
by using Laser welder or by wrapping 0.10
ligature around arm and soldering the
unit.
• Embed each bayonet in the soft acrylic
that will be used to form nance button
producing sheaths in which to insert the
removable arm.
• Activate the arms in the working cast as
desired.
• Appliance is placed in the mouth and
terminal ends of arms into lingual molar
band sheath.
• Removable arms can be reactivated with
debonding the occlusal rest of nance
button.
Removable 0.032” TMA arm

MODIFIEDPENDULUMAPPLAINCEFORANTERIOR
ANCHORAGECONTROL
• This latest modification was introduced by PABLO
ECHARRI and SCHUZZOin the year 2003.

• This design consists of four removable
arms for both first and second molars.
• The second molars are distalized after
which their arms are left passively in place
for anchorage and first molar arms are
activated for distalization.
• Pendulum is replaced with a nance button
after first molar distalization. A 0.016 SS
passive arch wire is placed to avoid any
incisor protrusion.
• E-Chain is used to distalize second and first
bicuspids.
• If anterior anchorage is critical, palatal
acrylic should be kept out of contact with
the incisors.
• Second bicuspid arm should not be cut for
spontaneous distalization to prevent incisor
protrusion.

THELOKARAPPLAINCE
• The Lokar appliance was developed by Dr. Lokarin the year 1994
• It consists of 2 basic components.
• A Mesial sliding component
• A component which inserts into the arch wire tube of the molar
• The distalizer is inserted into the arch wire tube of the first molar and the application is
adapted such that it is parallel to the plane of occlusion and as close to the teeth as
possible for comfort.
• An 0.12” stainless steel ligature wire is hand twisted around the premolar bracket before
the Lokar is fixed to the molar tube. This ligature wire is engaged around the mesial sliding
component of the distalizer and tightened to activate the appliance.
• The force is developed by Niti-Coil springs which get compressed during activation. The
anchorage is by a nance appliance, soldered to the premolars

• A 0.012” stainless steel ligature wire is hand twisted twice around the
premolar bracket such that the free ends of the ligature face distally. One
of the free ends is then passed over the mesial sliding component of the
mainframe and tightened to activate the appliance. The force is delivered
by the Niti coil spring which gets compressed during activation.
• The best activation is achieved by compressing he spring by 2-3mm.
Reactivation is done at 5 to 6 weeks interval.

FIXEDPISTON APPLIANCE
• The Fixed Piston Appliance introduced by
Greenfield
• Can produce bodily movement of Maxillary
first molars without the use of extra oral
appliances and with no loss of fast
anchorage.

• Maxillary 1st molar and 1st
premolar bands.
• 0.036” stainless steel tubing
(soldered to Bicuspids)
• 0.030” stainless steel wire
(soldered to first molars)
• Enlarged nance button,
reinforced with an 0.040” SS
wire.
• 0.55” (interior diameter) super
elastic open coil spring.

Advantages
• Produces bodily movement of maximum first molars with no
loss of anchorage.
• Does not require the need of patient compliance but allows
the use of head gear if required.
• Uses a light controlled force of only 1.5-2 Oz/tooth
• Does not interfere with occlusal plane thus maintaining
control of vertical dimension.

JONESJIG
• Jones Jig was developed by Jones and White in the year
1992
• Jones Jig uses an open coil spring NiTi to decliner 70-75 gm
of force over a compression range of 1-5mm to the Molars.

• A modified nance appliance is used with the Jones Jig because this can be
attached to first premolar, second premolar, or deciduous second molar.
• A 0.036” SS wire is bent to the palate on the cast extending it as far a the
canines and it is soldered to the anchor bands.
• Acrylic button is fabricated about half inch in diameter.
• The nance appliance is cemented and the Jones Jig is laid in place on both
sides.
• Reactivation is done after every 4 -5 week’s intervals.

ADVANTAGES
• The distal movement achieved with this approach appears to be dental
rather than skeletal.
• The extent of forward movement of the anterior teeth while using the
Jones Jig is very minimal.
• The Jones Jig along with the open coil spring can be used without the
need of a full banded upper arch.
• The coils of Jig can be changed with minimal time and the use of arch
wires and class II elastics can be avoided.

REMOVABLEMOLARDISTALIZATION SPLINT
• This was developed by Korrodi Ritto in the year
1995.
• The Removable Molar Distalization Splint can
achieve better patient cooperation than some
other removable devices.

• Clear splint is made from 1.5mm
Biocryl in a Biostar machine.
• If both upper first molar are to be
moved distally at the same time, the
splint extends from the area of upper
first or second premolar to the area
of upper left premolar
• If only one molar is distalized, the
splint extends to the terminal molar
on the other side.
• Two internal clasps are used for
retention and a Ni-Ti coil spring
produces 220gm of distal force. The
coils are reactivated.
Molar distalization splint

• The splint creates a separation of 1-2mm
between the maxillary and mandibular Molars at
the beginning of the treatment eliminating lateral
occlusal forces and thereby helping distalization.
• This appliance is smaller compared to the other
plates, it is more comfortable and esthetic to the
patient.

ADVANTAGES
• It is smaller than conventional removable plates.
• It is comfortable.
• Esthetics
• Better co operation of the patient.
• Molar distalization even in cases of deep over bite.
DISADVANTAGES
• There is more amount of molar tipping than bodily molar distalization.
(So it is ideally used only in cases where the molars are mesially tipped
prior to treatment).

DISTALJETAPPLIANCE
• The distal jet appliance was introduced in the
year 1996 by Carano and Testa.

• Bilateral tubes of 0.036” internal
diameter are attached to an acrylic
nance button.
• A coil spring and screw clasp are slid
over each tube.(NiTi coil spring of
150gms for children and 250gm for
adults.)
• The wire extending from the acrylic
through each tube ends in a bayonet
bend that is inserted into the lingual
sheath of the first molar band, this
results in force acting through the
centre of resistance of molar thereby
giving a translatory movement.
• An anchor wire from nance button is
soldered to bands on second
premolar.Distal Jet Appliance

MODIFICATIONS OF THE
DISTAL JET APPLIANCE

DOUBLE SET SCREWDISTAL JET
• This modification was introduced in the year
1998 by Jay Bowman.
• This modified distal jet incorporates two set
screws into activation order which permits an
easier, cleaner and more reliable conversion
to a molar nance holding arch.

• The mesial set screw is used
during active distalization.
• Upon distalization activation caller
is slid mesially to gain access to
the coil spring.
• The double set screw collar is slid
back to this junction. The mesial
screw is set on the tube and the
distal screw is set on the bayonet
wire locking the two pieces
together to prevent molar
movement.
• Lingual sheath on molar maybe
crimped to reduce any play of
double back wire inserted into it
and also rotation over the nance
acrylic button.
DOUBLE SET SCREW DISTAL JET

MODIFIEDDISTAL JET APPLIANCE
• This modification was introduced in the year
2000 by Quickand Harris.
• The basis of this modification is the rear entry
of the sliding section into the lingual molar
sheath so that the appliance pulls rather than
pushes the molars distally.

• The double back wire (or “foot”) is
inserted into the lingual sheath from
the distal.
• The foot should be longer than the
lingual sheath so that it can be tied
back to the sliding section with an
elastomeric or metal ligature.
• Sliding section is made of either
0.030” or 0.032” wire.
• Support tubes of corresponding
internal diameter are embedded to
acrylic nance button.
• Care is taken while bending the
distal portion of the sliding wire to
allow enough clearance from the
tuberosity of the palate when the
wire is removed
Distal jet with Rear entry

DISTALJETSIMPLIFIEDANDUPDATED
• Due to the problems frequently encountered with the use of
the previous distal jet appliances, Carano and Testa, again
along with Bowman introduced the latest of the modification
in the year 2002

• The locking mechanism of the distal jet consist of three interacting
components – lock, screw and activation wrench.
• This screw and wrench was too small for precise, positive control of the
appliance and too small for failure in certain situations.
• The screw and the activation wrench are much larger and more durable.
• The screw is placed more mesially and the horizontal barrel of the lock
has been extended by 7 mm extending the working range of the
appliance and simplifying activation and conversion.
• The new barrel is also much narrower to improve patient comfort to allow
more precise positioning of the tube and the piston.

• A minor and important change has been made in
the tiny distal stop that provides resistance to the
spring for compression,it is fabricated of
stainless steel tubing and will not deform under
pressure.
• It provides better resistance for more consistent
and positive spring compression and force
delivery during distalization.

THE KLOOPMOLARDISTALIZER.
• The K loop distalizer was introduced by Kalra in the year
1998

• The appliance consists of a K loop to provide the forces
and moments and a Nance button to resist anchorage.
• The K loop is made up of 0.017 X 0.025 “ TMA which can
be activated twice as much as stainless steel before it
undergoes permanent deformation.
• Force produced by the TMA will also be half.

• The loop of the K should be bent 8 mm in length and 1.5 mm wide.
• The legs of the loop are bent down 20° and inserted into molar tube and Premolar bracket.
• Wire is marked at the mesial of the molar tube distal of the premolar bracket.
• Stops are bent into the wire 1mm distal to distal mark and 1mm mesial to mesial mark.
• Each stop should be well defined and about 1.5 mm long. These bends help keep the
appliance away from muccobuccal fold, allowing a 2mm activation of the loop

• The 20° bends will produce moments that counteract the tipping moments
created by the force of the appliance and these moments are reinforced
by the moment of activation as the loop is squeezed into place.
• K loop is placed at the centre between 1st premolar and molar to prevent
any extrusive r intrusive force.
• For additional molar movement, the appliance is reactivated by 2mm after
6-8 weeks.

ADVANTAGES
• The advantages of the K loop are:
• Simple and efficient.
• Controls M: F ratio to produce bodily movement.
• Easy to fabricate and place.
• Hygienic and comfortable.
• Minimal patient cooperation.
• Low cost.
DISADVANTAGES
• Improper placement of the loop cold result in undesirable tooth
movements (extrusive or intrusive force).

Molar Distalization Techniques

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